No abstract

This paper draws on Foucault to understand the changing discourse and impact of structured 'health needs assessments' on health visiting practice. Literature about this activity makes little mention of the long-standing social purposes of health visiting, which include surveillance of vulnerable and invisible populations, providing them, where needed, with help and support to access protective and supportive services. Instead, the discourse has been concerned primarily with an epidemiological focus and public health, which is associated with risk factors and assessments. The use of pre-defined needs assessment schedules suggests that health visiting activity can be sanctioned and clients' needs serviced only if they reach the threshold of pre-determined, epidemiologically-defined risk. Their effect on practice is examined through a conversation analysis of ten health visitor/ client interactions using two different structured needs assessment tools. The study indicates that the health visitors, like their clients, were controlled by institutional expectations of their role; analysis of their conversations shows how they achieved the requirements of the organisational agenda. Structuring client needs and health visiting practice through the use of formal needs assessment tools emphasises the epidemiological focus of the health service above the need to arrange support for vulnerable individuals. In this respect, it serves as a marker in the continued medicalisation of health visiting.

High quality couple relationships are linked to high levels of overall wellbeing. Conversely, there is a strong link between poor quality relationships and poor physical and psychological health among adults and children. When characterised by destructive conflict between couples, including verbal aggression, the outcomes for health are particularly damaging. Physical health outcomes include coronary heart disease and raised blood pressure; psychological outcomes include lower ‘life satisfaction’ and increased depression. The impacts however, are far from universal and supportive friends or trusted professionals can help minimise these outcomes. The transition to parenthood is characterised by increased relationship strain, but is also a time of increased motivation to ‘get things right’ among new parents. Health visitors are in a prime position to discuss relationship issues and offer support to families. Training in Brief Encounters®, focusing on active listening skills and a strength-based approach, has been shown to enable professionals to provide a timely intervention at a time of stress and prevent longer term decline and crisis.

The Health Visitor Implementation Plan ( Department of Health, 2011 ) has created unprecedented demand for practice-based learning placements for student health visitors. This evaluation study set out to investigate and evaluate three models of practice-based teaching and learning across the East of England. The evaluation comprised two phases and gathered quantitative and qualitative data from a range of sources. The findings revealed that, irrespective of the practice teaching model, practice teachers conform to the Nursing and Midwifery Council (2008b) Standards to Support Learning and Assessment in Practice, and the vast majority of students felt able and/or confident to undertake their role. Any disparities are not related to the practice education model in operation. A number of key factors—relational attributes, structure and organisation and effective communication—emerged as important for learning.