Dr Jan Davison-Fischer

At least half of the 20% of mothers who experience mental health problems (MHPs) during pregnancy or after birth are not receiving the help they need that will lead to recovery. In order to identify where improvements need to be made, it is necessary to describe exactly what is being done and the barriers and facilitators that compromise or enhance optimal care. The majority of mothers experience mild to moderate anxiety or depression. The expectation is that primary care professionals, such as health visitors (HVs), can provide the support they need that will lead to recovery. The aim of this study was to explore the views of HVs regarding the content and purpose of an intervention to support mothers with MHPs, described as ‘listening visits’ (LVs). A link to an online survey was offered to the members and champions of the Institute of Health Visiting (n = 9,474) March–May 2016. The survey was completed by 1,599 (17%) of the target population, of whom 85% were offering LVs. The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a framework to describe commonalities and variations in practice. There appeared to be a shared understanding of the rationale for LVs but a lack of agreement about what the intervention should be called, the techniques that should be used and the duration, frequency and expected outcomes of the intervention. Contextual factors such as staff shortages; conflicting priorities; the needs and circumstances of mothers; the capability and motivation of HVs; inadequate training and supervision; and the absence of clear guidance contributed to variations in perceptions and practice. There are many ways in which the HV contribution to the assessment and management of mothers with MHPs could be improved. The intervention delivered by HVs needs to be more clearly articulated. The contextual factors influencing competent and consistent practice also need to be addressed.

Objectives. This review aims to describe the role of the school nurse in protecting children and young people from maltreatment by examining the international literature. Child maltreatment is a prevalent issue in global society today and includes physical, emotional and sexual abuse, neglect and exploitation. School nurses are ideally placed to identify and work with children and young people who are at risk of maltreatment through their regular contact with the school community. Design. Integrative literature review incorporating thematic analysis. Data Sources. Electronic databases British Nursing Database, Cumulative Index of Nursing and Allied Health Literature, Medline, PsycInfo, Cochrane Library Database for Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL). Search Terms: Role, School Nurse, Child Maltreatment. Review Methods. Initial title and abstract review of 444 studies resulted in 78 studies for full text review. Additional search strategies identified one relevant study. Inclusion and exclusion criteria were employed as follows; (1) study published in the English language, (2) peer-reviewed, (3) primary research, (4) inclusion of school nurses (or equivalent role internationally) in the study sample, and (5) a focus on the role of school nurses in preventing child maltreatment. Studies were appraised using the Critical Appraisal Skills Programme tool for qualitative studies and the Strengthening the Reporting of Observational Studies in Epidemiology checklist for mixed-methods and quantitative studies. Findings from the studies were identified, summarised and organised into a summary table, before being analysed thematically. Results. 21 studies met inclusion and quality criteria and were included in the review. Key themes that emerged from the analysis were; supporting the child and family, detective work, working with other professionals, training and supervision, barriers to protecting children and young people from maltreatment and trust. Conclusion. International literature highlights the variety of activities that school nurses may undertake in daily practice to protect children and young people from maltreatment. Several challenges to this role are identified, including time management and building relationships with children and young people. Recommendations for practice and further research are made.

This paper reports on a pilot project in which two postgraduate students were supported to function in the role of teaching assistants (TAs) as part of their learning experience. The project embraced the notion of students as producers rather than consumers. Using a reflective approach, this case study was jointly written by TAs and their teaching staff. It incorporates feedback from other students collected through an anonymous module feedback survey, which was analysed by attribution to themes. The role of TAs benefitted others students, staff, and the TAs; the project is a strong affirmation of the principle of treating students as producers. The impact of the role on both the students undertaking the TA role and the tutors was profound, and student experience was enhanced as a result. TAs can assist in bridging student-teacher communication gaps and support students’ learning through sharing their knowledge by creating resources. This article is written from the perspectives of both the TAs and the tutors.

Aim To provide new insights into heroin users' eating patterns in order to inform nutritional interventions. Design Seventy-seven audio-recorded in-depth interviews which elicited detailed data on eating patterns. Setting Community and residential drug services, pharmacies and peer support groups in Southern England, UK. Participants Forty current or ex-heroin users (21 men and 19 women), of whom 37 (20 men and 17 women) were re-interviewed after 3 months. Measurements Audio data transcribed verbatim, coded systematically and analysed inductively. Findings Heroin users' eating patterns were influenced by individual, social, cultural, economic and environmental factors. During active heroin use, participants consumed quick, convenient, cheap and sweet foods, ate infrequently and had little interest in food. Eating patterns often improved during stays in residential services and after heroin cessation. Ex-heroin users began to take pleasure in food preparation and eating and identified therapeutic benefits to cooking. Initially, weight gain was experienced positively, but subsequently generated anxieties as participants, particularly women, struggled to control their appetite and worried about becoming overweight. Findings complement and add to previous research and sociological and anthropological literatures. Conclusions Heroin users have dysfunctional eating patterns that are amenable to change and community and residential services could enable them to experience the many health, psychological and social benefits of improved eating practices. Nutritional interventions need to be tailored to individual needs and circumstances, but also monitored and evaluated so that there is a future evidence base.

The article draws on two separate studies employing developmental vignettes (hypothetical scenarios which unfold through a series of stages) to interview research participants. One study used the 'Davie' vignette, which was a conventional fixed narrative, while in the second, the 'Jack and Jenny' vignettes were made interactive by hyperlinking a series of PowerPoint scenarios and making the choice of the succeeding slide dependent on the interviewee's reaction to its predecessor. Our analytic standpoint, in respect of both vignettes, is that of Schutzian phenomenology. We point to differences in both topical and motivational relevances in the processes of interpretation undergone by participants in considering the vignette scenario and in the situation of action. However, we show that research participants' responses to vignettes can yield data of interest in their own right as participants perform 'Thou-orientations' and 'They-orientations' in their consideration of the stimuli. We close with a comparative evaluation of the fixed 'Davie' and the interactive 'Jack and Jenny' vignettes.