Description of studies and reviews examining the role of RNs in the provision of WCC
| STUDY | COUNTRY | DOCUMENT TYPE | DESIGN | INTERVENTION OR FOCUS | OUTCOMES OR CONCLUSION |
|---|---|---|---|---|---|
| Australia | |||||
| Mbwili-Muleya et al, 200014 | Australia | Primary research | Quantitative analysis; postal survey | Explore the level of contact that FPs have with MCH nurses when dealing with families in the postnatal period; describe the content of and FPs’ views on this communication (N = 715 FPs) | Although fewer than half of the FPs reported contact with MCH nurses in the previous month, most who did found this communication to be helpful |
| Barnes et al, 200315 | Australia | Primary research | Explorative descriptive study; case studies and focus groups | Assess the common services provided by CHNs in the Brisbane area and the effect that changes in the health system have had on CHN practice; explore nurses’ views on these changes (N = 22 nurses) | The main focus of CHN services to provide support and guidance to families remains the same, but is enacted differently, with a shift from universal to targeted programs. Challenges include lack of input from nurses into service development and the changing nurse-client relationship |
| Barnes et al, 200416 | Australia | Primary research | Explorative descriptive study; focus group discussion and workshop to consider the findings | Examine CHN roles, responsibilities, and PD needs (N = 22 nurses) | Four main roles were identified: supportive and nurturing; health education and promotion; resources and referral; and assessment and monitoring. Role changes consisted of increased group sessions, home visits, and planned programs. Need for increased PD is emphasized |
| Briggs, 200617 | Australia | International literature review | Narrative content analysis | A literature review to “describe and compare the practices of community CHNs when engaging with their clients, as depicted in the international literature”33 | Internationally, CHNs work to create a relationship of mutual trust and connectedness with families (specifically mothers); this is accomplished by having personal qualities of being empathetic, caring, reliable, genuine, and warm |
| Bryant et al, 201618 | Australia | Primary research | Qualitative, descriptive study; semistructured interviews | To explore MCH nurses’ practice of evaluating and facilitating caregiver-infant attachment, identifying factors that influence their practice (N = 12 nurses) | Five key themes were found: personal (emotions and attitudes), workplace (opportunities and challenges), knowledge (meaning of attachment and PD), intervention (observational, collaborative, and reflective skills), and skills (promotion of attachment, strategies, and services) |
| Kruske et al, 200619 | Australia | Primary research | Qualitative analysis; semistructured interviews | Explore the effects of policy documents on CFH nursing practice, describe the role of CFH nurses, and describe factors that influence the effectiveness of CFH nurses (N = 33 nurses) | Nurses continue to use an “expert” approach in their practice despite a policy shift toward the partnership model. Age of nurses, educational level, and the management systems in place all help explain the tension between policy and practice |
| Rowe and Barnes, 200620 | Australia | Primary research | Narrative inquiry; interviews and journal entries | Explore the role and usefulness of CHNs in aiding middle-class women, who are not considered a priority for targeted health services, navigate the transition into motherhood (N = 21 mothers) | Nurses play an important role in helping new mothers gain competence, by promoting interactive health literacy and supporting mothers as they develop a sense of maternal identity |
| Rush, 201221 | Australia | Primary research | Qualitative; in-depth interviews | Explore the role that MCH nurses play in dealing with women with postpartum depression (N = 8 nurses) | Nurses play an important role in screening mothers for postpartum depression and they feel confident doing so; however, their role is limited to referrals rather than diagnosis or treatment |
| Barbaro et al, 201122 | Australia | Discussion | Discussion of the Social Attention and Communication Study | MCH nurses trained for 2.5 hours to identify atypical infant development and to raise concerns with parents of at-risk children, followed by referral to an expert team (N = 241 nurses) | Nurses are capable of performing accurate developmental surveillance, as demonstrated by the high ascertainment rate for ASD and developmental delay through the nurse screening protocol. This is within the nurses’ scope of practice in systems such as the MCH centres in Victoria |
| Borrow et al, 201123 | Australia | Primary research | Descriptive, qualitative study; diary entries and focus groups | Explore the current practice of CHNs in Western Australia (N = 51 nurses) | CHNs play a large and multifaceted role in child health, and the role is continuously in flux. Diary analysis showed the most-documented outcome of a visit was related to health promotion; the most common reason for a visit was developmental screening. Focus group analysis themes included working in partnership with families, challenges to practice (working alone, time constraint, lack of resources), and disappointment with lack of clinical supervision and staff development |
| Hooker et al, 201224 | Australia | International scoping review | Descriptive summary and thematic analysis | Explore the role of the nurse in domestic violence screening in the setting of WCC as described in the international literature (N = 17 articles) | Outcomes included barriers to domestic violence screening, including a lack of privacy, knowledge, education, and resources, and enablers such as ongoing education, clinical guidelines, support, and access to debriefing. There was a limited focus on the effect on children at risk. Overall, there is limited international discussion on domestic violence screening during WCC |
| Jeyendra et al, 201325 | Australia | Primary research | Qualitative, descriptive study; face-to-face interviews | Explore the role of the FP in the greater western Sydney area in providing preventive services to well children and families (N = 23 FPs) | FPs’ role in preventive WCC is mainly “opportunistic rather than proactive,” largely owing to constraints on FPs’ time. FPs require further PD and could benefit from increased collaboration with WCC services such as the MCH nursing service |
| Laws et al, 201526 | Australia | Primary research | Qualitative, descriptive study, mixed methods; survey and semistructured interviews | Examine the child obesity prevention practices of MCH nurses, explore the key factors influencing such practices, and identify opportunities to enhance and support MCH nurses in this role (N = 56 surveys, 16 interviews) | MCH nurses frequently monitor growth and address infant feeding; are less likely to use growth charts, promote active play, and advise about limiting sedentary behaviour. Drivers of practice behaviour include parental receptiveness and maintaining rapport |
| Robinson et al, 201327 | Australia | Primary research | Qualitative study; questionnaire and semistructured interviews | Assess the role of PNs in addressing childhood obesity prevention, including nurses’ attitudes and barriers to practice (N = 59 PNs) | PNs are interested in childhood obesity prevention; however, barriers to practice exist, including a lack of confidence in this area, which could be addressed with further training. The Healthy Kids Check provides an ideal opportunity for nurse-provided obesity prevention |
| Sarkadi et al, 201528 | Australia | Primary research | Qualitative study; cross-sectional questionnaire | Evaluating MCH nurses self-perceived comfort, competency, attitudes, and difficulties in dealing with child behaviour problems in their clinics (N = 153 surveys) | Most nurses felt comfortable and competent with broaching the subject and discussing child behaviour, but fewer felt comfortable or competent with managing problems. Most nurses felt it was their role to deal with problems rather than refer. Main barriers were parental denial and resistance. Greater nursing experience led to increased comfort and competence |
| Walsh and Mitchell, 201329 | Australia | Primary research | Integrated mixed methods; self-report survey | Explore the role of PNs in child health and development. Describe responsibilities, PD needs, barriers, facilitators, and role satisfaction of PNs in this area (N = 29 PNs) | PNs are ideally placed to assist new parents in adapting to their new role and to provide child health and development support to those unable to access child health services. PNs are interested in expanding their role into this area; however, there is a need for additional education and PD |
| Schmied et al, 201430 | Australia | Primary research | Descriptive statistics and content analysis; surveys | Describe the extent of the CFH nursing service across Australia, including the ages and circumstances of the families as well as the nature and frequency of the CFH services provided (N = 1098 nurses) | Most nurses reported providing universal prevention services and meeting policy goals of making first contact with families within 2 to 4 weeks of birth. Barriers include time constraints, lack of resources, and lack of support; facilitators include supportive management and team, and PD support |
| UK | |||||
| Hampshire et al, 200131 | UK | Primary research | Descriptive, qualitative study; semistructured interviews and analysis of child health records | Assess what HVs and FPs think are the most important child health promotion issues and describe the content of child health surveillance reviews in the first year of life, as recorded in child health records (N = 28 FPs, N = 28 HVs) | Both HVs and FPs agree that HVs are the most important practitioner to discuss child health promotion with families, and HVs were shown to provide more health promotion than FPs. Overall, health promotion in the first year of life is not well recorded in child health records |
| Halpin and Nugent, 200732 | UK | Primary research | Small-scale qualitative, inductive, interpretive study; semistructured interviews | Explore how HVs view their role in dealing with families who have children with ASD (N = 11) | HVs perceived their role to be in recognizing atypical development and providing continuous support to the family. They thought that “developmental surveillance should continue, and they wanted further training and tools to aid in identifying atypical development”22 |
| Condon, 200833 | UK | Primary research | Cross-sectional survey; postal questionnaire | Assess to what extent national child health promotion policy is reflected in HVs’ practice across the UK (N = 1043 questionnaires) | Local policy on the Child Health Promotion Programme does not consistently reflect national recommendations, as large numbers of HVs continue to offer a more comprehensive service to children. Findings suggest that practitioners can mediate the structure and content of programs delivered |
| Other | |||||
| Benjamins et al, 201534 | Netherlands | Primary research | Controlled before-and-after study, qualitative and quantitative | Nursing competences; percentage of children assigned to nursing-only care; change in the number of abnormal findings and referrals with new working method; and experiences of professionals and parents with the new working method (N = 1997 children) | There was a significant increase in medical screening skills (P < .001) and no change in perceived general nursing competences. Overall, 69% of children were assigned to nurse-only care. There was no significant change in abnormal findings or referrals between experiment and control teams, except for hips (P = .034 and P = .035 for findings and referrals, respectively). Nurses and doctors perceived changes as positive, with some recommendations for improvement. Parents were generally happy, but thought there was a lack of continuity of care with the new method |
| Van Stralen, 199935 | Netherlands (Canadian publication) | Discussion | Personal reflection | Describe the structure and components of the system of preventive pediatric care in rural Netherlands | The Dutch system “offers a great deal of support and individualized care”15 for the well child through growth and development clinics that are disconnected from FPs. Care is provided by nurses and child health doctors at these clinics who collaborate as a team |
| Kearney et al, 200036 | US and Canada | Literature review | Systematic qualitative evaluation | Assess the effect that nurse-delivered interventions have on vulnerable young families and describe features of successful interventions (N = 20 studies) | Nurse-delivered home visits, on top of usual care, can have positive effects in maternal health, parenting skills, and maternal-child interaction, with limited improvement in child health and development and no improvement in use of WCC. Effective interventions used well-educated nurses, began in pregnancy, and lasted > 1 year with frequent visits, and focused on building trust |
| Kuo et al, 20064 | International | International comparison | Literature review and international experts | Describe the different structures and practices of WCC in 10 countries and compare with the US (N = 10 countries) | Some similarities exist; however, there are key structural differences in WCC among the 10 countries. In most countries, health promotion is separate from acute care, and the notion of a primary care provider as a “medical home” (as in the US) does not exist |
| Kuo et al, 200937 | International | Primary research | Structured interviews and case vignettes | Describe how “early child development services are provided in other countries in comparison with the [US]”; explore the roles of different health professionals (N = 20 child health experts from 10 countries) | The responsibility of providers in WCC is different across the board, with many countries relying on the nurse for most WCC, with the FP or pediatrician more involved when there is a problem |
ASD—autism spectrum disorder, CFH—child and family health, CHN—child health nurse, FP—family physician or general practitioner, HV—home visitor, MCH—maternal-child health, RN—registered nurse, PN—practice nurse, PD—professional development, UK—United Kingdom, US—United States, WCC—well-child care.