Jane V. Appleton

Constructivism: A Naturalistic Methodology for Nursing Inquiry

This article will explore the philosophical underpinnings of the constructivist research paradigm. Despite its increasing popularity in evaluative health research studies there is limited recognition of constructivism in popular research texts. Lincoln and Gubas original approach to constructivist methodology is outlined and a detailed framework for nursing research is offered. Fundamental issues and concerns surrounding this methodology are debated and differences between method and methodology are highlighted.

Children and young people’s missed health care appointments: reconceptualising ‘Did Not Attend’ to ‘Was Not Brought’ – a review of the evidence for practice

The issue of wastage caused by missed appointments features prominently at a time when cost-saving measures become ever more important in the health care economy. Missed appointments are said to cost the NHS in the region of £600 million per annum. Various strategies are being tried and tested to ensure that people attend their appointments (or are in for domiciliary visits) including texting and phoning reminders. Clearly, attending for health care is generally in a person’s best interests. However, in the UK, if appointments are missed, then the usual outcome is a ‘three (or even two) strikes and you are out’ approach with a notification to the General Practitioner. In this paper we will argue that the seemingly widespread ‘Did Not Attend’ (DNA) routine described above is not appropriate where children and young people are concerned. The issue here is that the child or young person ‘Was Not Brought’ (WNB) to their appointment, rather than the fact that they DNA. This is important, because not only is access to health care their fundamental right (United Nations Convention on the Rights of the Child, 1989: Article 24), but failure to attend for health care is recognised as a child protection issue within statutory definitions of neglect. Failings in presenting children for health care is also known to feature prominently in cases that have reached the threshold for Serious Case Reviews, and this paper summarises the evidence in this respect. We conclude the paper by suggesting that reconceptualising child and young person DNA as WNB will lead to positive interventions to safeguard and promote the welfare of children that go beyond the missed appointment to a move towards the child-centric practice described in recent key reviews.

Research and the organisation of complex provision: conceptualising health visiting services and early years programmes

This paper developed from discussions about the possible implementation and trial of an Australian maternal and early childhood sustained home visiting programme (MECSH), into a United Kingdom (UK) context. There are many similarities in services in the two countries, but some differences. To summarise and illustrate the complex and interconnected way that early years and preventive health services are specified, a diagram was developed, which provides a framework for this paper. The paper describes a health visiting service that encompasses universal, indicated and selective forms of prevention, with some embedded evidence-based programmes, forming part of a proactive and preventive service that is, itself, embedded within a wider resource system. Policy-driven terms derived from the English Health Visitor Implementation Plan have been used, but translated into the generic language of prevention (universal, indicated and selective), as a basis for future research. The place for different types of practitioner and needs of families with different levels of personal capacity or resource are also considered. Increased understanding about how social determinants affect the whole population across a gradient has drawn attention to the need for more universal prevention, to tackle health inequalities. The components of successful early intervention programmes are well established, but more information is needed to support universal preventive services, which are delivered in a way that is proportionate to need. This paper, including the diagram that summarises its contents, is presented to stimulate discussion as well as guide future research and service development.

Fourth Generation Evaluation of Health Services: Exploring a Methodology That Offers Equal Voice to Consumer and Professional Stakeholders

This article explores the need for a clear understanding of fourth generation evaluation as a necessary requirement for those hoping to achieve an effective analysis of health services. The weaknesses of the traditional approaches to evaluation are fully examined so that an effective choice of evaluation methodology can be made. Current health service thinking highlights the need to recognize the importance of both consumer and professional stakeholders, allowing each an equal voice. The authors aim to assist evaluators to select a methodology that will be the most effective medium for allowing this to occur.

Efficacy of a group-based parenting program on stress and self-efficacy among Japanese mothers: A quasi-experimental study

Early child development and the impact of parenting on later life are of global concern. The rise in child abuse and maltreatment in Japan suggests that measures to increase self-efficacy and reduce stress would benefit Japanese parents. In this study, we explored if Japanese parents attending a 123Magic parenting program reported reduced stress and enhanced self-efficacy. Questionnaire data were collected from 49 mothers attending a parenting program conducted in public nursery schools in one prefecture in Japan. There were significant changes in parenting self-efficacy scores (P < 0.001) and parenting stress scores (P < 0.01). Focus groups with 16 parents also found that there were benefits to parents in terms of increased confidence and less stress. The findings provide support for the role of public health nurses in delivering group-based parenting support in Japan.

Assessing vulnerability in families

The identification of children in need and the needs of their families is critically important in view of the requirements of the Children Act 1989 and the recommendations of the Department of Health (DoH) (1995) and the NHS Executive (NHSE) (1996). Furthermore, since the introduction of the NHS and Community Care Act 1990, the issue of health needs assessment has become increasingly important in negotiations between purchaser and provider agencies. Community nursing staff are expected to have well-developed assessment skills in order to be able competently to identify and articulate ‘health needs’, provide appropriate support services to clients and make referrals to statutory and voluntary agencies where necessary. Since community nurses, and in particular health visitors, play such a valuable role in case-finding and needs assessment, it seems highly relevant to examine how community practitioners assess vulnerability in families.

Delivering safeguarding children services in primary care: responding to national child protection policy

AIM This study set out to examine how Primary Care Organisations (PCOs) in England manage, organise and deliver their safeguarding children responsibilities. BACKGROUND In the light of changing organisational configurations across primary care, a wealth of policy directives and a climate of extensive media attention around child protection, this paper focuses on how PCOs respond to national policy and deliver safeguarding children services. METHOD This study, based in England, United Kingdom (UK), used a telephone survey method incorporating semi-structured qualitative interviews with Designated Child Protection Nurses. A maximum variation sampling strategy was used to identify two to three PCOs within each of the original 28 Strategic Health Authority sites. From the 64 PCOs approached, 60 Designated Nurses or their representatives agreed to participate in the research, with a response rate of 94%. Data analysis was informed primarily by Lincoln and Gubas (1985) three stages of a) unitising, b) categorising and c) pattern search. FINDINGS The findings outline how and to what extent PCOs respond to the national policy and organise and deliver their child protection services. The paper highlights some of the key challenges facing PCOs, in particular, safeguarding moving off the primary care agenda, child protection staff recruitment difficulties, a proliferation and overload of policy, resource implications for additional staff training, challenges to collaborative working, high referral thresholds to social care services and cutbacks in public health nursing services. This paper concludes by offering some suggestions about how child protection services could be improved as primary care faces another major reorganisation with the demise of Primary Care Trusts in April 2013.

Why was this child not brought

How do we react to the missed appointment? It is a busy clinic (is there any other type?) and the first reaction is likely to be relief. Then there is the realisation that some thought may need to be applied to the child who was not brought. Then there is the remembrance that there is a policy to be followed. Perhaps, it would have been easier if the child had come to the clinic… There are a multitude of issues that derive from a missed appointment. It has implications for the child or young person, the parent/carer, the health practitioner for whom the child had the appointment, the referrer, the Trust or other health provider, for Commissioners and possibly for the Care Quality Commission and Local Safeguarding Children Boards among others. It is easy to lose sight of the child or young person in all these. Even the terminology is open to debate. We have previously argued that ‘Was Not Brought’ (WNB) was a more appropriate nomenclature to use than ‘Did Not Attend’ (DNA) when applied to children and young people1 and that the reconceptualisation of the DNA as WNB would lead to positive interventions to safeguard and promote the welfare of children.2 Munro has also commented that the change from DNA to WNB is a simple mechanism for triggering a different reaction.3 These three articles stress the need …

Alcohol-related collateral harm, the unseen dimension? Survey of students aged 16–24 in Southern England

Abstract Aim: To ascertain young adults’ experience of alcohol-related collateral harm (ARC harm). Methods: An online survey collected quantitative and qualitative data from a convenience sample of students (N = 450) aged 16–24 in Southern England. Questions and analyses focused on harms they had experienced as a result of alcohol consumption by other people in their family or social circle. Findings: Sixty-four percent of the participants experienced ARC harm, including 50% of non-drinkers. In logistic regression analysis, ARC harms were associated with being female (OR = 1.62, 95% CI 1.01–2.62) family members who drank every day (OR = 2.65, 95% CI 1.49–4.69) being influenced by others’ drinking (OR = 2.03, 95% CI 1.32–3.10) being older (OR = 2.61 95% CI 1.57–4.34). No significant associations were found with high or low self-reported levels of alcohol consumption. Using q ualitative descriptors, the ARC harms reported were classified into a novel taxonomy comprising eight categories: nuisance/frustration/exasperation, tolerance/adjustment/accommodation, pressure into unwanted situations, unsought/inappropriate responsibility, psychological harm, physical harm/acute risk of physical harm, relationship harm, and undisclosed harm. Conclusions: A high level of ARC harm was reported and experience of ARC harm was linked to several predictors. Further work is required to validate the proposed taxonomy, and to promote consideration of the phenomenon of ARC harm in alcohol policy.

Male victims of domestic abuse: implications for health visiting practice

Domestic abuse is a significant public health issue globally. Although it is recognised that both sexes may be victims of domestic abuse, the phenomenon is commonly understood from the perspective of male to female violence, supported by a substantial body of research and policy focusing on female victims of domestic abuse. However, evidence shows that significant numbers of men are victims of female-perpetrated violence, but as the issue is under-explored, the extent and effects of abuse are poorly understood. For health visitors working within communities in the United Kingdom, knowledge of all aspects of domestic abuse is vital in the delivery of evidence-based practice. A systematically conducted critical literature review aimed at establishing the current body of knowledge on male victims of domestic abuse was undertaken, and implications for health visiting practice considered. Nineteen primary research studies were included in the review. A thematic analysis identified four themes: ‘violent relationship’, ‘harms and behaviours’, ‘risk’ and ‘seeking help’. Results show that men reported being victims of female-perpetrated physical, emotional, psychological and sexual abuse, with some experiencing severe aggression, control and fear. Health visitors have an important role to play in influencing policy and in practice addressing the health and social care needs of male victims of domestic abuse and their families.