Flying Start Student Nurse Induction Work Book (2015)
Why have a work book?
It is an NMC requirement that you complete a set amount of clinical hours
whilst on placement with the health visitor. These hours must consist of a
practice based experience or education relating to your current area of
practice. Whilst on placement, it is advisable that you complete a piece of work
relevant to your area of work. However you must be able to link this work to
practice and produce evidence of work undertaken, whilst you are in your
practice area.
Occasionally, there may be times when you will be unable to participate in
certain health visiting activities due to the sensitive nature of health visiting
work. You will need to complete your clinical hours in full, so when this occurs, it
is not an opportunity for you to go home. In order to take advantage of the
experiences and activities within the community setting, this workbook has been
compiled to provide you with some ideas about how to get the most out of this
unique setting. In the workbook, there are some suggestions about directing
your study. Any work you undertake can be used as evidence for your mentor
and will ensure that your competencies and clinical hours will be signed off.
Working with a health visitor will allow you to experience the complex social and
health needs within a community. During your nurse training, you may not get
another opportunity to work so closely with children and families so take full
advantage of every experience offered to you.
INTRODUCTION
You will be based with a health visitor during this community placement. Health
visitors are registered nurses who have completed a post graduate diploma in
Specialist Community Public Health Nursing (SCPHN). This course involves
periods of academic study in university as well on placement, supervised by a
Clinical Placement Tutor. Health visitors can enter the profession through the
direct entry route in some parts of England but this is not generally the
orthodox route to becoming a health visitor. At present, direct entry is not an
option in Wales.
In Wales, some health visitors work as part of the Flying Start. This is a Welsh
Government initiative targeting specific areas of need. It provides intensive
health visitor home visiting, educational opportunities such as childcare
placements and play groups, dietetics and speech and language therapy for
babies and children aged 0 – to 3 years and 10 months. The aim is to address
social inequalities and develop each individual child’s full potential, thus
providing each child with a “Flying Start” in life. Generic health visitors have
larger caseloads and do not visit clients at home as often. They are not able to
access the support services such as play groups in the same way. However, they
provide the same evidence based advice and support to families.
Health visitors work as part of an extensive, multi-disciplinary, primary health
care team providing a flexible, dynamic and health focused service to
individuals, families and the wider community. They offer evidence based advice
and provide practical help with the aim of promoting good physical and emotional
health and preventing illness. The role also involves addressing the impact of
social inequality on health by working closely with at-risk or vulnerable
individuals and families. Their unique position within the primary health care
team allows them to offer this service within the family home and within locally
run clinics.
During your placement, you will be given the opportunity to spend time with
other health professionals that make up the primary health care team. They
may practice from specialist outpatient clinics located in community clinics as
well as in the main teaching hospitals. This will allow you a greater understanding
of the important role of health promotion, safeguarding children and disease
management and prevention.
It is hoped that you will thoroughly enjoy your placement with the health
visiting service. We trust that you embrace this opportunity to achieve
professional as well as personal objectives. You can speak to your mentor at any
time to ensure you gain the most from your community placement. Please note,
there may be times when your mentor is not available, in this case you will be
allocated to another.
Health visitors: Specialist Community Public Health Nursing
Health visitors are public health nurses formally registered as Specialist
Community Public Health Nursing (SCPHN) (NMC 2004); their public health
remit and activities are identified as;
"Specialist community public health nursing aims to reduce health inequalities by
working with individuals, families, and communities promoting health, preventing
ill health and in the protection of health. The emphasis is on partnership
working that cuts across disciplinary, professional and organisational boundaries
that impact on organised social and political policy to influence the determinants
of health and promote the health of whole populations".
(Nursing and Midwifery Council 2004)
The Principles of Health Visiting
The work of the health visitor is categorised by 4 domains referred to as ‘The
Principles of Health Visiting’ (CETHV 1977) (Figure 1.1). These domains
encompass 10 key principles of public health practice (NMC 2004) aimed at
health promotion and health maintenance, the prevention of ill-health and the
reduction of risk factors that might undermine health. The health visitor works
with individuals, families and the wider community. Developing therapeutic
relationships and working in partnerships with clients is essential in order to
achieve successful health outcomes for families. Also, it is also essential that
health visitors develop good working relationships with other agencies. This
means utilising their expertise and knowledge combined with sharing information
as appropriate. This ensures professionals work together to achieve the same
positive health outcomes.
Figure 1.1: The Principles of Health Visiting
Health Visiting Domain
Public Health Principle
(Principle)
Search for health needs

Surveillance and assessment of the population’s
health and wellbeing
Stimulation of

Collaborative working for health and wellbeing
awareness of health

Working with and for communities to improve
needs
Influence on policies
health and wellbeing

affecting health
Developing health programmes and services and
reducing inequalities

Policy and strategy development and
implementation to improve health and wellbeing

Research and development to improve health
and wellbeing
Facilitation of health

enhancing activities
Promoting and protecting the population’s
health and wellbeing

Developing quality and risk management within
an evaluative culture

Strategic leadership for health and wellbeing

Ethically manage self, people and resources to
improve health and wellbeing
(Nursing and Midwifery Council 2004)
Health visitors work to raise awareness of the link between health and lifestyle.
This is achieved through providing non-judgemental, research- based advice and
information for clients to enable them to make informed choices and decisions..
Within each area, clients experience unique health and social challenges. These
can be identified through a community profile and a thorough assessment of
needs. It is important to note that health and wellbeing are influenced by
external forces as well as internal strengths and weaknesses. It is more than
just an absence of disease.
Health visitors undertake regular screening of children’s growth and
development. They are required to collate, analyse and interpret the acquired
information which may then indicate further support. There are times when
health visitors may need to make referrals to other agencies or they may need
to provide extra support for clients as part of the health visiting service such
as breastfeeding support or motivational interviewing. Referrals are made with
a client’s consent except in certain circumstances where a child is deemed to be
“at risk of significant harm”.
Figure 1.2: The principles applied in practice
Community Profile
Get together with other students based with Generic and Flying Start health
visitors in your area. It may be appropriate for you to gather information in
pairs and then feed back as a group in order to develop a detailed Community
profile.
Definitions
Community
Neighbourhood
Why do a community Profile
A community profile is a compilation of facts about an area or neighbourhood. It
is utilised in a variety of ways and is useful in building up a picture of the
community from a number of perspectives. The purpose of doing a community
profile is to gain a greater understanding of what a community consists of,
what services are required by that community and why it has or has not been
identified as needing extra funding for certain projects. It should include a
health needs assessment and it should explore socio-economic factors and
health issues.
Doing this profile early on in you placement will ensure you have a greater
understanding of the unique characteristics of the community. Also, it will assist
you to identify specific needs and health concerns which you may encounter
when you are out visiting with your mentor. This is linking theory to practice in a
practical way.
The community profile should comprise of ethnicities prevalent in the area,
health, levels of poverty and how poverty is defined, age, gender and levels of
employment and educational attainment. You will need to consider the level of
morbidity and common health conditions in the area and link these into possible
causal factors.
Whilst collecting information for your Community profile, think carefully about:

Your professional appearance and how this will affect the information
people give you. Please dress appropriately; smart casual attire with no
revealing clothes or jeans

Your professional attitude; looking interested and enthusiastic

Introducing yourself and wearing easily visible identification badges at all
times

Communication skills

Informed consent of participants

Being prepared

What are the relevant questions and why?
Suggestions for collecting your information
Census information
Census information normally provides the basic skeleton for any community
profile. Information is available on a wide range of key statistics, e.g. age,
ethnicity, employment and health. These are often collated to provide
statistics about a certain group within the census, such as the number of single
parent households or the number of pensioners living alone. Census figures are
available from a government website – www.statistics.gov.uk and local
authorities often utilise these figures to direct and allocate services. These
figures are posted on their websites.
Data is available at various levels: national, regional, local authority and ward. It
is also available at the smaller scale of super output areas. Super output areas
are small geographical areas used for the collation and publication of statistics,
for example, collating information about a particular housing estate. These
figures are available from a government website – www.statistics.gov.uk but it is
more difficult to locate the maps which show the boundaries of the super
output areas. However, the website does locate super output areas in specific
wards. Maps may be available from CANDL or from the local authority. Other
sources for useful statistics are the police, housing offices, library and the
Health Authority (public health).
Doctors surgery
Speak to the practice manager and ask for the surgery statistics. These may
include the age range of the patients, prevalent diseases and social issues such
as substance misuse. It is important that you maintain clients’ confidentiality
when collating this data.
Using maps
Completing a map of your neighbourhood is generally an indispensable part of
doing a community profile. Maps can be produced in a variety of ways – hand
drawn, traced from large-scale maps available in libraries, and now it is possible
to get unique ordnance survey maps printed off to order. Maps can then be
annotated with relevant local information such as key buildings, demographic
concentrations and anything else which seems significant. A good map makes an
excellent display, especially when used together with photographs.
Mapping techniques
Mapping in this sense is drawing together a list of the institutions and groups
which serve an area – from council offices to community groups. This can
provide a useful starting point for the interviewing discussed below.
Documentary research
It is always worth trying to find out what has been written about the area
previously. The local library is generally the best place to start. The council and
other organisations may also have various reports and profiles.
Observation
It is always worth walking the streets of your neighbourhood at different times
of the day and making a note of what you see. However, you must be aware of
your own personal safety at all times so please check with your mentor if it is
safe for you to do this. Photographs can also be used but please be aware of
residents’ privacy and data protection. Also, do not publish any photographs or
information on social media sites.
Surveys
Surveys are used to collate information about resident’s views and opinions.
They are valuable tools but are very labour-intensive, often requiring a team of
volunteers or students. It is not advisable that you knock on doors as this may
put your own personal safety at risk. Please wear your identification badge at all
times.
Snowball interviewing
It may be more useful for you to identify key people in the community, such as
the local community police officer or police community support officer, local
councillor and head teacher. You should also include local residents, such as the
chairperson of the local Tenants’ Association and other people active within the
locality. As you talk to people they will often suggest other people who can
provide useful information; thus the term, “snowball interview”. However, you
should check regularly that you are meeting a cross-section of the whole
community.
Making sense of the data
At first, it may seem challenging to collate this amount of varied data. However,
it is not that difficult and should be viewed as a challenge. It is important to
analyse and “make sense” of data collated. Therefore, it might be useful to
organise a group of students to compare and contrast the data you have collated
to determine if there are any contradictions or similarities.
Writing a Profile
You can present your profile in a variety of ways. It is important that your
information is clear and concise. You could split your profile into sections such
as :
Environment

Health

Culture

Local Services
Think about who would use this profile and how it could assist them in their
work. For example, could your health visiting team use the profile to identify
suitable support groups for their families?
Making the Most of a Profile
Doing a community profile is a lot of work, so it is worth thinking hard about how
to make the most of it. Below are a few pointers:

Make sure you leave enough time to present it in an appropriate and
appealing way

Make the most of contacts acquired whilst compiling the profile. Ask if
you can spend time with them to find out more about their role?

How could you use this profile to enhance your community placement?

The best profiles are participatory, where people get involved in the
process and this follows through into greater understanding of the area
and the potential for taking action.
Health Promotion
Taking Action
Previously, in this work book you and your colleagues took part in developing a
community profile. Following on from that profile you should be able to identify
an issue that is pertinent to your area. This does not have to be a child based
issue. If you are an adult branch nurse, choose an adult issue, but think
carefully how it may affect the family, an unborn child or the health of children
and adults within the household. Create a health promotion leaflet or poster
that depicts this problem and suggests solutions or coping mechanism for the
family or for those involved in promoting health in your community.
Activity
Part of a Nurse’s role is to understand the individual contributions of the wider
multidisciplinary team and how they fit into the patient journey. The best way
to do this is by spending time with these professionals and get to know their
role and how they work.
Arrange to spend a day with each member of the community Primary Health
Care team below. Following each visit construct a brief job description for each
member of the team and a description of how and when they would be involved
with the family. Please fill in the visiting contact list at the back of this work
book following your visit.

Practice Nurse

GP

Dietician

Speech and Langugae Therapist
Activity
Case study
Find a patient that has been involved with the health service and talk to
them about their experiences and which Health Professionals have been
involved so far.
Health
Community
nursery nurse
Visitor
Midwife
Community
mental health
team
Audiology
Community
Occupational
therapy
Paeds
PRIMARY
HEALTH
CARE TEAM
Community
nurse
Practice Nurse
Family
planning
G.P.
Enuresis clinic
Orthoptist
Physiotherapy
School Nurse
Speech
therapy
Child Protection and Safe guarding
Safeguarding children is a key priority for the Welsh Government and for local
agencies. We want to ensure that policies and practices across Wales; both at
national and local level, deliver the best outcomes for children in terms of
protecting them and safeguarding their welfare.
Following Lord Laming’s report into the death of Victoria Climbié a revised
framework for tackling child abuse through legislation, guidance and new
structures was established.
1. What are the recommendations that have come from this piece of
work?
2. How will this affect your actions as a qualified nurse?
Scenario 1
A mother starts to shout at a toddler in reception. She calls her a ‘stupid cow’
and gives her a hard slap.
1. Is this any of your business?
2. How would you respond?
Scenario 2
A 6 year old attends to have several teeth removed. He is very thin, his hands
feel cold, he is grubby, unkempt and uncommunicative. You remember
performing a number of extractions on his brother a few months ago.
How do you respond?
Scenario 3
A woman patient attends the surgery with 2 young children. She has facial
bruising and a missing tooth. She tells you that her partner did it but pleads
with you not to tell anyone.
How would you deal with this disclosure?
Domestic Abuse
Domestic abuse affects people from all walks of life, and from all cultural, social
and ethnic backgrounds. It affects the employed and unemployed, young or old,
male or female and is prevalent in all parts of the United Kingdom. Statistics
show that men are more likely to be the perpetrators of domestic violence but
it must be acknowledged that a small number of men are also victims of
domestic abuse. Domestic abuse significantly impacts on a child’s health and well
being. When children live in a home where domestic abuse takes place they are
at risk of significant harm as to witness or to be aware of abuse, threats or
violence is highly detrimental to children of any age, including the very young.
They could also be at risk of, or subjected to, serious systematic abuse
themselves. (Welsh Assembly Government, Tackling Domestic Abuse: The All
Wales National Strategy 2005).
The Reality of Domestic Abuse:
Research indicates:
• Domestic abuse is the largest cause of morbidity in women aged 19-44,
greater than war, cancer and motor vehicle accidents;(Flood-Page and Taylor
2003).
• Domestic abuse accounts for nearly one quarter of all recorded violent crime
in the UK; (Stanko)
• Throughout England and Wales one incident of domestic abuse is reported to
the police every minute; (Ibid)
• As domestic abuse is hidden, it is under-reported, and thus under-recorded;
Ibid)
Domestic Abuse Quiz
How many women experience domestic abuse in their lifetimes?
a. 1 in 100
b. 1 in 10
c. 1 in 4
How many men experience domestic abuse in their lifetimes?
a. 1 in 100 b.
b. 1 in 50
c. 1 in 9
In the UK, approximately how many women a year are killed by a current or
ex-partner?
a. 10
b. 100
c. 200
On average, how long does it take for a woman to leave an abusive
relationship?
3 years
7 years
10 years
Are women more / less at risk in the month after leaving a violent
relationship?
More
Less
Domestic abuse usually decreases if a woman is pregnant?
True
False
How many times is a woman likely to experience physical violence before
reporting it?
a. 3 times
b. 23 times
c. 35 times
How many women live in a refuge in any one day?
a. 3,000
b. 5,000
c. 7,000
Approximately what percentage of children on the child protection register
in England and Wales, have lived with domestic abuse?
a. 45%
b. 65%
c. 85%
What percentage of people would report their neighbour if they witnessed
them kicking an animal?
a.25%
b. 50%
c. 75%
What percentage of people would report their neighbour if they witnessed
them kicking their partner?
a. 25%
b. 50%
c.75%
Source: http://www.idas.org.uk/uploads/File/resources/quiz.pdf
Answers
C
C
B
B
More
False
C
C
B
C
B
Suggestions for development
Core Programme - Core visiting and assessment skills
Public Health
Immunisation
Design to smile
Healthy Food Plate
Billirubin
Newborn hearing assessments and Newborn blood spot
Speech and Language development
SUGGESTED READING LIST
Community Practitioner Journal
“Child development 0-5” by Mary Sheridan
“Health for all children” by David Hall
Parent Held Child Health Records
UHB Intranet for policies and standards
The Principles of Health Visiting: opening the door to public halth practice in
the 21st century” by Sarah Cowly and Marion Frost
The Incredible Years by Carolyn Webster-Stratton