There is increasing international interest in universal, health promoting services for pregnancy ... more There is increasing international interest in universal, health promoting services for pregnancy and the first three years of life and the concept of proportionate universalism. Drawing on a narrative review of literature, this paper explores mechanisms by which such services might contribute to health improvement and reducing health inequalities. Through a narrative review of empirical literature, to identify: (1) What are the key components of health visiting practice? (2) How are they reflected in implementing the universal service/provision envisaged in the English Health Visitor Implementation Plan (HVIP)? The paper draws upon a scoping study and narrative review. We used three complementary approaches to search the widely dispersed literature: (1) broad, general search, (2) structured search, using topic-specific search terms, (3) seminal paper search. Our key inclusion criterion was information about health visiting practice. We included empirical papers from United Kingdom (UK) from 2004 to February 2012 and older seminal papers identified in search (3), identifying a total of 348 papers for inclusion. A thematic content analysis compared the older (up to 2003) with more recent research (2004 onwards). The analysis revealed health visiting practice as potentially characterized by a particular 'orientation to practice.' This embodied the values, skills and attitudes needed to deliver universal health visiting services through salutogenesis (health creation), person-centredness (human valuing) and viewing the person in situation (human ecology). Research about health visiting actions focuses on home visiting, needs assessment and parent-health visitor relationships. The detailed description of health visitors' skills, attitudes, values, and their application in practice, provides an explanation of how universal provision can potentially help to promote health and shift the social gradient of health inequalities. Identification of needs across an undifferentiated, universal caseload, combined with an outreach style that enhances uptake of needed services and appropriate health or parenting information, creates opportunities for parents who may otherwise have remained unaware of, or unwilling to engage with such provision. There is a lack of evaluative research about health visiting practice, service organization or universal health visiting as potential mechanisms for promoting health and reducing health inequalities. This paper offers a potential foundation for such research in future.
International journal of health services : planning, administration, evaluation, 2015
This article discusses the achievements and challenges that England and Brazil face in relation t... more This article discusses the achievements and challenges that England and Brazil face in relation to their capacity to address inequalities in health through health promotion and public health policies. Using secondary data (policy texts and related documents), this article contextualizes, explains, and critically appraises health promotion and public health efforts for the reduction of inequalities in health in the 2 countries. A historic documentary analysis was undertaken, with hermeneutics as the methodological framework. The global economic crisis has prompted the so-called developed economies of Europe to reconsider their economic and social priorities. England represents a state facing this kind of challenge. Equally, Brazil is assuming new positions not only on the world stage but also in terms of the relationship it has with its citizens and the priorities it has for state welfare. The United Kingdom continues to finance a health care system allowing universal access in the f...
Health visitors are public health nurses who, unlike their medical counterparts, maintain contact... more Health visitors are public health nurses who, unlike their medical counterparts, maintain contact with a client caseload. All children under five years old are allocated to a health visiting caseload for purposes of health promotion and preventive care, although resource ...
Community Practitioner the Journal of the Community Practitioners Health Visitors Association, Mar 1, 2007
This paper provides a critical discussion of the research governance approval processes faced in ... more This paper provides a critical discussion of the research governance approval processes faced in a nationally-funded primary care health service survey. The study is investigating how a range of English primary care organisations are addressing child protection and safeguarding children responsibilities in the light of a wealth of policy directives following publication of the report of Lord Laming's inquiry into the death of Victoria Climbié in 2003. The principal investigator is a member of a local research ethics committee and has a good working knowledge of the Research Governance Framework. However, following multi-centre research ethics committee approval, a whole catalogue of difficulties emerged in gaining research governance approval for this study from primary care organisations. These challenges and our lessons for primary care are outlined in an organisational case study with the intention of generating debate around this fundamental stage in the research process. With the current restructuring of primary care, we believe the time is right to streamline research governance procedures.
International Journal of Nursing Studies, Jan 6, 2000
This paper outlines the detail of the case study method used in a project commissioned by the Eng... more This paper outlines the detail of the case study method used in a project commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment and quality of care in the context of the NHS and Community Care Act, 1990. It explains the methodological procedures and analytic processes which led to integration of data across the whole study, focusing on the role of a prior theoretical framework in case study design. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (N=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. They were interviewed after the observation period (N=33 practitioners), to determine the extent of formality they attached to each assessment, and elicit information about aspects which may be embedded in everyday practice as well as those recorded for explicit requirements.The preliminary analysis resulted in the modification of a model for assessing service quality, and identified various points where a 'policy-practice gap' might arise between policies and practice in both the health service and education. The practicalities of operationalising a multiple case study design into research are highlighted, and the mechanism for 'generalising to theory' illustrated.
This paper outlines the detail of the case study method used in a project commissioned by the Eng... more This paper outlines the detail of the case study method used in a project commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment and quality of care in the context of the NHS and Community Care Act, 1990. It explains the methodological procedures and analytic processes which led to integration of data across the whole study, focusing on the role of a prior theoretical framework in case study design. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (N=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. They were interviewed after the observation period (N=33 practitioners), to determine the extent of formality they attached to each assessment, and elicit information about aspects which may be embedded in everyday pr...
Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association, 2005
The second paper in this series of two on partnership examines the effects of family partnership ... more The second paper in this series of two on partnership examines the effects of family partnership (parent adviser) training which builds on health visitors' skills to facilitate partnership working with parents. This study was utilised as a pilot to identify a suitable method, to explore the interaction processes of health visitors who had undergone the training. The study draws together both quantitative and qualitative methods to seek to understand processes in depth. Three health visitors, who were part of a training group of 12, took part in the qualitative research using stimulated recall methodology. The quantitative data was collected from the whole training group using the Constructions of Helping questionnaire and the course evaluation form. The findings suggest that the family partnership training may be effective in enhancing partnership working in health visiting and that the stimulated recall methodology is an effective method of identifying the processes of interact...
Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association, 2005
This paper presents findings from a national study of the Irish public health nursing service and... more This paper presents findings from a national study of the Irish public health nursing service and focuses, in particular, on issues relating to service configuration. The findings are drawn mainly from a national questionnaire of public health nurses (PHNs) working with families with infants (n=613; response rate 54 per cent) and the data were gathered in 1999/2000. The average ratio of public health nurse (PHN) to population size was found to be 1:3997 with a range between 500 and 16,500. The vast majority of respondents (85 per cent) had responsibility for five or more client groups including the elderly, those requiring clinical nursing care, terminal nursing care, psychiatric care, school nursing and the organisation of the home help service. Statistically significant differences between and within health board areas in the extent to which other nurses were available to the service led to a conclusion that in these circumstances a standardised service across individual PHN areas...
There is increasing international interest in universal, health promoting services for pregnancy ... more There is increasing international interest in universal, health promoting services for pregnancy and the first three years of life and the concept of proportionate universalism. Drawing on a narrative review of literature, this paper explores mechanisms by which such services might contribute to health improvement and reducing health inequalities. Through a narrative review of empirical literature, to identify: (1) What are the key components of health visiting practice? (2) How are they reflected in implementing the universal service/provision envisaged in the English Health Visitor Implementation Plan (HVIP)? The paper draws upon a scoping study and narrative review. We used three complementary approaches to search the widely dispersed literature: (1) broad, general search, (2) structured search, using topic-specific search terms, (3) seminal paper search. Our key inclusion criterion was information about health visiting practice. We included empirical papers from United Kingdom (UK) from 2004 to February 2012 and older seminal papers identified in search (3), identifying a total of 348 papers for inclusion. A thematic content analysis compared the older (up to 2003) with more recent research (2004 onwards). The analysis revealed health visiting practice as potentially characterized by a particular 'orientation to practice.' This embodied the values, skills and attitudes needed to deliver universal health visiting services through salutogenesis (health creation), person-centredness (human valuing) and viewing the person in situation (human ecology). Research about health visiting actions focuses on home visiting, needs assessment and parent-health visitor relationships. The detailed description of health visitors' skills, attitudes, values, and their application in practice, provides an explanation of how universal provision can potentially help to promote health and shift the social gradient of health inequalities. Identification of needs across an undifferentiated, universal caseload, combined with an outreach style that enhances uptake of needed services and appropriate health or parenting information, creates opportunities for parents who may otherwise have remained unaware of, or unwilling to engage with such provision. There is a lack of evaluative research about health visiting practice, service organization or universal health visiting as potential mechanisms for promoting health and reducing health inequalities. This paper offers a potential foundation for such research in future.
International journal of health services : planning, administration, evaluation, 2015
This article discusses the achievements and challenges that England and Brazil face in relation t... more This article discusses the achievements and challenges that England and Brazil face in relation to their capacity to address inequalities in health through health promotion and public health policies. Using secondary data (policy texts and related documents), this article contextualizes, explains, and critically appraises health promotion and public health efforts for the reduction of inequalities in health in the 2 countries. A historic documentary analysis was undertaken, with hermeneutics as the methodological framework. The global economic crisis has prompted the so-called developed economies of Europe to reconsider their economic and social priorities. England represents a state facing this kind of challenge. Equally, Brazil is assuming new positions not only on the world stage but also in terms of the relationship it has with its citizens and the priorities it has for state welfare. The United Kingdom continues to finance a health care system allowing universal access in the f...
Health visitors are public health nurses who, unlike their medical counterparts, maintain contact... more Health visitors are public health nurses who, unlike their medical counterparts, maintain contact with a client caseload. All children under five years old are allocated to a health visiting caseload for purposes of health promotion and preventive care, although resource ...
Community Practitioner the Journal of the Community Practitioners Health Visitors Association, Mar 1, 2007
This paper provides a critical discussion of the research governance approval processes faced in ... more This paper provides a critical discussion of the research governance approval processes faced in a nationally-funded primary care health service survey. The study is investigating how a range of English primary care organisations are addressing child protection and safeguarding children responsibilities in the light of a wealth of policy directives following publication of the report of Lord Laming's inquiry into the death of Victoria Climbié in 2003. The principal investigator is a member of a local research ethics committee and has a good working knowledge of the Research Governance Framework. However, following multi-centre research ethics committee approval, a whole catalogue of difficulties emerged in gaining research governance approval for this study from primary care organisations. These challenges and our lessons for primary care are outlined in an organisational case study with the intention of generating debate around this fundamental stage in the research process. With the current restructuring of primary care, we believe the time is right to streamline research governance procedures.
International Journal of Nursing Studies, Jan 6, 2000
This paper outlines the detail of the case study method used in a project commissioned by the Eng... more This paper outlines the detail of the case study method used in a project commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment and quality of care in the context of the NHS and Community Care Act, 1990. It explains the methodological procedures and analytic processes which led to integration of data across the whole study, focusing on the role of a prior theoretical framework in case study design. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (N=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. They were interviewed after the observation period (N=33 practitioners), to determine the extent of formality they attached to each assessment, and elicit information about aspects which may be embedded in everyday practice as well as those recorded for explicit requirements.The preliminary analysis resulted in the modification of a model for assessing service quality, and identified various points where a 'policy-practice gap' might arise between policies and practice in both the health service and education. The practicalities of operationalising a multiple case study design into research are highlighted, and the mechanism for 'generalising to theory' illustrated.
This paper outlines the detail of the case study method used in a project commissioned by the Eng... more This paper outlines the detail of the case study method used in a project commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment and quality of care in the context of the NHS and Community Care Act, 1990. It explains the methodological procedures and analytic processes which led to integration of data across the whole study, focusing on the role of a prior theoretical framework in case study design. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (N=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. They were interviewed after the observation period (N=33 practitioners), to determine the extent of formality they attached to each assessment, and elicit information about aspects which may be embedded in everyday pr...
Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association, 2005
The second paper in this series of two on partnership examines the effects of family partnership ... more The second paper in this series of two on partnership examines the effects of family partnership (parent adviser) training which builds on health visitors' skills to facilitate partnership working with parents. This study was utilised as a pilot to identify a suitable method, to explore the interaction processes of health visitors who had undergone the training. The study draws together both quantitative and qualitative methods to seek to understand processes in depth. Three health visitors, who were part of a training group of 12, took part in the qualitative research using stimulated recall methodology. The quantitative data was collected from the whole training group using the Constructions of Helping questionnaire and the course evaluation form. The findings suggest that the family partnership training may be effective in enhancing partnership working in health visiting and that the stimulated recall methodology is an effective method of identifying the processes of interact...
Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association, 2005
This paper presents findings from a national study of the Irish public health nursing service and... more This paper presents findings from a national study of the Irish public health nursing service and focuses, in particular, on issues relating to service configuration. The findings are drawn mainly from a national questionnaire of public health nurses (PHNs) working with families with infants (n=613; response rate 54 per cent) and the data were gathered in 1999/2000. The average ratio of public health nurse (PHN) to population size was found to be 1:3997 with a range between 500 and 16,500. The vast majority of respondents (85 per cent) had responsibility for five or more client groups including the elderly, those requiring clinical nursing care, terminal nursing care, psychiatric care, school nursing and the organisation of the home help service. Statistically significant differences between and within health board areas in the extent to which other nurses were available to the service led to a conclusion that in these circumstances a standardised service across individual PHN areas...
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Papers by Sarah A Cowley