 | The examples and perspective in this article deal primarily with the United Kingdom and do not represent a worldwide view of the subject.(September 2015) |
Health visitors are professional individuals engaged in public health work within the domestic setting, predominantly found in countries with state-funded health systems. They are distinct from district nurses, who provide clinical healthcare, domestically.
Health visitors are mainly concerned with helping to ensure that people's domestic behaviour is sanitary, hygienic, and beneficial to the welfare of themselves and their families, particularly to their children. As their name suggests, they fulfill their role in the community, by visiting family homes, to give advice and support to all age groups.
They have a key role with regard to safeguarding vulnerable people, as they are often the first experts to enter the homes of individuals at risk of abuse and neglect, especially children.
A check at two years of age is now a major part of the standard provision. If the health visitor suspects that matters were serious enough to warrant child protection measures, it is their responsibility to initiate the process of intervention. The dual role of advice and inspection has made some families wary of health visitors, despite being appreciative of their potential for assistance.
In addition to their early years work, health visitors have now started to run health promotion schemes such as stop-smoking services, and to deliver certain vaccination programmes.
Many health visitors are represented professionally by the Community Practitioners and Health Visitors Association, which is part of Unite the Union.
At the time the health visiting profession began, living conditions for the urban poor were often cramped and extremely insanitary, leading to many business owners sending women around to workers' homes to educate their wives about sanitation and nutrition. The initial focus of health visiting was on families with young children. Visits would cover topics such as sanitation, feeding, nutrition, care, and support to both infants and parents. Typically there would be regular visits throughout a child's early years, to provide routine child development checks. Issues of hygiene, malnutrition, or disease, would be corrected with suitable advice, and reported to the relevant authorities where appropriate
The role of Health visitors was formalised with the establishment of the Ladies Sanitary Reform Association in 1862. By 1890 some local councils were paying the salaries of Health Visitors.
The role of health visitors was given greater weight following the Notification of Births Acts 1907 and 1915 and the Maternity and Child Welfare Act 1918 which empowered local authorities to establish maternal and child welfare services and led to the first training courses for health visitors. [1] In 1929, health visitors began to be employed by local councils on a statutory basis and since 1974 they have been employed by the National Health Service.
Beginning in 1945, health visitors operating in the UK were required to be Registered Nurses or Midwives who had undertaken further training to work as part of a primary health care team.
In the 1950s, their interventions were made more extensive to ensure they could provide a cradle-to-grave service, working also with the elderly and chronically ill.
In 1959 Elaine Wilkie was appointed tutor at Manchester University where she launched a community health nursing diploma. This led to the development of a qualification as a state registered nurse and health visitor, which in turn led to the development of the first UK nursing degree in the UK. [2] Wilkie worked at the University of Manchester with Fraser Brockington, Professor of Social and Preventive Medicine. The course started with nine students in 1959. [3]
In 1962, the Health Visiting and Social Work (Training) Act established the Council for the Training of Health Visitors (CTHV) and the Council for Training in Social Work (CTSW). The CTHV comprised 31 members of whom 14 were appointed by the Minister of Health. In 1970 the title of the CTHV was changed to the Council for the Education and Training of Health Visitors (CETHV). [1]
Under the Blair Ministry, rising case-loads were considered to be affecting the potential quality of interventions in young families. As a result, their work was refocused back to young families; the reduced intervention in elderly care has been accompanied by a commensurate rise in admissions of elderly patients to A+E departments and care homes.
After Sure Start was introduced, to provide general early years support to families, the refocusing on young families lead many health visitors to use Sure Start centres as their base. The Healthy Child Programme, published in October 2009, influences the core service available to families, breaking it down into two age groups : firstly the first 5 years, and secondly 5-19 year olds. The latter age group are traditionally dealt with by school nurses - a public health nurse embedded within, or frequenting a school - with health visitors handing over responsibility to them, for a child's development and welfare, once the child starts to attend school.
The 2010 Coalition Government sought to reverse the move towards reducing the scope of health visitors by giving a commitment to recruit more health visitors, to ensure that their caseloads were not negatively impacted. [4] The government's reorganisation of the NHS returned responsibility for public health, at a local level, to local councils once again, with national issues and oversight being provided by Public Health England. Health visitor services will therefore now be commissioned by local councils, in partnership with clinical commissioning groups.
In 1977 there were 10,623 health visitors in the UK. [5] In 2015 there were 12,292 in England and Wales, an increase from 10,046 in 2000.
In 2000 there were 297 children under 5 per health visitor, a figure which rose to 419 in 2011. [6]
In the early days of statutory health visiting, training in the UK was overseen by the Royal Sanitary Institute, who later evolved into the Royal Society for Public Health. Training was later taken over by the government's Ministry of Health, and they are now regulated by the Nursing and Midwifery Council.
Post-qualification, a 1-year full-time (or equivalent part-time) degree or masters level course.
The Journal of Health Visiting , launched in January 2013, is a monthly peer-reviewed journal for health visitors.
Researchers interested in the history of health visitors may be interested in consulting the Welcome Trust's London's Pulse collection, which provides a digital archive of London's Medical Officer of Health reports, for the period 1848–1972. These reports often referred to the activities of health visitors. [7]
A nursing home is a facility for the residential care of older people, senior citizens, or disabled people. Nursing homes may also be referred to as care homes, skilled nursing facilities (SNF) or long-term care facilities. Often, these terms have slightly different meanings to indicate whether the institutions are public or private, and whether they provide mostly assisted living, or nursing care and emergency medical care. Nursing homes are used by people who do not need to be in a hospital, but cannot be cared for at home. The nursing home facility nurses have the responsibilities of caring for the patients' medical needs and also the responsibility of being in charge of other employees, depending on their ranks. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day.
The Nursing and Midwifery Council (NMC) is the regulator for nursing and midwifery professions in the UK. The NMC maintains a register of all nurses, midwives and specialist community public health nurses and nursing associates eligible to practise within the UK. It sets and reviews standards for their education, training, conduct and performance. The NMC also investigates allegations of impaired fitness to practise.
A licensed practical nurse (LPN), in much of the United States and Canada, is a nurse who cares for people who are sick, injured, convalescent, or disabled. In the United States, LPNs work under the direction of physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their jurisdiction.
Allied health professions are health care professions that provide a range of diagnostic, technical, therapeutic, and support services in connection with health care. Their services are allied with and support the work of a number of other professions not considered allied health professions, such as medicine, nursing, dentistry, optometry, pharmacy, and others listed below as "excluded professions".
District Nurses work manage care within the community and lead teams of community nurses and support workers. The role requires registered nurses to take a NMC approved specialist practitioner course. Duties generally include visiting house-bound patients and providing advice and care such as palliative care, wound management, catheter and continence care and medication support. Their work involves both follow-up care for recently discharged hospital inpatients and longer-term care for chronically ill patients who may be referred by many other services, as well as working collaboratively with general practitioners in preventing unnecessary or avoidable hospital admissions.
Nursing in the United Kingdom has a long history. The current form of nursing is often considered as beginning with Florence Nightingale who pioneered modern nursing. Nightingale initiated formal schools of nursing in the United Kingdom in the late 19th and early 20th centuries. The role and perception of nursing has dramatically changed from that of a handmaiden to the doctor to professionals in their own right. There are over 700,000 nurses in the United Kingdom and they work in a variety of settings, such as hospitals, health centres, nursing homes, hospices, communities, and academia, with most working for the National Health Service (NHS). Nurses work across all demographics and requirements of the public: adults, children, mental health, and learning disability. Nurses work in a range of specialties from the broad areas of medicine, surgery, theatres, and investigative sciences such as imaging. Nurses also work in large areas of sub-specialities such as respiratory, diabetes, neurology, infectious diseases, liver, research, cardiac, and stoma. Nurses often work in multi-disciplinary teams but increasingly are found working independently.
Mary Carson Breckinridge was an American nurse midwife and the founder of the Frontier Nursing Service (FNS), which provided comprehensive family medical care to the mountain people of rural Kentucky. FNS served remote and impoverished areas off the road and rail system but accessible by horseback. She modeled her services on European practices and sought to professionalize American nurse-midwives to practice autonomously in homes and decentralized clinics. Although Breckinridge's work demonstrated efficacy by dramatically reducing infant and maternal mortality in Appalachia, at a comparatively low cost, her model of nurse-midwifery never took root in the United States.
The National Health Service (NHS) is the conglomerate name for the publicly funded healthcare systems of the United Kingdom, comprising NHS England, NHS Scotland and NHS Wales. Health and Social Care in Northern Ireland was created separately and is often locally referred to as "the NHS". The original three systems were established in 1948 as part of major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery—a health service based on clinical need, not ability to pay. Each service provides a comprehensive range of health services, provided without charge for people ordinarily resident in the United Kingdom apart from dental treatment and optical care. In England, NHS patients have to pay prescription charges; some, such as those aged over 60, or those on certain state benefits, are exempt.
Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses can be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialties with differing levels of prescription authority. Nurses comprise the largest component of most healthcare environments; but there is evidence of international shortages of qualified nurses. Nurses collaborate with other healthcare providers such as physicians, nurse practitioners, physical therapists, and psychologists. There is a distinction between nurses and nurse practitioners; in the U.S., the latter are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications unlike the former. They practice independently in a variety of settings in more than half of the United States. Since the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Family-centered care or Relationship-Centered Care is one of four approaches that provides an expanded view of how to work with children and families. Family-centered service is made up of a set of values, attitudes, and approaches to services for children with special needs and their families. In some family-centered settings such as the Hasbro Children's Partial Hospital Program, medical and psychiatric services are integrated to help teach parents and children methods to treat illness and disease. Family-centered service recognizes that each family is unique; that the family is the constant in the child's life; and that they are the experts on the child's abilities and needs. The family works with service providers to make informed decisions about the services and supports the child and family receive. In family-centered service, the strengths and needs of all family members are considered.
Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs). UAPs also provide bedside care—including basic nursing procedures—all under the supervision of a registered nurse, licensed practical nurse or other health care professional. UAPs must demonstrate their ability and competence before gaining any expanded responsibilities in a clinical setting. While providing this care, UAPs offer compassion and patience and are part of the patient's healthcare support system. Communication between UAPs and registered nurses (RNs) is key as they are working together in their patients' best interests. The scope of care UAPs are responsible for is delegated by RNs or other clinical licensed professionals.
Nursing in Japan did not develop as an occupation until the end of the nineteenth century. Initially introduced only in Tokyo in the late 1860s, small schools utilizing Western models were being opened by the late 1880s. In response to disaster relief, the Japanese Red Cross became an integral part of nursing development. By 1915, nurse registration had been established and public health nurses began working throughout the country. Nursing universities were established in the twentieth century and regulations were passed to develop standards for training and public health.
Nurse-Family Partnership (NFP) is a non-profit organization operating in the United States that connects mothers pregnant with their first child with registered nurses, who provide home visits until the child's second birthday. NFP intervention has been associated with improvements in maternal health, child health, and economic security.
In 2002, nursing homes in the United Kingdom were officially designated as care homes with nursing, and residential homes became known as care homes.
The history of nursing in the United Kingdom relates to the development of the profession since the 1850s. The history of nursing itself dates back to ancient history, when the sick were cared for in temples and places of worship. In the early Christian era, nursing in the United Kingdom was undertaken by certain women in the Christian Church, their services being extended to patients in their homes. These women had no real training by today's standards, but experience taught them valuable skills, especially in the use of herbs and folk drugs, and some gained fame as the physicians of their era. Remnants of the religious nature of nurses remains in Britain today, especially with the retention of the job title "Sister" for a senior female nurse.
The Community Practitioners and Health Visitors Association is a Trade union and professional association for health care staff in the UK and Ireland. It is part of Unite the Union.
Auxiliary nurse midwife or nurse hybrids commonly known as ANM, is a village-level female health worker in India who is known as the first contact person between the community and the health services. ANMs are regarded as the grass-roots workers in the health organisation pyramid. Their services are considered important to provide safe and effective care to village communities. The role may help communities achieve the targets of national health programmes.
Nora Wattie MBChB (Aberdeen), DPH (Cambridge) was a pioneer of social medicine, setting up Glasgow’s internationally renowned ante-natal care service.
Elizabeth Elaine Wilkie OBE FRCN (23 August 1915 - 14 December 1998) was a Scottish nurse and the first Director of the Council for the Education and Training of Health Visitors in the UK. Wilkie was instrumental in the development of Health Visitors training in the UK. She received an OBE for her work.
Charlotte Kratz MBE, FRCN, PhD was a trained nurse from the United Kingdom known for her pioneering community health work.
