Health visitor education for today's britain: Messages from a narrative review of the health visitor literature

Highlights •An aspirational ‘orientation to practice’ underpins all health visitors' work •Practice focuses on home visiting, forming relationships and needs assessments •Health visitors' knowledge, skills and abilities are central to effective practice •The large amount of the learning needed is not well covered by current preparation •A radical re-think of health visitor education is needed to accommodate the depth and breadth of knowledge skills and abilities required for practice Objectives This paper draws on a narrative review of the literature, commissioned to support the Health Visitor Implementation Plan (DH, 2011a), and aimed at identifying messages about the knowledge, skills and abilities needed by health visitors to work within the current system of health care provision. Design The scoping study and narrative review used three complementary approaches: a broad search, a structured search and a seminal paper search to identify empirical papers from the health visitor literature for review. The key inclusion criteria were messages of relevance for practice. Data Sources 378 papers were reviewed. These included empirical papers from the United Kingdom (UK) from 2004 – February 2012, older research identified in the seminal paper search and international literature from 2000- January 2016. Review Methods The review papers were read by members of the multi-disciplinary research team which included health visitor academics, social scientists and a clinical psychologist managed the international literature. Thematic content analysis was used to identify main messages. These were tabulated and shared between researchers in order to compare emergent findings and to confirm dominant themes. Results The analysis identified an ‘orientation to practice’ based on salutogenesis (health creation), human valuing (person-centred care) and viewing the person in situation (human ecology) as the aspirational core of health visitors' work. This was realised through home visiting, needs assessment and relationship formation at different levels of service provision. A wide range of knowledge, skills and abilities were required, including knowledge of health as a process and skills in engagement, building trust and making professional judgments. These are currently difficult to impart within a 45 week health visitor programme and are facilitated through ad hoc post registration education and training. The international literature reported both similarities and differences between the working practices of health visitors in the UK and public health nurses worldwide. Challenges related to the education of each were identified. Conclusions The breadth and scope of knowledge, skills and abilities required by health visitors makes a review of current educational provision desirable. Three potential models for health visitor education are described