Coronavirus (COVID-19) Family Nurse Partnership insights: evaluation report

Appendix 2. Marked Up Questionnaire

• Total number of respondents = 90 Family Nurses.
• All responses completed online.
• Questions and responses are group under the following domain headings:
  • Visiting Patterns/Contacts; Changes to Service Delivery Following COVID-19 Outbreak; Home Visiting During the COVID-19 Outbreak; Remote Programme Delivery and Perceptions of Telehealth; Therapeutic Relationship; Identification of Concerns; Referrals; Assessments and Observations using Telehealth; Training, Guidance and Support; Clinical Supervision; Communication with Colleagues; External Partnership Working; Additional Comments - FNP Service Delivery During COVID-19.
• Data collection period: 19 January 2021 – 10 March 2021.

Visiting Patterns/Contacts

Q1 - How often were you able to provide the expected number of visits/contacts, based on fidelity, to clients prior to the COVID-19 restrictions?

Item / Percentage

1. Always 21%
2. Most of the time 64%
3. About half the time 9%
4. Sometimes 4%
5. Never 1%

Q2 - Since the COVID-19 restrictions have come into place, how often, if at all, are you able to provide the expected number of visits/contacts (i.e., virtual or face to face), based on fidelity, to clients now?

Item / Percentage

1. Always 7%
2. Most of the time 59%
3. About half the time 20%
4. Sometimes 9%
5. Never 3%
6. Same as before 2%

Q3 - How would you describe the overall level of FNP additional visits/contacts (i.e., more than fidelity) you were providing clients, prior to the COVID-19 restrictions?

Item / Percentage

1. Far above average 3%
2. Somewhat above average 25%
3. Average 67%
4. Somewhat below average 4%
5. Far below average 0%

Q4 - Since the COVID-19 restrictions have come into place, how would you describe the overall level of additional visits/contacts (i.e., virtual or face to face) you are now providing, over and above 'normal' visiting patterns?

Item / Percentage

1. Far above average 2%
2. Somewhat above average 20%
3. Average 52%
4. Somewhat below average 15%
5. Far below average 4%
6. Same as before (pre-COVID-19) 7%

Changes to the Service Following the Covid-19 Outbreak

Q5 - To what extent, if at all, do you think the following factors have changed since the COVID-19 outbreak started?

	Item	Decreased significantly	Decreased slightly	Stayed the same	Increased slightly	Increased significantly
1	Client engagement with the FNP service	9%	46%	32%	13%	0%
2	Client retention	1%	18%	74%	6%	1%
3	Overall client vulnerability	2%	2%	7%	42%	47%
4	Overall number of vulnerable clients	0%	0%	20%	47%	33%
5	Clients' abilities to achieve personal goals and outcomes	39%	44%	10%	3%	3%
6	Personal workload	1%	7%	26%	45%	21%
7	Complexity of caseload	0%	2%	23%	45%	30%
8	The overall effectiveness of local FNP service delivery in your Health Board	7%	34%	44%	11%	3%
9	The overall efficiency of local FNP service delivery in your Health Board	6%	22%	54%	17%	1%
10	Your team's ability to achieve intended programme outcomes	16%	40%	39%	3%	2%

Home Visiting During the Covid-19 Outbreak

Q6 - Have you continued to offer home visits during the COVID-19 outbreak?

Item / Percentage

1. Yes 100%
2. No 0%

Q7 - What proportion of your caseload have you offered home visits to during this time?

Item / Percentage

1. 100% 29%
2. 99-75% 15%
3. 74-50% 20%
4. 49-25% 22%
5. 25-1% 13%
6. None 0%

Q8 - When a home visit was offered to a client, how often was this offer taken up by the client?

Item / Percentage

1. Always 41%
2. Most of the time 51%
3. About half the time 5%
4. Sometimes 3%
5. Never 0%

Q9 - Please state the main reasons given by clients who have declined the offer of a home visit during COVID-19, if any?

Summary of Most Common Text Responses

1. Concerns about transmitting or contracting COVID-19
2. Self-isolating clients/family members
3. Vulnerable and shielding clients/family members
4. Other family members declining visitors due to concerns about COVID-19
5. No declines or very small proportion of declines overall

Remote Programme Delivery And Perceptions Of Telehealth

Q10 - Do you have previous experience of using the following telehealth technologies with FNP clients prior to the COVID-19 outbreak?

	Item	Yes	No	Don't know
1	Telephone calls	92%	8%	0%
2	WhatsApp	31%	69%	0%
3	Mobile apps	17%	81%	2%
4	Attend Anywhere	9%	91%	0%
5	Near Me	7%	92%	1%
6	Video Call (other)	11%	89%	0%
7	Other (please specify)	8%	86%	5%

Q11 - Since the COVID-19 restrictions have been introduced, how frequently do you use the following modes to deliver the FNP service?

	Item	Always	Most of the time	About half the time	Sometimes	Never
1	Telephone calls	5%	23%	33%	38%	1%
2	WhatsApp	3%	8%	3%	31%	56%
3	Mobile apps	0%	0%	3%	18%	79%
4	Attend Anywhere	1%	12%	22%	24%	40%
5	Near Me	1%	18%	24%	36%	21%
6	Video Call (other)	0%	9%	8%	18%	65%
7	Text messaging	21%	23%	11%	27%	17%
8	Home visits	1%	19%	34%	45%	1%
9	Other (please specify)	0%	8%	12%	15%	65%

Q12 - To what extent do you agree with the following statements?

	Item	Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
1	I feel comfortable delivering the FNP service using Telehealth	17%	48%	14%	15%	6%
2	I am familiar with the technologies required to deliver FNP remotely	46%	48%	5%	1%	0%
3	I would like to continue using Telehealth to deliver FNP in the future	11%	46%	13%	15%	14%
4	I have access to adequate training and resources for using Telehealth within FNP	26%	45%	14%	14%	0%
5	I have access to the necessary tools and equipment for remote service delivery of FNP	39%	40%	8%	10%	2%

Q13 - How would you rate the quality of your overall clinical observations when using remote delivery, compared with face-to-face visits?

Item / Percentage

1. Much better 0%
2. Somewhat better 1%
3. About the same 6%
4. Somewhat worse 76%
5. Much worse 17%

Q14 - Please select from the following to indicate your preference for future delivery of the FNP service [Most (1) - Least (4) preferred]:

	Item	Most Preferred Option (1)	(2)	(3)	Least Preferred Option (4)
1	In-person home visiting only	55%	35%	5%	5%
2	Telehealth delivery only	4%	4%	14%	77%
3	Mixed-mode (face-to-face and Telehealth delivery)	42%	25%	26%	7%
4	Other (please specify)	8%	23%	15%	54%

Q15a - In your opinion, do you think FNP could be delivered effectively to clients using a multi-faceted approach, such as face to face and telephone without compromising the essence or outcomes of the programme?

Item / Percentage

1. Yes (please explain why) 68%
2. No (please explain why) 32%

Q15b_TEXT - Yes (please explain why) and Q15c_TEXT – No (please explain why). Summary of most common text responses:

	Responses for 'Yes (please explain why)'	Responses for 'No (please explain why)'
1	Provides convenient options to maintain engagement with clients who have other commitments (e.g., work or education).	Many clients uncomfortable or have difficulties engaging via telehealth
2	Most clients have adapted and engaged well with telehealth delivery.	Therapeutic relationship is harder to establish
3	Mixed-mode delivery is effective but option for remote delivery should be dependent on client level of vulnerability.	Communication during face-to-face interaction is much more valuable. Easier to explore feelings, body language and subtle signs that may indicate a larger issue.
4	Mixed-mode delivery helps to save time and costs associated with work-related travel and missed appointments. Allows better time management for FNs.	Assessments and clinical observations are more challenging
5	Improved access for clients living in rural areas	Difficulties conducting DANCE and PIPE activities as well as IPV and other assessments via telehealth

Q16 - To what extent do you agree with the following statements? The use of Telehealth (e.g. Attend Anywhere/Near Me or telephone calls etc.) in delivering the FNP service will lead to:

	Item	Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
1	Increased communication and connection with clients	5%	38%	24%	25%	8%
2	Lower workloads for FNP nurses	10%	29%	19%	24%	19%
3	Greater client self-efficacy	4%	31%	35%	23%	8%
4	Clients having more time to achieve personal goals and programme outcomes	1%	14%	39%	36%	10%
5	Higher client retention	1%	26%	35%	24%	14%
6	Improved long-term outcomes for clients and children	2%	11%	37%	29%	21%
7	A client preference for Telehealth communication in place of home visiting	5%	12%	29%	29%	25%
8	Exclusion of clients due to a lack of technological access	34%	36%	13%	13%	4%
9	Improvements in the quality of assessment carried out by FNP nurses	0%	4%	20%	30%	46%

Therapeutic Relationship with Clients

Q17 - Overall, has your relationship with clients got better, worse or stayed the same since the COVID-19 outbreak started?

Item / Percentage

1. Much better 0%
2. Somewhat better 13%
3. About the same 64%
4. Somewhat worse 21%
5. Much worse 1%

Identification Of Concerns

Q18 - Do you feel that clients are contacting you more or less frequently with any issues and concerns following the COVID-19 outbreak?

Item / Percentage

1. Much more frequently 12%
2. Somewhat more frequently 33%
3. About the same as before 45%
4. Somewhat less frequently 10%
5. Much less frequently 0%

Total 84

Q19 - Since the COVID-19 restrictions began, do you feel that you are able to identify needs and/or any issues that your clients might have, compared with previous ways of working (pre COVID-19)?

Item / Percentage

1. Definitely yes 2%
2. Probably yes 27%
3. Might or might not 36%
4. Probably not 31%
5. Definitely not 4%

Total 84

Referrals

Q20a - Overall, have you been able to submit referrals successfully during the COVID-19 outbreak?

Item / Percentage

1. Yes 57%
2. No (Please specify, why not and what agencies?) 43%

Total 84

Q20b_TEXT - No (Please specify, why not and what agencies?). Summary of most common text responses:

1. Many services had limited operation due to COVID-19 or were not operating at all in some areas.
2. Difficulties accessing services due to confusion around which ones were still operating, mixed communication with other agencies.
3. Services were not accepting referrals or were unresponsive to requests.
4. Challenges obtaining mental health support.
5. Services not providing face-to-face support which could lead to client non-engagement or inadequate level of support.

Total count of agencies referred to for Q20b_TEXT - No responses:

Local Authority

Agency Count

• Nursery 1
• Social Work 1
• Housing 5
• Money advice 2

Healthcare

Agency Count

• Childsmile 1
• Mental health 9
• Learning disability 1
• Speech and Language 1
• Contraceptive and sexual health services 4
• GP 2
• Postnatal checks 2
• Paediatricians 1

Parent/child groups

Agency Count

• Groups for mums 2
• Childcare 2
• Playgroups 1

Third Sector

Agency Count

• Charity organisation's 9

Other

Agency Count

• Work experience/employment 2

Total Count = 46

Assessments And Observations Using Telehealth

Q21 - How would you rate the following aspects of delivering FNP when using Telehealth in comparison with face-to-face visits?

	Item	Much better	Somewhat better	About the same	Somewhat worse	Much worse
1	To what extent do you feel able to make observations of the child using Telehealth when compared with face-to-face visits?	0%	0%	6%	65%	29%
2	To what extent do you feel that you are able to carry out child assessments effectively using Telehealth when compared with face-to-face visits?	0%	0%	14%	63%	23%
3	How would you rate your overall ability to assess clients' home environments using Telehealth when compared with face-to-face visits?	0%	0%	2%	52%	46%

Training, Guidance And Support

Q22a - Have you been provided with any guidance to support your working following the COVID-19 outbreak?

Item / Percentage

1. Yes (please provide details) 90%
2. No 4%
3. Unsure 6%

Q22b_TEXT - Yes (please provide details). Summary of most common text responses:

Category / Responses

1. COVID-19 Risk Mitigation and Health & Safety Guidance Conducting essential visits, PPE, COVID-19 risk assessment guidance
2. Clinical Training Scottish Government clinical guidance IPV training (telehealth-specific),
3. FNP-specific National FNP guidance; supervisory support for home visiting in accordance with guidelines,
4. IT Training Near Me and Attend Anywhere guidance,
5. Other Self-care resources and guidance, local Health Board guidance

Q23a - Have you been offered any training opportunities to support your working following the COVID-19 outbreak?

Item / Percentage

1. Yes (please provide details) 68%
2. No 23%
3. Unsure 10%

Q23b_TEXT - Yes (please provide details). Most common text responses:

Category / Responses

1. IT Training Training to use telehealth software/hardware, mainly NHS Near Me/Attend Anywhere, and Microsoft Teams
2. FNP-specific How to deliver PIPE, DANCE and FNP facilitators via telehealth
3. Clinical Child protection, IPV training, breastfeeding,

Clinical Supervision

Q24 - Please rate the following factors in terms of receiving/providing supervision via Telehealth:

	Item	Extremely good	Somewhat good	Neither good nor bad	Somewhat bad	Extremely bad	Total
1	Overall experience	31%	45%	18%	6%	0%	83
2	Relationship with supervisor	53%	28%	17%	2%	0%	83
3	Quality of supervision	54%	31%	12%	2%	0%	83
4	Level of support	52%	35%	9%	2%	1%	82

Q25a - Do you think this model of supervision could continue successfully in the future?

Item / Percentage

1. Yes 70%
2. No (if not, why not?) 30%

Q25b_TEXT - No (if not, why not?)

Summary of Most Common Text Responses

1. Less connection with colleagues: Family nurses do not feel well connected to colleagues during remote supervision and meetings.
2. Privacy concerns whilst home working or in shared office space. Distractions whilst working from home disrupts meetings also.
3. Internet connectivity issues disrupt the flow of conversations.
4. Quality of supervision is affected. Communication is richer in person. Better able to identify non-verbal ques and body language, conversation flow is more natural and personable.
5. A mixture of face-to-face and remote supervision would be acceptable.

Q26 - Has supervision of FNP nurses during the COVID-19 outbreak continued as per the core model?

Item / Percentage

1. Yes 95%
2. No 5%

Q27 - Please add in any comments you wish to make about your experience of receiving/providing supervision via Telehealth during COVID-19:

Summary of Most Common Text Responses

1. Supervision via telehealth has worked well overall and comparable to face-to-face meeting. Family nurses feel well supported. Microsoft Teams works well.
2. Remote delivery saves travel time and grants flexibility in regard to location
3. Preferences expressed for face-to-face supervision instead of telehealth as level of connection is not the same. Some felt relationships had been impacted by ongoing online communication.
4. Less distractions during online supervision, meetings are more focussed
5. Impacted negatively by connectivity and technology problems

Communication With Colleagues

Q28 - How has the quality of communication with fellow staff members and colleagues been following the COVID-19 outbreak, compared to before?

Item / Percentage

1. Much better 0%
2. Somewhat better 2%
3. About the same 26%
4. Somewhat worse 50%
5. Much worse 21%

External Partnership Working

Q29 - How has the quality of communication with external partner agencies been following the COVID-19 outbreak, compared to before?

Item / Percentage

1. Much better 0%
2. Somewhat better 9%
3. About the same 29%
4. Somewhat worse 51%
5. Much worse 11%