“…Cuthill identified that working in the client's home may remove some professional barriers, facilitating relationship building (Cuthill & Johnston, 2019). However, nurses in many of the studies were aware of the double‐edged nature of the nurse‐client relationship,Nurses consistently described their relationships with the families they served as being critical for the program to be successful, and this cornerstone was also related to how they managed the process of reporting (Holland et al, 2021, p. 7).…”
Section: Resultsmentioning
confidence: 99%
“…Nurses consistently described their relationships with the families they served as being critical for the program to be successful, and this cornerstone was also related to how they managed the process of reporting (Holland et al, 2021, p. 7).…”
Section: Resultsmentioning
confidence: 99%
“…Clinical supervision was highlighted as necessary to reflect on the conflicting roles in the nurse‐client relationship (Dmytryshyn et al, 2015; Holland et al, 2021; Hooker, Small, & Taft, 2016; Jack, Kimber, et al, 2021). Home visitors described the tension of ensuring safety for the child and the harm that disruption to the family home could bring from a disclosure of domestic abuse.…”
Aims
To systematically review and synthesize qualitative research exploring home‐visiting nurses' roles and identify the challenges for nurses working with women experiencing family violence.
Design
We undertook a thematic synthesis of qualitative studies, focusing on the family violence work of nurse home visitors.
Data sources
A systematic search of four scientific databases (ProQuest Central, CINAHL, MEDLINE, EMBASE) was undertaken in August 2021. Grey literature was searched, including government and non‐government research documents, theses, clinical guidelines, policy documents and practice frameworks.
Review methods
Inclusion criteria included research from high‐income countries, peer‐reviewed qualitative studies in English published from 1985 to 2021, and included research on home‐visiting nurse family violence practice. The first author conducted the data search and the initial screening. The first and second authors independently reviewed the full text of 115 papers, identifying 26 for inclusion in the thematic synthesis (Figure 1—PRISMA flowchart).
Results
The thematic synthesis identified two themes: (1) relationship building—with the client, with services and with colleagues/self; and (2) family violence practice—ask/screen, validate/name, assess risk/safety plan and safeguard children.
Conclusion
The thematic synthesis confirmed the multiple roles fulfilled by home‐visiting nurses and enabled insight into the challenges they face as they undertake complex and demanding work. The roles of the home‐visiting nurse have evolved, with the initial focus on safeguarding children leading to broader family violence nursing practice roles, including the identification of family violence and safety planning discussions with women.
Impact
Our meta‐synthesis has confirmed the high‐level communication and rapport‐building skills required by nurses undertaking complex and conflicting roles. Nurses need support and supervision to undertake emotionally demanding work. Integrated health systems, clinical practice guidelines and tools, and training programmes need to encompass the breadth and complexity of the roles of these specialist practitioners.
“…Cuthill identified that working in the client's home may remove some professional barriers, facilitating relationship building (Cuthill & Johnston, 2019). However, nurses in many of the studies were aware of the double‐edged nature of the nurse‐client relationship,Nurses consistently described their relationships with the families they served as being critical for the program to be successful, and this cornerstone was also related to how they managed the process of reporting (Holland et al, 2021, p. 7).…”
Section: Resultsmentioning
confidence: 99%
“…Nurses consistently described their relationships with the families they served as being critical for the program to be successful, and this cornerstone was also related to how they managed the process of reporting (Holland et al, 2021, p. 7).…”
Section: Resultsmentioning
confidence: 99%
“…Clinical supervision was highlighted as necessary to reflect on the conflicting roles in the nurse‐client relationship (Dmytryshyn et al, 2015; Holland et al, 2021; Hooker, Small, & Taft, 2016; Jack, Kimber, et al, 2021). Home visitors described the tension of ensuring safety for the child and the harm that disruption to the family home could bring from a disclosure of domestic abuse.…”
Aims
To systematically review and synthesize qualitative research exploring home‐visiting nurses' roles and identify the challenges for nurses working with women experiencing family violence.
Design
We undertook a thematic synthesis of qualitative studies, focusing on the family violence work of nurse home visitors.
Data sources
A systematic search of four scientific databases (ProQuest Central, CINAHL, MEDLINE, EMBASE) was undertaken in August 2021. Grey literature was searched, including government and non‐government research documents, theses, clinical guidelines, policy documents and practice frameworks.
Review methods
Inclusion criteria included research from high‐income countries, peer‐reviewed qualitative studies in English published from 1985 to 2021, and included research on home‐visiting nurse family violence practice. The first author conducted the data search and the initial screening. The first and second authors independently reviewed the full text of 115 papers, identifying 26 for inclusion in the thematic synthesis (Figure 1—PRISMA flowchart).
Results
The thematic synthesis identified two themes: (1) relationship building—with the client, with services and with colleagues/self; and (2) family violence practice—ask/screen, validate/name, assess risk/safety plan and safeguard children.
Conclusion
The thematic synthesis confirmed the multiple roles fulfilled by home‐visiting nurses and enabled insight into the challenges they face as they undertake complex and demanding work. The roles of the home‐visiting nurse have evolved, with the initial focus on safeguarding children leading to broader family violence nursing practice roles, including the identification of family violence and safety planning discussions with women.
Impact
Our meta‐synthesis has confirmed the high‐level communication and rapport‐building skills required by nurses undertaking complex and conflicting roles. Nurses need support and supervision to undertake emotionally demanding work. Integrated health systems, clinical practice guidelines and tools, and training programmes need to encompass the breadth and complexity of the roles of these specialist practitioners.
“…This possibility is consistent with the higher surveillance bias estimate when a 3-month window was used and a lower surveillance bias estimate when a 12-month window was used, which suggested that reports shortly before the family exited the program contribute more to surveillance bias. Although it is possible that a family leaving the program could trigger a report by a concerned home visitor, we did not encounter this situation in a recent qualitative study of this program (Holland et al, 2021). It is more likely that a report contributed to the family exiting the program.…”
Section: Discussionmentioning
confidence: 99%
“…Although we would expect our estimate to be higher than these previously reported estimates because ours included indirect surveillance bias, it was similar to the higher of the previous estimates, which either did not include indirect surveillance bias or included only some indirect sources. It is unclear how the home visitor background would impact the estimate, but training and experience may impact a home visitor’s recognition of maltreatment and decisions around reporting (Holland et al, 2021). The lower estimate by Duggan et al may reflect differences in training and/or the method of detecting surveillance bias; these authors reviewed home visitor documentation while we relied on CPS records.…”
It is unclear if surveillance bias (increased reports to Child Protective Services [CPS] related to program involvement) has a substantial impact on evaluation of home visiting (HV) prevention programs. We estimated surveillance bias using data from Connecticut’s HV program, birth certificates, CPS, and hospitals. Using propensity score matching, we identified 15,870 families similar to 4015 HV families. The difference-in-differences approach was used to estimate surveillance bias as the change in investigated reports from the last 6 months of program involvement to the next 6 months. The median age of the children at program exit was 1.2 years (range: 60 days, 5 years). We estimated that 25.6% of investigated reports in the HV group resulted from surveillance bias. We reviewed CPS reports of 194 home-visited families to determine if a home visitor made the report and found that 10% were directly from home visitors. Program evaluations should account for surveillance bias.
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