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In the October
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When asked by the Gazette to write about a typical day as a Health Visitor I found it difficult because no two days are alike. The most consistent thing is the way my day starts: the alarm goes off, I switch it off and then struggle to get up; mornings are not my best time. However, with two children to get going on their way to school, time is of the essence. I have been a Health Visitor in Gamlingay for just over five years and work directly with the Doctor’s surgery in the town. Very few people know what a Health Visitor does unless they have direct contact, so perhaps this is a good place to start. First and foremost, we are nurses. Some of us also used to be midwives, which I was from 1980-1982. Health Visitors are required to complete a 1-year full time course, which includes subjects such as social policy, the environment, health, and psychology. Our main role, unlike the traditional role of the nurse is to work with people who are healthy, providing them with information in a bid to keep them that way.The majority of our work at present is with the “under fives” and their families, but our remit is the ‘cradle to the grave’. We would like to look at health as a wider community picture, providing information and activities for the prevention of coronary heart disease and cessation of smoking, however our work time is limited. To make moves towards achieving these aims we are employing more community nursery nurses to assist us with some of our tasks, such as behaviour management and development checks for the under fives. This will enable us to develop our role in the future. Whilst those are our aims, this is a relatively typical day at present. I usually arrive at work around 8.30am having dropped my son at school. The first thing I do is listen to the messages on the ansa-phone, anything from 2-10 messages. I then take my post across the road to the Doctor’s surgery where couriers from Bedford and Cambridge call in order to provide an internal post run. By the time I have talked to the receptionists, picked up my incoming post and walked back across the road it is almost 9am, and the phone starts to ring. The next hour is usually spent answering the phone, answering the front door (we have no administration staff), returning phone calls to those who left messages, general paperwork, and making appointments. Usually during this time, my colleagues, the District Nurses who are also based in the building have made me a very welcome cup of coffee. Around 10am, I start on my home visits and this is where my day varies the most. I always visit by appointment and never turn up unexpectedly. My first port of call today is to a new baby (11 days old) and his family. At this stage, I overlap visits with the midwife and most of the parent’s questions have been answered, although there are usually a few left for me. Nevertheless, there is the usual paper work to be completed. We provide parents with a personal child health record book for their baby, in which all the professionals record with the aim of providing open information about their child. In addition to this a ‘birth to five’ book is provided. This provides information and advice on the care of the baby until he or she is five. Unlike most other books, it is not sponsored by a company and therefore provides practical unbiased information. More often than not this visit is the only opportunity to meet the father of the baby and so I try to emphasise that we are a family visitor and not just there for the mum and baby. My next call is to a 3-week-old baby and his mum. As expected, when the midwife has stopped visiting, there are lots more questions. These are mainly about feeding and care of the baby, but all very important. During this visit, I complete my examination of the baby, which besides a physical examination includes weighing the baby, and measuring the head circumference and length. These are all recorded in the baby's personal record book, and can provide a guide as to whether the baby is thriving. Next, to a family who are having difficulty with their toddler’s sleeping habits. It is important before offering any advice to establish what is happening and what the parent’s aims are. We do not all have the same ideals in life. After discussing the issues, advice is given and the mother reassured that this problem is quite common. Most people believe their child is the only one doing something that is not ‘socially acceptable’. A visit was arranged for one week later to review progress and support the family. This on-going support is to reassure parents that their actions are appropriate, but also to review the goals if necessary. Then back to base, collect and sort the post, check the ansa-phone and, hopefully, eat lunch. Just finished my lunch and the doorbell goes. A mum saw my car and popped in to ask advice about her 3-year-old. This often happens and if I have the time I will always see people, if not I make an appointment. On this particular occasion, the mother’s concerns are about her son’s speech, which is not progressing as well as the family would have hoped. This is now causing the little boy some frustration because people could not understand what he was saying. After assessing his speech, and there was indeed some delay we discuss the options. We decide to refer him for a routine hearing test in order to ascertain his hearing is satisfactory for speech development. Whilst the indications are that this would not highlight any problems it is good practice to confirm it. We also decide to refer him to speech therapy for a routine assessment. The therapist holds a session at the same base as myself and is therefore convenient for families. In the interim, I suggest a few exercises that will encourage his speech before she could see him. Health visitors take parental concerns very seriously and often find that they have thought about a problem for many weeks before making contact. Just managed to finish when my first development check for the afternoon arrives. I have three 2-year-old assessments to complete at 30-minute intervals. These checks are part of the child health surveillance programme, as are the 8-week, 8-month and 3½ year check. The three children are all very similar in lots of respects. Mostly shy to start with, refuse to be weighed and measured and want to take my toys with them as they leave. This check is informal, i.e. not task orientated, giving parents more opportunity to ask questions about their children. Inevitably, one of the issues is ‘lack of eating’. By this age children become ‘faddy’ eaters and often use this as attention seeking behaviour. In addition, another problem is 'temper tantrums'. Alternatively, called ‘developing their own personality’. Again I do not confess to having all the answers, but I am able to provide parents with coping tactics in order to keep the behaviour within their control and not the child’s. A general assessment of development and health is also made, but from the parents perspective. After clearing my toys away and doing yet more paperwork; just time for one more visit. This to a lady with post-natal depression. This is far more common than people think and does not always occur just after the baby is born, it more commonly occurs around 3-5 months later. Whilst women are feeling this way it has a devastating affect on them as individuals and their family, leaving husbands feeling low themselves. The women themselves often feel as though they are a failure. My role here is to identify these mothers and provide regular home visits and counselling for as long as necessary. Obviously some will recover more quickly than others, but all do get better, although at the time, they feel they never will. Groups are also available locally to provide support from others who are feeling the same and I am able to refer into these. That completes another (professional) day. I work part time and so I finish at 3.30pm. I usually get back to the office to check my ansa-phone before I go home, but I cannot always guarantee this. If my last visit runs late because the family needs more time, then I will stay with them. When I got back on this particular day there was a message from my colleagues at Sandy Health Centre. They were asking for help to cover a session of development checks and asked if I could be available. Sandy has had a Health Visitor vacancy for more than one year now and are having problems covering their work. Staff shortages in nursing also apply to health visiting. That about summarises a typical day. But there is far more to the job than today’s tasks. In addition to my role as a Health Visitor, I also teach student Health Visitors the practical aspects of the job. 50% of their course is practical based with Community Practice Teachers such as myself, and 50 % in the University. This role is new to me, but I have just trained my first student (successfully). It is a role that I hope to continue for many years to come. I also attend many courses, some mandatory, and some by choice. This enables me to keep my own skills up to date. One of my newest roles is prescribing. I am not able to prescribe as extensively as the GPs, but this is being expanded all the time and will provide a better service for families. My paper work and attendance at meetings has increased considerably in the last couple of years, but I know this has happened in many professions, not only my own. I am sure there is a purpose to this, only I’m not sure what it is yet. Contrary to people’s ideas, Health Visitors are not there to look at how tidy their houses are. Obviously if there is a health risk, we would discuss it. However, our main aim is to make sure families are healthy and happy. Most people also believe we have a child protection role, which we do. This is however a minimal role and if we are visiting families where this is an issue, our aim is to keep families together by providing services by working with other agencies. Group work such as post-natal and parenting groups are another forum where we can provide support and information. Last but not least, we also provide Child Health Clinics (baby clinic), where parents can bring their babies and children to either escape the house, weigh their children, or seek advice; we do not mind the reason. I enjoy my job and the variety it offers. I am also looking forward to my next student in September and teaching her not only about the role, but also how Gamlingay sits between the counties of Bedfordshire and Cambridgeshire! I am sure you can appreciate this causes difficulty for us. There are new challenges ahead and time permitting I hope these can be met.
Having read this, if you would like to talk to me about anything please contact me at:
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