Nikki Forsyth, Queen’s Nurse from NHS Grampian shares her views on why Health Visitors are essential keyworkers at this time of pandemic.
The COVID-19 pandemic has required workers across services to be redeployed in order to meet staffing demands and ensure the continued provision of care to those in hospital and unwell during this time. But, is there a greater need for community services such as Health Visiting to remain in their roles?
There has been talk about Health Visitors being redeployed to support nursing services and this has happened in some areas, this is understandable as we are registered nurses and/or midwives but I feel we are far more essential in our current roles not just during COVID-19 but in preparation for post COVID-19. We will be part of the frontline as we move to a new way of working and we begin to look at the support and care required for our communities that the coronavirus pandemic has exacerbated or created.
Health visitors are also known as Specialist Community Public Health Nurses, we have undertaken training in addition to our nursing or midwifery education to deliver a universal service that is about promoting health and reducing health inequalities, our client group is children age 0-5 and their families. Whilst we provide a universal service a needs assessment identifies those that are vulnerable and a more targeted service is then provided, often in conjunction with other agencies such as education, social services and those in the third sector. Can you imagine the level of vulnerability there will be post COVID-19?
How do we define vulnerability?
It is the ability of a person or group to cope with and recover from adversity and is ever evolving. We could argue that the children of the world are currently experiencing an adverse childhood experience, they have been taken out of their normal routine, unable to see family or friends. They may be in the shielding group or living with a parent who is; they may live in a household in which domestic abuse occurs or be subjected to physical, emotional or sexual abuse or are being neglected. All these factors are heightened by the current situation, the usual protective factors are unavailable and there are limited opportunities to ask for help with less visiting, less contact with professionals and less opportunities to leave the house. Isolation is exacerbating mental health issues; for some people the pandemic has caused a rising level of fear and anxiety, children learn how to respond to situations through the role models around them and are particularly attuned to their care givers. Alcohol sales have increased by 30% at last report, we are aware that health harming behaviors, such as smoking and drinking, are used to cope with stress; and the amount of families becoming impoverished because of job losses and the stalling of the economy is distressing; demands on food banks and applications for benefits are on the increase.
Traumatic events such as bereavements, relationship breakdowns, even house moves can’t be processed and dealt with in the usual manner meaning potential post-traumatic stress may be another health issue to be supported.
As Health Visitors, we routinely offer support and do targeted work with all of these issues, and it is part of our role to recognize unmet need and influence policy. As well as supporting our clients through this strange and unprecedented time we have the opportunity to be identifying health issues and working on the policies and procedures that will help us to address them and benefit families.
we are public health nurses for a public health crisis.
Health Visitors are part of a multiagency team and communication is key especially when it comes to safeguarding. At present the need for new ways of working is apparent as a key area when creating a plan for a child and their family is observation, but COVID-19 has limited home visiting. Observation of children and their families remains an essential element of assessment and planning if we are going to ‘get it right for every child.’ What if the rise of eHealth initiatives enables services to do more work together allowing clients to benefit from our collective skill set at the same time? This could give a clearer picture of what a child and their family need to thrive and provide a coordinated approach when supporting them. A strengths-based focus with input from several services simultaneously could give a well-rounded assessment on all dimensions of health. Post COVID-19 we could be prepared to rise to the challenges it has created by rapidly deploying our skills in needs assessment and planning how we will reduce the rising inequalities and promote health, both physical and mental, emotional wellbeing and resilience for future adversity with the other future frontline services such as mental health teams. Referring back to our other title, Specialist Community Public Health Nurses, we are public health nurses for a public health crisis.