Family Nurse Partnership: 10 year analysis
To mark the first ten years of the Family Nurse Partnership in Scotland, we have undertaken a review of data from the programme over this time.
FNP Scotland Core Model Elements
Core Model Elements (CME) 1: Client participates voluntarily in the Family Nurse Partnership (FNP) programme
Family Nurse Partnership (FNP) clients participate voluntarily in the program. In all situations, clients must be enabled to understand that they are participating in the programme voluntarily and that they may withdraw from the program at any time. Written materials, including pamphlets setting out the voluntary nature of the programme and/or signed consent should be used to support this.
Core Model Elements (CME) 2: Client is a first-time mother who can receive the programme
First-time mother is either a nulliparous woman (i.e. has experienced no previous live births) or has never parented a child before. Women who have experienced a neonatal death, have had a child removed from their care immediately after birth, or had their first baby adopted immediately after birth would therefore be eligible for inclusion in the programme.
Core Model Elements (CME) 3: Client meets socioeconomic disadvantage criteria at intake
In broad terms "socio-economic disadvantage" means living on a low income compared to others in Scotland, with little or no accumulated wealth, leading to greater material deprivation, restricting the ability to access basic goods and services. Socio-economic disadvantage can be experienced in both places and communities of interest, leading to further negative outcomes such as social exclusion (Scottish Government 2018).
Core Model Elements (CME) 4: Client is enrolled in the programme early in her pregnancy and receives her first home visit no later than the 28th week of pregnancy.
A client is considered to be enrolled when they receive their first FNP visit and any necessary consent forms have been signed. Prior to this, FNP nurses may undertake pre-enrolment visits to assess a woman's eligibility explain the programme to the prospective client and invite them to participate. The 28th week of pregnancy is defined as no more than 28 weeks and 6 days of gestation.
Core Model Elements (CME) 5: Each client is assigned an identified FNP nurse who establishes a therapeutic relationship through individual FNP home visits
The process of developing and maintaining relationships is central to nursing professional practice. A specific type of relationship, the therapeutic relationship, is developed between the assigned FNP nurse and the client through the one-to-one home visits that occur over the duration of the programme. The overarching core competency for a FNP nurse is: The ability to support and maintain a therapeutic relationship with each client and use FNP programme methods to enable necessary changes in understanding, capabilities, and behaviours; ensuring the mother is able to nurture, develop and protect her child and herself from harm.
Core Model Elements (CME) 6: Client is visited face‐to-face in the home, or occasionally in another setting (mutually determined by the Family nurse and client), when this is not possible.
The programme is delivered in the client's home, which is defined as the place where she is currently residing and/or to which she feels an emotional connection. Her home can be a shelter, refuge, mother & baby home or a situation in which she is temporarily living with family or friends for the majority of the time. Meeting with the client in this kind of living arrangement should be considered as meeting with her in her home.
Core Model Elements (CME) 7: Client is visited throughout her pregnancy and the first two years of her child's life in accordance with the current standard FNP visit schedule or an alternative visit schedule agreed upon between the client and nurse.
The client (and boyfriend, partner, and/or family when appropriate) is visited throughout her pregnancy and the first two years of her child's life. A schedule of visits with proposed content has been developed for the programme to: match the expected stage of programme delivery and public health issues; schedule assessments for maternal, or child health and development; build the therapeutic relationship; and support achievement of three program goals.
The standard schedule of visits is established as:
- Four weekly visits upon initial enrolment prenatally, then every other week until delivery
- Six weekly visits after infant birth, followed by visits every other week until the baby is 21 months of age
- Monthly visits from 21 through 24 months of age.
An Alternate Visit Schedule is defined as any planned visit schedule other than noted in the standard schedule. The mothers and children enrolled in FNP deserve the support that can be provided throughout the full length of the programme. It is also often the case that a client's circumstances and needs will alter over the course of the programme, becoming more, as well as less, acute over time. Therefore, it is expected that the programme will continue until the child's second birthday for all clients regardless of visit schedule.
Core Model Elements (CME) 8: FNP nurses and supervisors are registered nurses or midwives with a minimum education at degree level
FNP requires that a registered nurse or registered midwife deliver the program. Similarly, all FNP supervisors must also be registered nurses/midwives. A registered nurse/midwife is someone recognised as professionally licensed or regulated in either or both of these professional roles according to the policies of the FNP host country. All FNP nurses (defined as a registered nurse or midwife for the remainder of this document) should hold a minimum education at degree level in nursing /midwifery. FNP nurses are usually hired by the implementing agency/site, which will have its own recruitment rules and processes. It is expected that license holders/National Units in each country will assure themselves that this process results in the employment of FNP nurses and supervisors with a valid registered professional license (nurse or midwife), baccalaureate/bachelor's degree, and the desired skills, knowledge and abilities required to successful deliver the FNP program. In addition to these academic qualifications, nurses must have personal qualities, values, and beliefs that will ensure that she is a good fit with the spirit of FNP.
Core Model Elements (CME) 9: FNP nurses and supervisors develop the core FNP competencies by completing the required FNP educational curricula and participating in on-going learning activities
FNP educational curricula (for FNP nurses and supervisors) are devised by Clinical Leads in each country, and agreed with their International FNP consultant, based on the International guidance. In countries where a variance has been granted to incorporate a 'family partnership worker', 'community mediator' or similar role, an FNP specific educational curriculum will need to be developed by the country for this role. See guidance document Nurse-Family Partnership Core Competencies
FNP education curriculum should incorporate:
Conceptual and intellectual knowledge regarding the program theories, research base, conceptual model and use of Core Model Elements and quality improvement in replication.
Sense-making i.e. reflection on the programme model in relation to the learner's own experience and nursing practice foundations, consideration of the application of the model in practice and development of a coherent clinical model of practice, integrating the various inter-related elements [e.g. the programme domains, use of dyadic assessment, PIPE, Motivational Interviewing skills, and the Strengths and Risks Framework
Skills development. This is a significant part of the FNP education programme and needs to be intentional using multi-staged, multi-faceted and multi-modal methods. This learning is best done face to face with opportunities for demonstration, practice and feedback.
Core Model Elements (CME) 10: FNP nurses, using professional knowledge, judgment and skill, utilise the Visit Guidelines; individualising them to the strengths & risks of each family, and apportioning time appropriately across the six programme domains.
The purpose of the FNP visit guidelines is to maintain consistency in implementing the FNP model, to ensure that comprehensive information and essential information is introduced to clients and to support reflection and goal setting with clients. They provide the flexibility needed to meet the clients' needs and desires as well as programme goals. In addition, they provide the framework that helps FNP nurses and clients avoid focusing on the day-to-day challenges the client may be facing and instead focus on potential solutions and introduce other issues of relevance and importance through an agenda matching process.
The guidelines also introduce content that supports clients in developing the knowledge, skills and self efficacy to achieve the three FNP programme goals of:
- Improved pregnancy outcomes through the practice of good health-related behaviours
- Improved child health and development
- Improved economic self-sufficiency
Core Model Elements (CME) 11: FNP nurses and supervisors apply the theoretical framework that underpins the programme (self-efficacy, human ecology, and attachment theories) to guide their clinical work and achievement of the three FNP goals.
The underlying theories are the basis for the FNP Programme. The clinical methods that are presented in the education sessions and promoted in the FNP Visit-to-Visit Guidelines are an expression of these theories.
Core Model Elements (CME) 12: Each FNP team has an assigned FNP Supervisor who leads and manages the team and provides nurses with regular reflective supervision
A full time FNP supervisor can lead a team of no more than eight FNP nurses and a team data manger/administrator. The minimum team size is four FNP nurses with a half time (0.5wte) supervisor. It is important that FNP team members are supported by FNP supervisors who understand the requirements and expectations of the role and the programme model and for this reason it is recommended that nurse supervisors have a very small caseload of FNP clients. Arrangements should be made for supervisors to reflect on their role and FNP with a qualified person that understands reflective practice and has an adequate understanding of the FNP model. The individual providing reflective supervision to the FNP supervisor is ideally in a position at the same level or higher to the organisation agency - it cannot be provided by FNP nurses.
Core Model Elements (CME) 13: FNP teams, implementing agencies, and national units collect/and utilise data to: guide programme implementation, inform continuous quality improvement, demonstrate programme fidelity, assess indicative client outcomes, and guide clinical practice/reflective supervision.
FNP nurses collect information for four distinct purposes:
1. To support and guide clinical practice
2. To assess and guide programme implementation through documentation of the FNP services received by clients
3. To measure achievement of core programme goals
4. To inform reflective supervision and support quality improvements
Information is recorded on data collection forms, which are recorded into the Turas FNP information system. Data collected is analysed and reports are generated for individual clients, nurses and teams. In addition, this data can be used by the Scottish Government analytical research team (contingent upon adherence to required permissions for release of data), alongside other data, to inform the evaluation of the implementation of FNP in Scotland.
Core Model Elements (CME) 14: High quality FNP implementation is developed and sustained through national and local organised support
Organised support should include national strategic, operational and clinical leadership (as set out in the licensing requirements) as well as local site support for implementation and on-going quality improvement
Local site support for FNP includes:
Ensuring that local community leaders and agencies working in the field provide guidance regarding the introduction and maintenance of the programme within the site context. This is usually organised through a local FNP Advisory Board or other formal service network ensuring that the necessary infrastructure and resources for the team, including office equipment, printed guideline materials and other resources, mobile phones, lap tops etc., are made available
Additional Approved Model Element (AAME) (1): Delivery of the Scottish Child Health programme (pre-school) – child health reviews
The children of clients enrolled on the Family Nurse Partnership (FNP) programme should receive the child health reviews as part of the Scottish Child Health Surveillance Programme (Pre-School).
Across Scotland, the role of the named person is supported through the Getting it Right for Every Child (GIRFEC) approach in responding to the wellbeing needs of children and young people and improving outcomes. The named person is a clear point of contact that provides direct support or will help access relevant services. For children within the FNP programme, Family Nurses are the named person until programme completion, and at which point this transfers to the Health Visitor.
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