Section 3
3 Impact and outcomes
"The [Family Health Nursing] course has prepared me well for my future role and I plan to continue with evidence-based practice and encourage my colleagues to do the same."
Family Health Nurse student
The achievements of the Family Health Nurse pilot are represented in this chapter by mapping some outcomes against the core 'capability' elements from Delivering Health, Enabling Care. Some are person-related outcomes, while others point to lessons learned from the process of developing and testing a new role.
Evidence from a variety of sources is used to support commentary on the impact and outcomes of the role. This includes empirical research, discussions at the National Implementation Group and achievements reported as part of the practice development work.
It is recognised that outcomes tend to arise as a result of collective action by a number of stakeholders, including families, and are not dependent on input from any single professional group. It is also recognised that work carried out by Family Health Nurses with individuals, families and communities may also be undertaken by other community and public health nurses.
Delivering services closer to home
Using a generalist model, the Family Health Nurse can act as the 'lynchpin' for a family and offer a single point of contact with services. In the Glasgow Caledonian University research project (Parfitt et al, 2006), several service users described the security they felt in having someone close by they could talk to about their anxieties. Most said they would contact the Family Health Nurse in the first instance about presenting health issues; they felt she knew them and they trusted her ability to help them find the best solution to their problem.
In the absence of a Family Health Nurse, some said they would either not seek help from any other community nurse or would contact the GP directly. This highlights a key strength identified by Family Health Nurses, colleagues and service users in the research - the role has responded to unmet need.
Support and protection of the public
The focus on protection issues has largely, but not exclusively, been fixed on protecting children and young people. Many of the Family Health Nurses in remote and rural areas worked closely with school health services and health visitors and made contributions to health programmes within schools. One Family Health Nurse set up self-awareness sessions for young parents in the community through a joint initiative with Woman's Aid and the Child Care Partnership Forum. Another is running a weekly drop-in session that has been used by local teenagers to seek confidential advice on addiction and family problems.
Caring for older people
Although Family Health Nurses were frequently involved in delivering clinical care to older people and supporting their carers, they also had a developing role in health improvement work with this group. Two Family Health Nurses set up a mature swimmers' group which provided supportive and therapeutic functions. One member of the group reported that the water exercises had resulted in her cancelling a referral to the physiotherapy service, highlighting the importance of proactive health improvement work. In another area, an exercise group for people over 50 was set up in response to local identified need.
Unscheduled care and planned care
The generalist model provides 'a one-stop-shop' approach to care delivery that complements services provided by the GP. The success of the model, however, is dependent on access to specialists who can support the Family Health Nurse and to whom he or she can refer service users when appropriate (Parfitt et al, 2006).
One service user explained how valuable the holistic perspective of the Family Health Nurse was. She felt that the specialist practitioners she consulted did not have time to gain the full picture of her multiple health problems. The only person to explore these issues with her was the Family Health Nurse, who was able to share the knowledge with specialists and advocate on the individual's behalf.
Many of the Family Health Nurses have gone on to complete programmes of nurse prescribing, which enables them to diagnose and treat certain symptoms and conditions. One has a specialist interest in acupuncture which developed when the GP who previously provided this service moved from the area. A request from the community resulted in the Family Health Nurse undertaking training to enable her to diagnose and treat specific conditions.
Another found that patients in her community were waiting six weeks following myocardial infarction (heart attack) before commencing a rehabilitation programme in the local hospital, with no support being provided in the intervening period. She started working with individuals during this period and made links with the rehabilitation team.
Anticipatory care, improving health, public health and reducing inequalities
Identification of risk factors and early intervention are key to improving health. The Family Health Nurse approach to family assessment was seen as a valuable strategy in identifying and assessing risk factors.
A short audit of a men's health group concluded that Family Health Nursing was a valuable service. Initially, the young men were reluctant to discuss subjects related to sexual health and low self-esteem was noted in their verbal communication, but over a period of time, the Family Health Nurse was able to work with them to achieve better health outcomes. The men found it easier to understand the risks posed to their health through using the genogram (family health tree) as a visual aid. Data gleaned from the family health assessment and genogram are important for the practice profile, not only in terms of identifying individual family risk factors and recognising local trends in disease or dominant health problems, but also in acting as a motivator for families to explore lifestyle change.
Family Health Nurses in a remote and rural setting have responded to a request from the local community to conduct health checks within the workplace. They have developed an electronic version of the genogram to encourage people to look at health risks and consider lifestyle improvement. The approach demonstrates a way to target a sometimes hard-to-reach group within the community. As the intention is also to include other community-based nurses in the work, the approach provides a vehicle through which skills and knowledge can be shared in pursuit of a common goal.
Supported self-care, patient empowerment and managing long-term conditions
One Family Health Nurse was approached by
a person with a long-term condition who was informed of the role by a social worker. The person had previously declined services from other staff, as they felt they did not require nursing care. The Family Health Nurse is now working with the family to help identify personal strengths and areas for development. The family has increased their awareness and are taking responsibility to improve their quality of life while supporting the family member with the long-term condition.
Family health genograms have helped individuals and families make decisions about lifestyle changes in relation to obesity, smoking and alcohol consumption. One family with a history of diabetes has engaged with the Family Health Nurse to improve their health through a programme of healthy eating and physical activity to reduce risk factors.
Leadership
Most of the Family Health Nurses identified the need to consolidate their learning from the programme before taking on an active leadership role. Consolidation is key to developing expertise and confidence to enable leadership to flourish. While some Family Health Nurses had previously worked as team leaders, others had been practising as community staff nurses prior to the pilot. Several undertook the national leadership programme and found this a valuable 'add-on' to their existing skills toolkit.
There are numerous examples of where Family Health Nurses have taken a lead in aspects of practice. Box 3.1 shows how two Family Health Nurses took the lead to work with communities in a different way.
eHealth
Information technology systems have been problematic in some remote and rural areas, with limited access to hardware and difficulties with e-mail systems. This is also a recognised problem for other nurses working in some community settings.
Having a robust IT system is crucial in enabling Family Health Nurses to contribute to the national eHealth programme. One Family Health Nurse has developed expertise in this area and has a part-time remit to develop electronic records locally and to contribute to the national electronic community health information project (eChip).
Box 3.1 Engaging with the local community
A Family Health Nurse team based within a local community centre gathered information from members of the community using a suggestion box and poster display seeking ideas on what kind of activities they would like. The topics requested included weight management, physical activity, first aid and social events for older people. In response to this, a number of initiatives have been developed:
- a six-week programme of physical activity and healthy eating talks with cookery demonstrations was funded after networking with the healthy living co-ordinator
- the NHS Board resuscitation officer has provided basic life support training to community members
- two members of the community have undertaken training in running weight management courses
- there is a 'drop-in' afternoon for older people which has involved a number of activities, including belly dancing!