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Health visiting is governed by four principles which are the search for health needs, the stimulation of awareness for health needs, raise awareness of health needs and the influence on policy affecting health (). Performing a holistic Health needs assessment is a fundamental part of health visiting. The assessment process is one of the principles set out in the standards of proficiency for Specialist Community Public Health Nurses (Nursing and Midwifery Council, 2004). Wright (1998) explains assessment of health needs is not a process of relying on personal experience or listening to client’s, but is a systematic method of recognising health needs that are unmet and making changes by encouraging client’s to meet these unmet needs.
Using a model or a framework is a systematic method of collecting information allowing a clear identification of problems or needs that need to be addressed. Such framework would also go on to guide the planning and implementation of interventions required to meet the priorities for individuals and families.
The framework taken from system one, Child Individuals needs assessment was used to perform an assessment. System one is a computer system used in the authors practice area to record patient information. The Child individual needs assessment has been developed from the Framework for the Assessment of Children in Need and their Families (DoH, 2000). This assessment framework supported the shift in policy from one that focused on abuse and significant harm to an assessment that adopted a broader view of children’s needs and wellbeing and identified impairment in terms of developmental need (Cowley, 2008).
Consent has been gained to use the information. In accordance with the Nursing and Midwifery Council (NMC) The Code (2008), and to protect confidentiality the names mentioned will remain anonymous.
This case study focuses on a mother, Jody who is a single parent of three children. Due to the current demands on the Health Visiting team an antenatal contact visit had not been done. The Health Visiting team had been notified about the birth of baby Harrington and therefore this was a planned home birth visit at 14 days.
Health visitors have core contacts they make with families as part of the Health Child Programme () and one them is an antenatal contact. This contact allows health visitors to establish a relationship with families and identify their need. Cowley (2008) states visiting clients in their homes allow health professionals to identify a families area of need and then target services appropriately for their need. However research has demonstrated an antenatal contact is useful to in helping health professionals to identify the risk and resilience factors and create a therapeutic relationship with the client which is necessary for the delivery of future services (Puura et al, 2002, Robert et al, 2002). Recommendations made recently suggest any preventative strategies need to be initiated in the antenatal period (Cowley, 2008).
Coles et al () explains a starting point for assessing individual’s needs is to analyse whether the need is normative which is defined by professionals, felt need which is defined by the client, expressed need when a felt need become a demand and comparative needs when comparing to others around them and fall short of the established standard. Wills (2007) explains it is important to consider that needs will be thought of differently depending on who is being consulted.
The assessment covered Economic Wellbeing Observations which included residence and accommodation status as this can impact on a child. Jody living in a third floor council flat with three children, explained that she would like more space as the flat had two bedrooms with a living room she thought was not big enough. She explained the first bedroom was where she slept and would now have baby Harrington with her in the room. The second bedroom which was small, had a bunk bed and had no room to play in was shared by her eldest daughter Rosie, eleven years old and her younger daughter Ella four years old.
The early life environment of a child shapes their life course and in turn can have an effect on their health status over a course of time (Wills, 2007). Housing is an environment where children spend most of their time in the first few years of life therefore require adequate space to live and sleep in. Good quality homes are important for the health and well-being of adults as well as children (). A child’s development and wellbeing is shaped by factors such as family characteristics and the social, economic and physical environments in which they are raised. Poor housing environments and overcrowding can have significant impact on children’s physical and mental health as well as emotional and cognitive development (Marsh et al, 1999).
The House of Commons () explains overcrowding as having too many people in one room or a room that is not an adequate size. Living in an overcrowded house has found to be linked with ill health costing the NHS approximately 600 million a year (House of Parliament, 2011). Research suggests that poor housing and overcrowding can have a physical impact on a child’s healthy development leading to increased risk of asthma, respiratory distress, anxiety as well as lead to accident and injury. Adequate sleep, nutrition and exercise also contribute to a child’s healthy physical functioning. Jody revealed she had visited the GP several times in the course of three months complaining that Ella had recurrent chest infections, and taken baby Harrington to the GP the day before as she felt he was having difficulty breathing. Jody went on to say that the bedrooms were showing signs of damp and she had reported this to the housing company and was yet to come out review this. Jody saw the need for more housing space as an expressed need as she wanted more living space for herself and children to play in.
The housing report (2012) states the latest data found that the number of people living in overcrowded conditions continues to rise, as in 2009 – 2010 there were 630,000 in overcrowded housing which has risen to 655,000 in 2010 – 2011.
The assessment revealed Jody had no extended family support as her family live in the south of England therefore are far to offer consistent support. Jody had moved to the area over eight months ago following the breakdown of her relationship. The father had left the family due to drinking habits and since the family had struggled to make ends meet. Jody is in receipt of benefits and has not made many friends in the area.
Parents are an essential part of a child’s development and require support to enable them to provide the right environment. Jody appears to be socially isolated, Armstrong (2002) articulates social isolation can occur when there is a lack of family and peer support. With the lack of this support Jody had it indicated that she had a risk of developing postnatal depression which can have detrimental effects on baby Harrington and her elder two daughters (Bee and Boyd, 2009). Honey, Bennett and Morga (2002) suggest research indicates postnatal depression can hinder a mother’s ability to look after the child as well as affect the relationship between mother and child. This can cause problems in the child’s emotional and cognitive development. Jody revealed since she had come home from the hospital she had a few teary moments but now felt fine, and also said she had postnatal depression following the birth of Ella. The author planned another visit which would be in a fortnight. This visit would include an assessment of postnatal depression which is carried out at four to six weeks in the practice area. A tool called the ‘Edinburgh postnatal depression scale’ would be used, which is a ten question self report questionnaire designed by Cox, Holden and sagovsky (1987). (ADD STRENGTHS/ WEAKNESSES OF TOOL?) Meredith and Noller (2003) proposed maternal depression increases the risk of difficult attachment with the infant, developmental, social problems and may lead to suicide.
Baby Harrington being 14 days old was in the infancy stage of lifespan development. During infancy a baby will change physically more than any other stage of their life (Bee et al, 2009). Early childhood is consequently the most crucial and vulnerable period of brain development during lifespan. The start of Baby Harrington’s life will lay the foundations of good health and well being for later years. Therefore what happens during pregnancy and the early years of life lays the foundations for future development of cognitive, language, physical, emotional, behavioural and social. Language and cognitive development is important during the first six months to three years of life. Sheridan (2008) proposes stimulation, warmth and positive parenting from parents during the early years is vital for the infant to gain maximum growth in the brain. The brain is increasingly sensitive to the influences of the external environment during early childhood. A child in an environment with increased stimulation will mean a child will learn and develop more. A child in an environment with less stimulating, emotionally and physically supportive, development of the brain is affected leading to cognitive, social and behavioural delays. High levels of stress during early childhood increases the risk of learning problems and stress related disease in to the adult years of life.
The author found support to be a normative need for Jody, as a supported family environment is a fundamental component in raising a child. Jody’s perception was that she was coping with the current situation and did not need support from family or friends as she felt she would be judged by them for not being a good parent to her children.
Income was another factor identified through the assessment. The low income was a felt need for Jody as she said her parents were helping her financially. The author saw that having adequate income as a normative need in order to provide the children as well as Jody herself adequate healthy nutrition and a healthy future of well being. A newborn baby can increase expenditure on a family. This may cause Jody stress as it is an increase on feeding another child,
Health in the UK is strongly associated with income and is a key determinant of health (Naidoo,). Naidoo () explains having a low income can affect children and adults health directly; this can be due to not having enough to eat or enough to buy a healthy diet. Research suggests obesity in low income families to be linked (). Jody does not drive therefore finds it difficult at times to access the larger supermarkets and is reliant on her local grocery store which can have limited choice and be more expensive. Mostyn et al (2011) suggest if money is an issue parents will feed children food they know they will be likely to eat to avoid wastage. Obesity in children can lead to health problems later in life such as heart disease and diabetes ().
Living with a low income can also cause multiple stresses such as lead to parents worrying about their future well being of their children (). Children who live in families in poverty with a low income are also at an increased risk of lower academic achievement (). Jody revealed that she would start looking for employment in the area. Naidoo et al () states individuals who are unemployed are at a greater risk of ill health and mortality.
Neumans systems model is a theory based on the importance of an individual’s wellness in relation to stress and their reaction to these stressors. Neuman defines stressors as any condition or situation that cause an alteration in the individual’s normal state of wellness. The stressors are determined by variables affecting the client system; physiological condition, developmental status, sociocultural influences, cognitive skills and spirituality. The model proposes a continuum of wellness to illness, with the focus on the individual’s continuum being influenced by the interaction they may have with a variable and the stressors they encounter. Neuman identified environment that surrounds an individual at any given time can affect their well being.
Environment and the individual
Clients are influenced by environmental factors
The role of the health professional is to focus on the stressors and keep the stressors and the stress response from having a detrimental effect on the individual. This is done through three levels of prevention. Firstly primary prevention is protecting client wellness through prevention and reducing the possibility of an encounter with a stressor as a reaction to the stressor has not yet occurred. This is done by strengthening the individual’s line of defence. Secondary prevention is treating symptoms to stabilize the individual’s system by strengthening the internal line of resistance reducing the reaction to the stressor. Tertiary prevention focuses on educating an individual to prevent a reoccurrence of an stress response to the stressor through strengthening resistance to these stressors.
Jody’s environment was a stressor for her as it was affecting her and her children as they did not have enough space to live in and the children did not have space to play. According to neumans model this will affect jodys stability and
The absence of ill health and disease is not solely dependent on health. Robinson et al (1996) explains this as only one determinant of health. Health is the state of an individual’s optimal well being (WHO,). There are wider determinants of health. Factors such housing, having a safe physical environment, lifestyle, health beliefs, cultural norms, education, socio economic factors employment, emotional and mental state of an individual affects health ().
The author found the child assessment to be holistic. Assessing infant development holistically has never been so important (Cowley, 2008). Robinson (2010) purposes having this holistic approach of assessment allows an understanding of a child within the context of their family, community and culture in which they grow up in. Cowley et al () suggests that the framework should not be used as a checklist to assess needs. A needs assessment should include a client centred approach.
The framework used for the holistic assessment did not consider the cultural beliefs of an individual or have space were their beliefs could be recorded. There were no prompts of what information was required if an individual had low income or housing that was not adequate.
Apply neuman and weaknesses and strength of model! Marmot?
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