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An award-winning Health Visitor: How Ruth’s Clinical Doctorate research helps improve Health Visitor practice when planning interventions with parents
At first, in my career, I wanted to find ways of improving my own nursing practice. That’s only natural in the work setting isn’t it? – wanting to be the best that you can be to provide excellent care for your patients. Over time I began to learn that it was also really important to find ways to influence colleagues’ practice too, in order to collectively have a positive impact on patients, clients, babies, children, young people and families served by the NHS.
So at the beginning of my research career, when I was completing a taught MSc in Nursing (RCN Institute) I explored what it feels like to be a breastfeeding mother working outside the home – because I wanted to be able to support breastfeeding mothers effectively in my Health Visitor practice. And when I completed this piece of work my research supervisor Dr Marilyn Kirshbaum, working at the University of Sheffield, suggested applying for funding for a PhD. ‘But how will that work?’ I asked ‘How will that help me to improve my practice?’ ‘How can I be a health visitor and study at the same time?’
So it was with great delight that I discovered, after a bit of searching, that the University of Stirling – which was right on my doorstep – had just started to provide a Professional Doctorate programme for Nurses and Midwives (and subsequently Allied Health Professionals) and that I could continue to nurse at the same time as pursuing an academic career.
And what was the Clinical Doctorate Programme like? Well it’s been everything that I could have hoped for.
I’ve had the opportunity to discuss, debate and write assignments on a range of provoking subjects related to practice; I’ve been examined on my practice, and I have been given the opportunity to try out quality improvement skills in practice.
I have also been given opportunities, through the wider University community, to improve my IT skills, including managing and using spreadsheets and using research software. I’ve been immersed in the theory and practice of project management and I’ve met some incredibly inspirational people over the years.
I have received amazing support from my peers – both at work, and on the Programme. Who would have thought that a Health Visitor and School Nurse could learn so much from a colleague whose speciality is cancer care, reducing healthcare acquired infections, working with young people with mental health issues or a speech and language therapist? But it happened. And in addition there has been a real respect for each other’s roles and responsibilities in practice as we have tried to understand the healthcare context within which each of us works.
And what gradually dawned on me – as I progressed through the ‘Clin. Doc’ Programme – was that this was just as much about ensuring that I was in a position where I could put my learning into practice and influence the practice of colleagues in my workplace, as it was working through the various assignments and the research study. Basically I needed to ensure that my world of practice ‘kept up’, because (apart from everything else) on the Programme we were constantly being challenged about the need to improve the quality of the service that our organisation provided, and we were also encouraged to have the confidence to move out of our comfort zones to do this if required.
So an opportunity arose and I moved to work in Glasgow City as a Practice Development Nurse supporting Health Visitor and School Nurse teams who are working with some of the most vulnerable and disadvantaged children and families in Scotland. Since my arrival I have been continually impressed by the knowledge, skills, compassion and resilience that the team leaders and team members show in their practice – and I am continually learning from them too.
A few ‘thank-you’s – thank you so much to Jane Walker from the Queen’s Nursing Institute Scotland for the Community Nursing Award presented to me and to Professor Jayne Donaldson and Dr Ashley Shepherd for their nomination.
The Award, for ‘promoting excellence in community nursing’, means a great deal to me, because it implies that the research that I’ve carried out to complete the Clinical Doctorate Programme at Stirling University, School of Health Sciences, is recognised as ‘valuable’ to Health Visitor and School Nurse practice – which became one of my key ambitions during the Programme.
Professor Kate Niven and Dr Kath Stoddart, Directors of the Programme, have been incredibly supportive and helpful in very practical ways, and Dr Ashley Shepherd and Professor Helen Cheyne, my research supervisors, have provided me with guidance through their wisdom and knowledge.
And last, but not least, I am indebted to my husband Tom, and the rest of my family for their patience and support as I have completed the Clinical Doctorate Programme; but they know it’s not ‘the end’ of hard work as they know me well enough to understand that I am still as ambitious as ever to work with Health Visitors and School Nurses so that together we can continue to find ways to improve the lives of babies, children and young people.
If you are interested in my research study I have already presented the findings at the RCN International Research Conference 2015 in Nottingham and a PDF copy of the presentation is available here.
Ruth Astbury, 26 June 2015
Winner of University of Stirling’s QNIS Postgraduate Academic Award in recognition of promoting excellence in community nursing.
Breastfeeding is widely accepted as having health and wellbeing benefits for mothers and babies. Consequently national policies have been developed and significant investment made, to encourage more women to breastfeed. Despite this, breastfeeding rates in Scotland have increased very little in the last ten years.
My curiosity about why this might be led me to undertake my PhD with the University of Stirling. While there are many factors which affect breastfeeding decision making, having a family history of breastfeeding appears to be one of the most important. Women who were not breastfed themselves are nearly 30% less likely to start breastfeeding than those who were breastfeeding themselves as babies. There are, however, few studies which have investigated this area.
My study begins to fill this gap by investigating the experience of being the first to breastfeed in a family and making a different feeding choice from that of one’s own mother and sisters. This was though the analysis of conversations with fourteen mothers who had breastfed, using semi structured interviews and a new research tool which I developed, the Infant Feeding Genogram, which shares similarities with ‘family tree’ diagrams. Participants were selected through local toddler groups and via social media and a qualitative method, Interpretative Phenomenological Analysis, was used to analyse the data.
The analysis found four high level themes:
- Breaching family and social norms;
- Volitions and imperatives;
- Unprepared for the challenge; and
- A sacrifice but worth it.
These themes were integrated and demonstrated that breastfeeding was not the straightforward process women were expecting from antenatal classes, rather it could be isolating, painful, distressing and conflictual.
Women found that formula feeding was the default position and that their immediate community and family culture was unsupportive of breastfeeding, involving both overt criticism and more subtle undermining. To avoid this and to maintain relationships, many women adapted their behaviour, for example not breastfeeding in public or in front of family members or avoiding asking for parenting help. There were also, however, powerful moments of joy and connection from the exclusive relationship they formed with their baby. This raised their self-esteem and helped them feel like ‘complete mothers’. This fitted with their understanding of some of society’s positive representation of breastfeeding as being the ‘best and most natural’ way to feed a baby.
Undertaking this research has led me to make some recommendations about how to improve women’s breastfeeding experience. Firstly, breastfeeding needs to be represented in a more realistic way in antenatal classes which acknowledges the physical and emotional difficulties that women often experience. Added to this, policy-makers need to consider the implications of the ‘Breast is Best’ and breastfeeding as ‘natural’ messages that are often used in public health messages, as although they appear to influence some women’s decision making and raise their self esteem, they have implications for women who make formula feed their babies, who were judged by breastfeeding mothers for making a less acceptable decision.
Finally, the health service needs to take a mother and family focussed approach to breastfeeding, recognising the importance of infant feeding history and family members’ limited ability to provide support to their daughters when they breastfeed. This means health professionals need the skills to actively involve women and their families in looking at their family stories which support or undermine women’s breastfeeding and the Infant Feeding Genogram appears to be a useful tool to assist with this.
Having satisfied some of my own curiosity, my next steps involve sharing my ideas and testing them with practitioners and policy makers to see if they also find them interesting and useful. This feedback will shape the next stages, which I hope will involve developing and testing this new focus with women and their families. Please don’t hesitate to get in touch, if you would like to be involved in this process.
Dr Kirsty Darwent, The Family Therapy Training Network
email : Kirsty.firstname.lastname@example.org
First published 22 June 2015
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