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BACKGROUND: Assessment of family health need is a central feature of health visiting practice in which a range of skills, knowledge and judgements are used. These assessments are pivotal in uncovering need, safeguarding children and in determining levels of health intervention to be offered to children and their families by the health visiting service in the UK. OBJECTIVES: The central focus of this paper is to outline the critical attributes of the basic principles that underpin health visiting assessment practice that emerged as part of a case study enquiry. DESIGN: A case study design informed by a constructivist methodology was used to examine health visitors' professional judgements and use of formal guidelines in identifying health needs and prioritising families requiring extra health visiting support. SETTINGS: The main study was conducted in three community Trust case sites in England, UK, with pilot work being undertaken in a fourth site. METHODS AND PARTICIPANTS: Fifteen health visitors participated in the main study and data were collected during 56 observed home visits to families receiving extra health visiting support. Separate in-depth interviews were conducted with the health visitors, pre- and post-home contacts, while 53 client interviews also took place. RESULTS/CONCLUSIONS: The analysis suggests that there are certain fundamental elements associated with the majority of health visitor assessments and these have been termed assessment principles. These characteristics are integral to, and provide the basis upon which health visitors' assessments are conducted and professional judgement is formed. They reflect the basic principles of health visiting assessment practice, which exist despite the constraints and realities of the practice context and can be differentiated from the activity centred methods of assessment processes. [ABSTRACT FROM AUTHOR]

The aim of this paper is to examine health visitors' use of formal guidelines in identifying health needs and prioritising families requiring extra health visiting support. With the increasing emphasis on targeted health visiting, a case study was used to explore the extent to which health visitors in three case sites use needs assessment guidelines in the assessment of family health need. The findings indicate how the presence of core visiting protocols hints at elements of control by managers, leading to conflicts in the relationship between professional judgements and official guidelines. Despite a management ethos of guideline formulation, several contradictions exist for which these guidelines are a focus. These include: little involvement of health visitors in guideline development, some staff not informed about the existence of formal guidelines, little evidence of guidelines contributing to improved client outcomes and their limited use by many health visitors in practice. Thus, even when guidelines exist, no accurate predictions can be made about health visitors' knowledge of or use of such guidelines in practice. [ABSTRACT FROM AUTHOR]

AIM: This paper presents our journey through a contemplation of the philosophical origins of constructivism to consider its role as an active methodology in qualitative research. METHOD: The first part of the paper summarizes the philosophical background of constructivism and the five principles underpinning this paradigm as described through the works of Guba and Lincoln. The philosophical roots of constructivism are then compared with postpositivism, critical realism and participatory inquiry. The paper moves on to consider their common methodological steps, before examining how the constructivist research strategy is being adopted and adapted within the pragmatics of health service research. Recent studies will be drawn upon to illustrate the use of constructivist methodology. CONCLUSION: Questions are raised about the role of philosophy and the extent to which it should or does underpin or influence qualitative research strategies. We believe that if researchers gain an understanding of both philosophy and methodology a richer and more robust study is likely to result. [ABSTRACT FROM AUTHOR]

This paper will explore the concept of intuition in nursing from an acute care and community nursing perspective. It will consider definitions of intuition and examine the research which can inform our understanding of this important component of decision making. In the current health service climate, which demands measurable research-based evidence, the involvement of intuition as an element of judgement is often denigrated. The result is that many nurses are being forced to be covert in their use of this crucial aspect of judgement and focus solely on the conscious elements of decision-making. However, research evidence would suggest that intuition occurs in response to knowledge, is a trigger for action and/or reflection and thus has a direct bearing on analytical processes in patient/client care. The authors therefore argue that the essential nature of intuition cannot be ignored in the practice, management, education and research of nursing. [ABSTRACT FROM AUTHOR]

This paper will describe a method of documentary analysis used in a study examining the validity of clinical guidelines issued to health visitors to assist them in identifying families requiring increased health visitor support. This forms the preliminary work for a wider study examining how health visitors decide to increase support to vulnerable families. Although a number of published research texts discuss the value of records and documents as important data sources for health service researchers, there is relatively little information available about the processes of documentary analysis. This paper offers one method for analysing clinical practice guidelines, it describes the development of a critique and analysis tool and explores the strengths and weaknesses of this particular analysis instrument. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe part of the findings of a research study which explored the health visitor's role in identifying and working with vulnerable families in relation to child protection. One objective of the study was to describe and analyse the work which health visitors undertake with vulnerable families aimed at preventing crisis, ill-health and child abuse. This paper outlines this aspect of the research and looks specifically at health visitors' perceptions of their work and interventions with vulnerable families and children. Health visitors working in an inner city area and a suburban area were sampled and pilot work was undertaken in a third suburban area. Stage one involved a postal survey of 102 health visitors, in which a response rate of 58 (57%) was obtained. Stage two involved 12 in-depth interviews with health visitors. One major finding of this study highlighted the fact that the health visitor's role when working with vulnerable families appears to be one of diversity and conflict. In the light of the current National Health Service reforms it seems of paramount importance that health visitors illustrate to others, both managers and other health/social service professionals alike, the important function of their work with these vulnerable groups. This is essential to ensure that health visitors' work with vulnerable families in relation to child protection is understood and valued and that the needs of vulnerable families continue to be identified. This paper contributes to the knowledge base of health visiting and raises some important issues for professional health visiting practice. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe part of the findings of a study which explored the health visitor's role in identifying and working with vulnerable families in relation to child protection. The study was conducted using a broadly qualitative approach. A two-stage approach was undertaken to explore the concept of vulnerability and to assess health visitors' work in this area of practice. In stage one a postal survey of 102 health visitors was conducted with a response rate of 58 (57%). In stage two 12 in-depth interviews were completed with health visitors. This paper outlines one major aspect of the findings and focuses specifically on health visitors' perceptions about the concept of vulnerability and its relevance to child protection work. The analysis suggests that vulnerability is a nebulous, transient and complex concept influenced by multiple interacting factors. The existence of a continuum of vulnerability is clearly evident. It appears that families move in and out of vulnerability at various stages of the life cycle and this is largely dependent on 'internal' and 'external' stress factors and coping ability. This paper contributes to the knowledge base of vulnerability and raises a number of issues for health visiting practice. [ABSTRACT FROM AUTHOR]

This paper presents an overview of the research surrounding the role of the health visitor in identifying and working with vulnerable families in relation to child protection. Only a limited number of empirical studies have been completed within the field of health visiting, so this review draws on most of the literature published over the last 15 years, which is mainly British in origin. No previous reviews have focused on this specific area of health visiting. Clearly with the recent increase in public and official recognition of child protection issues and the continuing debate of health visitor involvement within this area, this review takes a significant step forward in drawing together relevant research. The review focuses on research within three main areas. Firstly, the health visitor's role in working with vulnerable families in relation to child protection is explored. The clients' perceptions of this role are also explored. Secondly, the identification of vulnerable families by health visitors and non-health visitors is explored. Within this area a number of studies by non-health visitors investigating screening approaches to child abuse have been reviewed, because they play such a major role in the literature and appear to have influenced subsequent health visitor research. Thirdly, a review of health visitors' preventive work with vulnerable families is completed. [ABSTRACT FROM AUTHOR]

Background: A Childhood Obesity Risk Estimation tool (SLOPE CORE) has been developed based on prediction models using routinely available maternity and early childhood data to estimate risk of childhood obesity at 4-5 years. This study aims to test the feasibility, acceptability and usability of SLOPE CORE within an enhanced health visiting (EHV) service in the UK, as one context in which this tool could be utilised., Methods: A mixed methods approach was used to assess feasibility of implementing SLOPE CORE. Health Visitors (HVs) were trained to use the tool, and in the processes for recruiting parents into the study. HVs were recruited using purposive sampling and parents by convenience sampling. HVs and parents were invited to take part in interviews or focus groups to explore their experiences of the tool. HVs were asked to complete a system usability scale (SUS) questionnaire., Results: Five HVs and seven parents took part in the study. HVs found SLOPE CORE easy to use with a mean SUS of 84.4, (n = 4, range 70-97.5) indicating excellent usability. Five HVs and three parents took part in qualitative work. The tool was acceptable and useful for both parents and HVs. Parents expressed a desire to know their child's risk of future obesity, provided this was accompanied by additional information, or support to modify risk. HVs appreciated the health promotion opportunity that the tool presented and felt that it facilitated difficult conversations around weight, by providing 'clinical evidence' for risk, and placing the focus of the conversation onto the tool result, rather than their professional judgement. The main potential barriers to use of the tool included the need for internet access, and concerns around time needed to have a sensitive discussion around a conceptually difficult topic (risk)., Conclusions: SLOPE CORE could potentially be useful in clinical practice. It may support targeting limited resources towards families most at risk of childhood obesity. Further research is needed to explore how the tool might be efficiently incorporated into practice, and to evaluate the impact of the tool, and any subsequent interventions, on preventing childhood obesity., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: High-quality pre-registration student nurse training and development is integral to developing a sustainable and competent global nursing workforce. Internationally, student nurse recruitment rates have increased since the onset of the COVID-19 pandemic; however, attrition rates for student nurses are high. During the pandemic, many student nurses considered leaving the programme due to academic concerns, feeling overwhelmed, and doubting their clinical skills. Little was known about the extent to which nursing education prior to COVID-19 had prepared students for their role in managing the healthcare crisis or the impact on their resilience. Thus, this study aimed to explore how the COVID-19 pandemic impacted on the resilience levels of student nurses across the United Kingdom., Methods: Data were collected as part of a multi-site qualitative study named 'COV-ED Nurse' and involved pre-placement surveys, placement diaries, and post-placement interviews with nursing students. Student nurse participants were recruited from across the United Kingdom, from all years of study, and from all four nursing branches: children, adult, mental health, and learning disabilities. Participants were asked to complete a pre-placement survey that collected demographic details and information about their placement expectations. They were also asked to record a weekly audio-visual or written diary to describe their placement experiences, and, on completion of their placements, students were interviewed to explore their experiences of this time. Data were thematically analysed using the Framework Approach. Ethical approvals were obtained., Results: Two hundred and sixteen students took part in the wider study. The current study involved a subset of 59 students' data. Four main themes were identified: 'coping with increased levels of acuity', 'perceived risks of the pandemic', 'resilience when facing uncertainty and isolation', and 'the importance of coping mechanisms and support structures.', Discussion: From this study, we have generated insights that can be applied to nursing research, education, policy, and practice and identified the wide-ranging impact that the COVID-19 pandemic had on student nurses and their abilities to remain resilient in an unstable environment. The value of communication and support networks from a wide range of sources was highlighted as key to navigating many uncertainties. In addition, the extent to which students were able to navigate their personal and professional roles and identities influenced their ability to cope with and continue along their training pathways., Competing Interests: None., (Crown Copyright © 2023 Published by Elsevier Ltd.)

Aim: To synthesise what is known from current international evidence about how parents are supported by significant others when they are faced with making decisions about their child's cancer care., Background: Parents are faced with making challenging decisions when their child has cancer and may benefit from support. Whilst previous research has comprehensively explored how healthcare professionals can offer support, little attention has been given to how support may be informally provided from a parent's network of significant others., Method: An integrative literature review was undertaken and reported following the ENTREQ framework. Literature was identified from comprehensive database searching across four relevant databases (CINAHL, PubMed, PsychINFO and British Nursing Database) and hand-searching reference lists of retrieved studies. Studies that met the inclusion criteria were critically appraised and then analysed using the Constant Comparative Analysis method., Results: Twenty-six articles were included in the review. Two overarching themes were identified. Theme 1-Dimensions of Decision-Making support-included three sub-themes: informational, emotional and instrumental mechanisms of support. Theme 2-Expectations of Decision-Making support-identified that parents' expectations of their own role, and the role of their significant others, affected how decision-making was supported., Conclusions: Parents may seek and receive support from various significant members of their network, but there is a fine line between supportive and unsupportive behaviours., Relevance to Clinical Practice: Each family's unique personal, social and cultural context strongly impacts on their support needs, and nurses and other healthcare professionals should be mindful of how parents may access support from their significant others. Further in-depth research around this area would contribute important knowledge around parents' support needs., (© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Certain parental cognitions about child sleep and bedtime behaviours used with their child have been linked to poorer child sleep. However, previous research has focused on mothers and explored only a limited range of sleep-related cognitions and practices. The present study investigated whether parental cognitions and sleep-related practices (both in connection with their own sleep and their child's sleep), alongside the bedtime behaviours used with their child were associated with and/or were predictive of their child's sleep. Mothers and fathers from 44 families (with a child aged 12-24 months) separately completed questionnaires reporting (i) their cognitions (about their own sleep and their child's sleep), (ii) sleep-related practices (used in connection with their own and their child's sleep) and (iii) bedtime behaviours used with their child. Child sleep was assessed through parental report and actigraphy. Both parents' cognitions about their own sleep predicted cognitions about their child's sleep. Mothers' own sleep-related practices predicted the types of practices they used with their child. Different patterns of maternal and paternal variables influenced parental perceptions of their child having a sleep problem. The present findings highlight the importance of including mothers and fathers in child sleep research. Parents' dysfunctional cognitions (their own sleep) and broader sleep-related practices (their own and child sleep) should be considered when exploring influences on child sleep. Results have possible implications for targets of interventions for child sleep problems and also potential implications for theoretical models of child sleep., (© 2022 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Aim: To examine how school nurse practice evolved as a result of the Covid-19 pandemic., Design: A scoping review of international literature, conducted and reported in line with Arksey and O'Malley's (2005) framework., Data Sources: Searches were conducted in September 2021. Ten databases were searched: The British Nursing Database, CINAHL, Cochrane Library, Consumer Health Database, Health and Medicine, Nursing and Allied Health, Public Health, PsycINFO, PubMed and Web of Science. Relevant grey literature was identified through hand searching., Review Methods: A minimum of three reviewers independently screened articles and two reviewers independently undertook data extraction, with any decisions made collaboratively with the wider team. Much of the literature was not empirical work and so it was not possible to apply a traditional quality appraisal framework., Results: Searches identified 554 papers (after deduplication) which were screened against title and abstract. Following the full-text review, 38 articles underwent data extraction and analysis. The review findings highlighted that school nurses adapted their practice to ensure they were able to continue providing their formal and informal school health offer to children, young people and their families and continued working closely with the multidisciplinary team. In addition, the expanded public health role generated by Covid-19 for school nurses' work was considerable, multi-layered and added to their routine workload. School nurses displayed resilience, adaptability and creativity in their response to delivering services during Covid-19., Conclusion: School nurses took on a leading public health role during the Covid-19 pandemic. Some developments and practices were highlighted as beneficial to continue beyond the pandemic. However, formal evaluation is needed to identify which practices may merit integration into routine practice. Continued investment in staff and infrastructure will be essential to ensuring school nurses continue to expand their practice and influence as public health experts., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Child maltreatment has detrimental social and health effects for individuals, families and communities. The ERICA project is a pan-European training programme that equips non-specialist threshold practitioners with knowledge and skills to prevent and detect child maltreatment. This paper describes and presents the findings of a rapid review of good practice examples across seven participating countries including local services, programmes and risk assessment tools used in the detection and prevention of child maltreatment in the family. Learning was applied to the development of the generic training project. A template for mapping the good practice examples was collaboratively developed by the seven participating partner countries. A descriptive data analysis was undertaken organised by an a priori analysis framework. Examples were organised into three areas: programmes tackling child abuse and neglect, local practices in assessment and referral, risk assessment tools. Key findings were identified using a thematic approach. Seventy-two good practice examples were identified and categorised according to area, subcategory and number. A typology was developed as follows: legislative frameworks, child health promotion programmes, national guidance on child maltreatment, local practice guidance, risk assessment tools, local support services, early intervention programmes, telephone or internet-based support services, COVID-19 related good practices. Improved integration of guidance into practice and professional training in child development were highlighted as overarching needs. The impact of COVID-19 on safeguarding issues was apparent. The ERICA training programme formally responded to the learning identified in this international good practice review., (© The Author(s) 2022.)

This integrative review aims to evaluate the experiences of health and social care practitioners with regard to how they exercise professional curiosity in child protection practice. Professional curiosity gained significant currency following the Munro Review of Child Protection (2010) in England, as a means of seeking clarity on what is happening within a family. However, a recurrent finding from child safeguarding practice reviews is that practitioners continue to struggle to exercise curiosity. This is evident within both the United Kingdom and international literature, although descriptors for the concept may differ. This study attempted to identify facilitators and barriers to applying professional curiosity to provide a greater understanding of this theoretical concept. Title and abstract review of 1428 articles identified from databases and 11 from other sources resulted in 52 papers for full-text review. The quality of each article was appraised using the Critical Appraisal Skills Programme tool for qualitative studies, the Mixed Methods Appraisal Tool (MMAT) for quantitative/mixed method studies and the Joanna Briggs framework for theoretical/opinion papers. Key findings were recorded in the Summary Table of Literature Reviewed. Data extracts were thematically analysed. Twenty-four papers predominantly from the UK, but also from Australia, Italy, Sweden and USA formed the data set. Overarching themes that emerged from the thematic analysis included: noticing dissonance, emitting curiosity, constructing meaning, facilitators, individual professional challenges, organisational and macro-level influences and conceptual development. This review demonstrated that professional curiosity is multifaceted and involves a whole system approach, from empowered, knowledgeable and competent frontline practitioners to creative, innovative and empathic organisations, that value staff contributions and place the child's best interests at the forefront of service development. Recommendations are made for practice and further research., (© 2022 John Wiley & Sons Ltd.)

Background: Antibiotics savelives and have been effectively and reliably used for decades to treat infections and improve health outcomes. This trust in antibiotics has contributed to over prescribing and the emergence of antimicrobial resistance. Significant amounts of antibiotics are still widely prescribed and taken, especially in young children. However, there is a paucity of existing literature relating to how mothers, who are the main carers of young children, may be influenced by their trust in antibiotics., Aims: To explore what factors influence mothers' decisions to seek antibiotics for their young children., Design: Qualitative case study using postcode boundaries., Methods: Thematic analysis of qualitative data from mothers of children under 5, recruited via community playgroups within the case. Data were collected between October 2018 and May 2019, from six focus groups (n = 19) and one-to-one interviews (n = 14). Thematic analysis of the data consisted of six phases: data familiarization; generating initial codes; searching for themes; reviewing themes; defining and naming themes; and producing the report., Results: Mothers were influenced by their belief and trust in antibiotics. Antibiotics were identified as symbolic of recovery, healing and of providing protection and safety., Conclusion: By understanding the symbolic power of antibiotics on maternal decision making, all antibiotic prescribers may be able to offer and provide reassuring alternative and acceptable treatment options to mothers, rather than using antibiotics., Impact: This paper introduces the concept of antibiotics as powerful symbols which influence antibiotic seeking behaviour. This in turn may result in inappropriate use of antibiotics which contributes to the risk of antimicrobial resistance developing. Although the majority of antibiotics are still prescribed by doctors, the number of nurse prescribers has been increasing. Therefore, an increased awareness of antibiotic symbolism, in all prescribing clinicians, is important to enable future local and national strategies to be developed, to support maternal decision making and reduce antibiotic seeking behaviour., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Child sleep is a common parental concern and there is an array of resources available to parents. However, an exploration of UK parents' help-seeking behaviours around child sleep is lacking. This study sought to identify the resources parents use to seek information and help for child sleep, as well as to explore what factors parents prefer about certain sources and their reservations about using other resources. Parents of 6-36 month old children residing in the United Kingdom (UK) completed an online questionnaire between October 2015 and October 2016 about their use, opinions and experiences regarding resources for child sleep. Quantitative data were descriptively analysed and thematic analysis was conducted on parents' open-ended text responses. Participants were 266 UK parents (97% mothers). Parents' ages ranged from 21 to 45 years (M = 33.49 years, SD = 4.71) and all resided in the United Kingdom (UK). General Internet searches were the most commonly reported source used by 47% of parents with a range of other informal resources also frequently consulted. Health Visitors (HVs) were the most accessed healthcare professional reportedly consulted by 38% of parents. Seven themes represented parental preferences for their resource use. Most strongly endorsed included a desire for information from other parents, particularly those with practical experience and accessing information that aligned with their parenting values. Parents preferred sources that provided support and reassurance, as well as those that afforded parents the ability to select relevant elements from a range of information. Seven themes represented parents' reservations about resources. Most strongly endorsed were concerns about reliability, being judged and challenges associated with filtering vast amounts of information. Parents reported having reservations towards sources if they had a previous negative experience with the source. Possible implications of the findings and specific suggestions about how existing and future resources could be adapted to better meet parents' needs are highlighted., (© 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

Introduction: Exposure to adverse childhood experiences (ACEs) is associated with poorer health outcomes throughout life. In England, health visiting is a long-standing, nationally implemented service that aims to prevent and mitigate the impact of adversity in early childhood, including for children exposed to ACEs. A range of health visiting service delivery practices exist across England (from the minimum five recommended contacts to tailored intensive interventions), but there is a lack of evidence on who receives what services, how this varies across local authorities (LAs) and the associated outcomes., Methods and Analysis: This study will integrate findings from analysis of individual-level, deidentified administrative data related to hospital admissions (Hospital Episode Statistics (HES)) and health visiting contacts (Community Services Data Set (CSDS)), aggregate LA-level data, in-depth case studies in up to six LAs (including interviews with mothers), a national survey of health visiting services, and workshops with stakeholders and experts by experience. We will use an empirical-to-conceptual approach to develop a typology of health visiting service delivery in England, starting with a data-driven classification generated from latent class analysis of CSDS-HES data, which will be refined based on all other available qualitative and quantitative data. We will then evaluate which models of health visiting are most promising for mitigating the impact of ACEs on child and maternal outcomes using CSDS-HES data for a cohort of children born on 1 April 2015 to 31 March 2019., Ethics and Dissemination: The University College London Institute of Education Research Ethics Committee approved this study. Results will be submitted for publication in a peer-reviewed journal and summaries will be provided to key stakeholders including the funders, policy-makers, local commissioners and families., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

The responsiveness of professionals working with children and families is of key importance for child maltreatment early identification. However, this might be undermined when multifaceted circumstances, such as the COVID-19 pandemic, reduce interdisciplinary educational activities. Thanks to technological developments, digital platforms seem promising in dealing with new challenges for professionals' training. We examined a digital approach to child maltreatment training through the ERICA project experience (Stopping Child Maltreatment through Pan-European Multiprofessional Training Programme). ERICA has been piloted during the pandemic in seven European centers involving interconnected sectors of professionals working with children and families. The training consisted of interactive modules embedded in a digital learning framework. Different aspects (technology, interaction, and organization) were evaluated and trainers' feedback on digital features was sought. Technical issues were the main barrier, however, these did not significantly disrupt the training. The trainers perceived reduced interaction between participants, although distinct factors were uncovered as potential favorable mediators. Based on participants' subjective experiences and perspectives, digital learning frameworks for professionals working with children and families (such as the ERICA model nested in its indispensable adaptation to an e-learning mode) can represent a novel interactive approach to empower trainers and trainees to tackle child maltreatment during critical times such as a pandemic, and as an alternative to more traditional learning frameworks.

Background: Overuse of antibiotics and inappropriate prescribing has resulted in rapid development of antimicrobial resistance. Most antibiotics in the United Kingdom (71.4%) are prescribed in primary care by general practitioners, with about half prescribed for viral rather than bacterial illnesses., Aims: To explore antibiotic prescribing and factors which may influence maternal decision making to seek antibiotics for their young children., Methods: Data for children under five years were gathered using a mixed-methods case study approach. Quantitative general practice antibiotic prescribing data ( n  = 697 children) was statistically analysed and these results were further explored in six focus groups with mothers ( n  = 19) of children under five. The qualitative data was thematically analysed., Results: Quantitative data identified nearly half of children received antibiotics. Children under one were prescribed the fewest antibiotics. Qualitative focus group data showed mothers trusted their general practitioner to provide expert care for their child and often wanted convenient and timely access to advice and reassurance rather than treatment., Conclusion: Antibiotics are frequently prescribed for young children in primary care. Healthcare professionals need to understand the maternal influences contributing to antibiotic use in children and consider strategies and interventions to reduce unnecessary antibiotic prescriptions., Impact Statement-Implications for Research/practice: Nurses and health visitors should have a greater role in supporting maternal decision making for managing their children's illnesses.

Mothers often make key decisions regarding their children's health. They hold core beliefs and attitudes towards healthcare providers, relying on healthcare services to provide support, advice and reassurance. It is crucial that health providers form authentic relationships with families with young children, in order to effectively provide healthcare, support and information as needed. In this paper, we explore mothers' views on the accessibility and expertise of healthcare professionals caring for their child's health. A case study, using a geographic post code as the case boundary was used. Focus groups and semi-structured interviews with mothers of children aged under five years old were conducted. Participants (n = 33) were recruited from local playgroups and six focus groups (19 participants) and 14 individual interviews were conducted. Qualitative data were analysed using thematic analysis. General Practice (including general practitioners [GPs] and practice nurses) was considered to be the preferred option when seeking timely healthcare advice and information. Participant mothers were open to accessing professional advice concerning their child's health, from a range of health professionals and understood the role and potential contribution of various health professionals. However, some factors, influenced mothers' decision-making. These were captured in three themes: maternal perceptions of GPs as accessible experts; practice nurses as approachable and reassuring sources of advice; and difficulty in accessing health visiting services primarily due to service funding cuts. Further investment in primary care services, including expansion of the practice nurse role and an increase in health visiting service provision, may help to provide sufficient support for mothers seeking healthcare advice. In addition, healthcare service strategies, which engage with mothers and ensure nurses are recognised as knowledgeable, accessible, supportive and a suitable alternative to GPs, would be beneficial., (© 2020 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

Background: Healthcare professionals (HCPs), largely doctors, paediatricians, health visitors, midwives, and practice nurses, are in a good position to provide information, help, advice, or guidance to parents for child sleep. However, evidence suggests that there is a gap between the number of parents who desire assistance from HCPs and those that make use of these sources, yet very little is known about the reason for this apparent disparity. The aim of this study was to understand the barriers reported by parents to consulting HCPs about child sleep., Methods: In this study, 266 U.K.-based parents of children aged 6-36 months old completed an online questionnaire (between October 2015 and October 2016) about their help-seeking behaviours in relation to child sleep. This included reporting perceived barriers to consulting HCPs for child sleep information and advice about problems., Results: Thematic analysis highlighted five themes, which parents reported acted as barriers to them consulting HCPs. Specifically, parents perceived HCPs to have a lack of knowledge or training around the topic of child sleep and that advice would be limited in terms of breadth of information or management options that would be offered. Parents were also concerned about wasting their own or HCPs' time, perceived there was a lack of continuity in the information they received, and held concerns about possible negative consequences for their family if they shared details about any child sleep difficulties., Conclusions: Possible practical approaches to address the barriers reported by parents are highlighted. This includes improving training around the topic of child sleep for HCPs and adapting the content or manner in which the topic of child sleep and any associated issues are addressed with parents., (© 2020 John Wiley & Sons Ltd.)

This article reports the findings from a new form of review: a focused mapping review and synthesis. The aim was to create a contemporary, snapshot profile of the nature and scope of gender-based violence (GBV) studies conducted in Europe. GBV is one of the most prevalent human rights violations in the world affecting mainly women and girls. The policy context of GBV in Europe has gathered momentum in recent years, but we do not have a clear picture of how this relates to research activity. Thirteen journals were purposively selected on their likelihood to publish GBV research. All articles published in these journals during 2015 and meeting our inclusion criteria were retrieved. Data were extracted according to (1) types of methodologies used, (2) geographical location of research, and (3) patterns of research activity/interest. Thirty-two articles met the inclusion criteria. Many titles and abstracts were not explicit about the gendered nature of the research which made retrieval and analysis difficult. A range of methodologies were reported, with single-country research conducted more than international collaborations. Intimate partner violence and sexual abuse attracted most research interest. No studies explored female genital mutilation/cutting and only one investigated early and forced marriage. The findings have implications regarding GBV research in Europe, and we explore them in relation to relevant European policy. Researchers can help raise the profile of the gendered nature of most violence-related research by being explicit about this in their publications. Increasing opportunities for cross-national research will help address the global nature of GBV. Tackling GBV requires synergy of empirical evidence and policy to drive the agenda.

At least half of the 20% of mothers who experience mental health problems (MHPs) during pregnancy or after birth are not receiving the help they need that will lead to recovery. In order to identify where improvements need to be made, it is necessary to describe exactly what is being done and the barriers and facilitators that compromise or enhance optimal care. The majority of mothers experience mild to moderate anxiety or depression. The expectation is that primary care professionals, such as health visitors (HVs), can provide the support they need that will lead to recovery. The aim of this study was to explore the views of HVs regarding the content and purpose of an intervention to support mothers with MHPs, described as 'listening visits' (LVs). A link to an online survey was offered to the members and champions of the Institute of Health Visiting (n = 9,474) March-May 2016. The survey was completed by 1,599 (17%) of the target population, of whom 85% were offering LVs. The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a framework to describe commonalities and variations in practice. There appeared to be a shared understanding of the rationale for LVs but a lack of agreement about what the intervention should be called, the techniques that should be used and the duration, frequency and expected outcomes of the intervention. Contextual factors such as staff shortages; conflicting priorities; the needs and circumstances of mothers; the capability and motivation of HVs; inadequate training and supervision; and the absence of clear guidance contributed to variations in perceptions and practice. There are many ways in which the HV contribution to the assessment and management of mothers with MHPs could be improved. The intervention delivered by HVs needs to be more clearly articulated. The contextual factors influencing competent and consistent practice also need to be addressed., (© 2019 John Wiley & Sons Ltd.)

Objectives: This review aims to describe the role of the school nurse in protecting children and young people from maltreatment by examining the international literature. Child maltreatment is a prevalent issue in global society today and includes physical, emotional and sexual abuse, neglect and exploitation. School nurses are ideally placed to identify and work with children and young people who are at risk of maltreatment through their regular contact with the school community., Design: Integrative literature review incorporating thematic analysis., Data Sources: Electronic databases British Nursing Database, Cumulative Index of Nursing and Allied Health Literature, Medline, PsycInfo, Cochrane Library Database for Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL)., Search Terms: Role, School Nurse, Child Maltreatment., Review Methods: Initial title and abstract review of 444 studies resulted in 78 studies for full text review. Additional search strategies identified one relevant study. Inclusion and exclusion criteria were employed as follows; (1) study published in the English language, (2) peer-reviewed, (3) primary research, (4) inclusion of school nurses (or equivalent role internationally) in the study sample, and (5) a focus on the role of school nurses in preventing child maltreatment. Studies were appraised using the Critical Appraisal Skills Programme tool for qualitative studies and the Strengthening the Reporting of Observational Studies in Epidemiology checklist for mixed-methods and quantitative studies. Findings from the studies were identified, summarised and organised into a summary table, before being analysed thematically., Results: 21 studies met inclusion and quality criteria and were included in the review. Key themes that emerged from the analysis were; supporting the child and family, detective work, working with other professionals, training and supervision, barriers to protecting children and young people from maltreatment and trust., Conclusion: International literature highlights the variety of activities that school nurses may undertake in daily practice to protect children and young people from maltreatment. Several challenges to this role are identified, including time management and building relationships with children and young people. Recommendations for practice and further research are made., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Aims and Objectives: To understand the factors influencing parental attitudes towards antibiotic prescribing., Background: Overuse of antibiotics and inappropriate prescribing has resulted in rapid development of antimicrobial resistance (AMR) and is a significant global threat to patient safety. In primary care settings, substantial numbers of antibiotics are prescribed for young children, despite viral nature of illness for which antibiotics are ineffective. Parents play a vital role in decision-making regarding accessing healthcare services and requesting treatment for their children., Design: A systematic review was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (Moher et al., Systematic Reviews, 4, 2015, p. 1)., Methods: The CINAHL, MEDLINE, PsycINFO, The Cochrane Library, BRITISH NURSING INDEX, EMBASE and PUBMED databases were searched for primary research published between 2006-2016. All types of primary research were searched and screened against inclusion criteria. The Critical Appraisal Skills Programme tool was used to appraise identified publications. Quantitative data were summarised descriptively, and qualitative data were thematically analysed., Results: A total of 515 publications were initially screened, and 55 full-text articles were eligibility assessed. Twenty papers met inclusion criteria. Four main themes were identified: the quality of relationships with healthcare providers, dealing with conflicting messages, rationalising antibiotic use and parental practices informed by past experience., Conclusions: Parents wanted reassurance and advice regarding children's illnesses, had poor antibiotic knowledge and were influenced by personal past experiences. More accessible education, including simple information leaflets, is required. Further research on the influence of culture, ethnicity and socio-economic factors would be beneficial., Relevance to Clinical Practice: Healthcare professionals must provide adequate time for reassurance and explanations of decision-making. Easy-to-read information regarding appropriate antibiotic usage should be easily accessible for parents., (© 2017 John Wiley & Sons Ltd.)

'Think Baby' is an innovative online learning resource which has been developed to help student health visitors (and other specialist community public health nurses) build their skills in observing and assessing mother-infant interactions. The project's development and pilot work was funded by a small grant from the Higher Education Academy. It builds on the findings of the team's previous research, which found health visitors' initial training had left them ill-prepared to assess the intricacies of mother-infant relationships. The 'Think Baby' project sought to develop online training resources for student health visitors using video footage of mothers and babies to illustrate different types of interactions. A small group of student health visitors were engaged in reviewing and evaluating the materials and considering their acceptability. Once developed, the materials were piloted with student health visitors from three universities, community practice teachers and a health visitor academic, and they were then adapted for wider roll out. 'Think Baby' enables student health visitors to develop their core skills in assessment, which is really important in identifying when early help and support are needed for mothers and infants.

Background: Given the significance of reliably detecting cases where mother-infant relationships are not developing successfully, it is important that initial assessment processes are as sensitive and specific as possible., Objectives: This study sought to examine the processes by which health visitors identify problems in mother-infant relationships in the post-natal period., Design: Mixed methods., Settings: Two universities and two primary care trusts., Participant: In Phase One 17 first-time mothers and their 6- to 16-week-old infants were recruited. In Phase Two, a sample of 12 health visitors participated., Methods: The study incorporated two data collection phases. In Phase One, each mother's interaction with her baby was video-recorded for 20min in an observation laboratory. The video-recordings were coded and resultant data were analysed to derive a number of quantitative measures of interaction quality, including mothers' responsiveness and sensitivity to their infants as rated by the Global Ratings Scales (GRS) of Mother-Infant Interaction. In Phase Two, 12 health visitors rated and assessed 9 clips of the video-recorded mother-infant interactions. The rationales for their ratings were then explored through in-depth interviews. Health visitor ratings of the video clips were compared to the GRS ratings. The relationship between the main focus of each health visitor rating, as reported in the interview, and the consistency of ratings with the GRS ratings were then investigated., Results: Correlations between individual health visitors' ratings and the GRS ratings ranged from .17 to .83 and were statistically significant in only four cases. There was a weak relationship with health visitors' years of experience (r(s)=.47, NS). When explaining their judgements, health visitors tended to comment on the mother's behaviours or the relationship between the mother and baby and often ignored the behaviour of the baby. There was a highly significant relationship between the consistency of health visitor/GRS ratings and the number of references to the baby in the health visitors' explanations (r(s)=.75, p=.005)., Conclusion: This study contributes to the understanding of how health visitors make assessments of mother-infant interactions. The frequent lack of attention and reference to the baby's behaviour suggests an area for further training., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

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 Guba's (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.

This paper aims to reinforce the importance of a well funded health visiting service in safeguarding and protecting children. While the issues involved in safeguarding and child protection have not really changed in essence, in recent years the practice context, organisational climate and policy drivers have. This paper briefly outlines health visitors' work with children and families, reiterating the profession's track record in safeguarding and protecting children work and discussing how important the health visitor role is and how eroded it has become. The small body of research evidence in this area is discussed, current policy drivers examined and obstacles to good safeguarding practice described. Health visitors' work in child protection is important, and part of a continuum of public health activity including universal preventative work, identifying and working with vulnerable children and their families, and protecting children from abuse and neglect.

This paper aims to inform and encourage community practitioners to contribute to the evidence available to their colleagues, in order to develop practice, education, policy and research. It begins by discussing the main reasons for publication, as well as outlining some of the commonly-held myths and realities of the publication process. Key steps to publication are considered, including deciding on a topic and focus, assessing the material and targeting the right journal. Many community-based professionals are increasingly interested in writing for publication, and 'Community Practitioner' provides an ideal channel through which to disseminate evidence for community practice. This paper outlines the many different forms in which authors may write for publication in this journal, including opinon pieces and clinical updates, as well as more in-depth and lengthy professional papers.

Public health and health promotion agendas are usually determined by adults, even when the 'target' population is children and young people. Adult-centred frameworks for health maintenance and the promotion of well-being risk ignoring young people's conceptualizations and experiences of health and health-relevant behaviours. However, the current policy emphasis in the UK and elsewhere apparently seeks to position young people at the centre of their own health-related decisions. Building on the United Nations Convention on the Rights of the Child, this paper examines and critiques policies relating to young people in UK, European and worldwide contexts. This paper then introduces data from two qualitative studies conducted in the UK. These studies illustrate that young people's definitions of health often run counter to prevailing public health and health promotion discourses. Young people do, however, often exhibit strategies for managing their health, even though they are frequently restricted by the perceptions that adults have about their lives and behaviour. This paper argues that the new policy discourse is not yet being systematically turned into action to give all young people a voice. This is important to begin to understand young people's perspectives about what matters to them and what really influences their health behaviours.

Background: Accurate assessment of family health need is a core health visiting skill, requiring considerable knowledge and expertise. To date, there has been only limited empirical examination of the types of knowledge and ways of knowing which are likely to influence health visiting practice during family health needs assessments., Objectives: This paper will present a detailed analysis of health visiting assessment processes and will explicate some of the many elements associated with the processes of identifying and assessing family health needs., Design: An in-depth case study was undertaken to explore health visiting practice across three study sites. The focus of interest was to attempt to understand the factors that may influence a health visitor in making a professional judgement to offer a family extra support., Settings: The study was conducted in three community Trust case sites in England, UK., Methods and Participants: The study was informed by a constructivist methodology. Data collection took place during 56 observed home visits to families receiving increased health visiting support and intervention. Following the home visits separate in-depth interviews were undertaken with the health visitors and the clients., Results/conclusions: This paper will explicate some of the many elements associated with the processes of identifying and assessing family health needs. It endeavours to unravel some of the complexity and intricacies of these processes and provide insights into health visitors' practical 'know-how'.

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 Guba's 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.

One of health visitors' main roles is that of case finding and actively searching for health needs. This paper describes part of the findings of a study evaluating the clinical practice guidelines issued to health visitors to assist them in identifying families requiring increased health visitor support. A postal questionnaire was distributed to all Community Trust Chief Nurses in England (179), employing health visiting staff. The aim of the questionnaire was to assess the extent to which clinical guidelines are used throughout the country to identify families requiring extra health visiting support and to examine their validity and reliability. The survey results confirm the widespread existence of clinical guidelines in England to assist health visitors in identifying vulnerable families requiring extra support. The study provides evidence that the guidelines are largely subjective and invalid in nature. Questions are raised about the relationship between clinical guidelines and professional judgements.

Over the last 20 years qualitative research methods have increased in popularity in the field of nursing research, yet critical issues of validity and reliability are often overlooked in published research reports. Thus, the aim of this paper is to describe the steps which the author followed to address issues of rigour in one qualitative research study. The study was conducted to explore the health visitor's role in identifying and working with vulnerable families in the community in relation to child protection. This paper will focus on how issues of validity and reliability were addressed in terms of qualitative interview data.