evidence into practice using a strength based approach in family nurse partnership (fnp) gail...
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Evidence into Practice
Using a Strength Based Approach in Family Nurse Partnership (FNP)
Gail TrotterFNP Implementation Lead, Scotland
Aims of Family Nurse Partnership
• To improve pregnancy outcomes and maternal health
• To improve child health and development and future school; readiness and achievement
• To improve parents economic self-sufficiency
Professor David Olds: Pioneer USA
• Works with pregnant teenagers and their partners until the child reaches 2 years
• Preventative intensive early intervention• Strength based, promotes “self efficacy”• Intensive home visiting manualised programme• Mandatory training for Family Nurses: Masters level• Role of Midwife remains the same• Intense relationship• Fidelity Requirements
• Testing FNP City Edinburgh CHP• First time parents 19 years or under at LMP• Planning to stay resident in Edinburgh: 2 years• No plans for relinquishment of baby• Opt-in programme• “Entitlement”
Focus on Strengths
Traditional Way
• Looks for “clues” that will reveal problems
• Looks for “clues” that reveal hidden strengths and possibilities
• Tries to understand, fix problems or patterns in client's lives
• Tries to understand how positive change occurs in client's lives
• Elicits detailed descriptions of problems
• Elicits detailed descriptions of goals and preferred futures
• Focuses on identifying “what's wrong, what's not working” and on deficits that can be fixed
• Focuses on identifying “what's right and working” and focus on strengths, skills and resources
Strength Based
The client is the expert on her own life
Client Centred Principle
They have the solution!
Client is the Expert
Being Client Centred Can Lead Towards “Self Efficacy”
A person’s belief that they can carry out behaviours asked of them
Does not mean being unaware of risk.
GIRFEC
Focus on Strengths
• Learning a new way of supporting client• Unlearning an old style of working• Forget, borrow, learn principles• Avoiding advice giving: guiding approach• Agenda matching: finding the “hearts desire”• Exploring ambivalence with clients
Traditional to Strength Based
Traditional to Strength Based
• Seeing the world through the eyes of the client• Hard to reach, hard to engage• Eyes with a “dangerous filter”• Response to emotional danger
Responses to Emotional Danger
Angry
Sad
ASHAMED INSECURE
FRIGHTENED
CONFUSED
REJECTED OPPOSITIO
NAL
DISTRUSTFUL
DEVALUED
• “Dancing not wrestling”
• “Rolling with the blows”
• Not giving up
• Doing what you say you will do
• Remaining compassionate
Supporting the Practitioner to Respond
• Appreciating it is hard!• Understanding and confident practitioners• Meaningful: educational and training• Appropriate supervision• Collecting and sharing the evidence• Trusting the client • Organisational support: parallel
processing• Baby benefits most
Key to Working this Way
But does it really work?
How the Programme Works
Relationship
Impact
Learning Experience
Behaviour Change
• Improvements in women’s antenatal health
• Reductions in children’s injuries• Fewer subsequent pregnancies• Greater intervals between births• Increases in fathers’ involvement• Increases in employment • Reductions in welfare dependency• Reduced substance use initiation
and later problems• Improvements in school readiness
Consistent Results Across 3 Trials in USA
Programme effects greatest among those most susceptible
UK Evidence So Far
• England evaluations• It is a model that works in England• Acceptable to the client: very low attrition• Educational materials transferable• Early signs: higher breastfeeding rates, decreased smoking
in pregnancy, high uptake AN care, low substance initiation• Nursing workforce feeling fulfilled• 18 RCTs England• Scottish Government evaluation, Scotland