30th September 2016
My name is Jackie Gaventa, I am a Health Visitor (HV) based in Hornsey Central Health Centre in West Haringey. I am a senior practitioner in the Muswell Hill/Highgate team which includes a mix of experienced and recently qualified health visitors, paediatric nurses, nursery nurses and admin support.
I work compressed hours from 8am to 6pm on Monday to Thursday.
I use my car at work to access families and centres across the large patch I cover, using my time more efficiently.
A typical day…..
Arrive in the health centre car park, empty at this hour, well almost as I spot a couple of kids enjoying the space to practise their skateboarding, again. Shooed them off the tarmac as I pointed out the danger to themselves and service users driving into the car park. Grrr. Collect a cup of fresh-brewed coffee from the café in the health centre, a friendly place which is a hub for patients and staff and does a great deal on tea and toast for patients attending for their fasting blood tests.
Up to the office on the 2nd floor, I am one of the first to arrive, turning on the lights and opening the locked filing cabinets as I go. In a large health centre with many professional and service users, safe storage of sensitive documents is of ongoing importance.
Answering emails. I encourage my clients to use e mail and text messaging to contact me, as I appreciate that parents may want to ask questions at all hours of the day and night. So dropping me an email and getting their questions answered when I pass through the office seems to work well for us all. Some of the questions today include an adoptive mother asking where to find a mum and baby group; a mother asking about eczema management for a 10 week-old baby; a mother of 3 week-old twins concerned the babies are constipated and questions about the BCG vaccine from a parent with a 1 month-old baby. Write up the electronic records for these children as I go along. Note that other emails in my inbox are invitations to a Child Protection Conference, a reminder about a training update and several from senior managers with Trust information to share. Spend a few minutes completing an online questionnaire from the Institute of Health Visiting collecting data regarding effective communication between HVs and GPs to inform a national survey.
Re-check my electronic diary to ensure there are no changes to the schedule I have planned for today. Short conversation with a new HV who has recently joined the team. Explained how to make a referral to the Orthoptist, for an 8 month-old baby with a squint who we saw in baby clinic yesterday. Completed the daily Lone Working Log so my team manager always knows where I am going to be located during the day, and set off for my first appointment.
Drive up to Highgate to attend a Child In Need meeting located in a nursery. Mother is a 20 year-old single mum who has 2 children, the older girl has just started at nursery and I have concerns about her slow language development. Mum does not share my concerns, so there is an agreement that nursery will assess the child over the next few weeks as she settles in and, if a problem is identified, the nursery will complete a speech and language referral. The 3 year-old also has dental caries, the professionals discussed oral health promotion with mum today; nursery will reinforce healthy diet and snacks, encouraging mum to come in at lunchtime to help. The HV will refer the child to the community dental team for assessment and treatment.
Home visit to new parents with a 4 week-old baby. Mum has struggled to breastfeed and is feeling under pressure from mother-in-law; she has been topping up baby with formula. Mum was tearful when she disclosed this, saying she just wants to breastfeed her baby. I weighed baby and assessed his general condition, urine and stool output – baby seen to be thriving and was alert and active. Breastfeeding discussed at length and I observed a breastfeed, sitting alongside mum and encouraging her, gently suggesting techniques to improve the position of baby to ensure an effective latch and suckling. Checked with dad that mum has enough support in the home so she can concentrate on establishing breastfeeding. Reassurance given to mum that she is doing well and baby is a healthy weight. During the feed baby was observed to gaze steadily at mum, an opportunity for me to discuss baby brain development and how parents can play with and stimulate infant development. Dad expressed surprise that baby can see properly at this age. I demonstrated an app on my iPad, using the device as a camera to show what a new baby can see. Encouraged dad to hold baby at eye level and practise sticking out his tongue, dad was thrilled when baby responded by mimicking his tongue thrust. Encouraged mum to attend the family centre where she can access further breastfeeding support and meet other new mothers.
Onto Children`s Services offices in Wood Green for a Core Group meeting with teenage parents and their young baby. Parents are managing well and meeting the infant`s basic care needs. Mum is distressed about the very poor state of their accommodation in a tiny bedsit, 4 flights of stairs to negotiate with baby and buggy, and sharing a bathroom with other families. Social worker contacted the housing key worker and, via speakerphone, we all discussed the progress of plans to rehouse the family.
Back to the office to meet up with my student health visitor. As a practice teacher I have responsibility for training one qualified nurse in a pupillage system each year, where she/he trains alongside me, spending half the week at university and half the week in practice. Over my quick sandwich lunch, I encouraged the student to reflect on her experience this morning when she went as an observer to a group run by the nursery nurse on the HV team, teaching parents about introducing solid food to infants. Shared with the student the electronic records for a newborn we are visiting this afternoon. The hospital discharge information can give an indication of any health concerns for mother or baby and information about the birth.
New birth visit. My student is only 3 weeks into her training, so she observed me leading on the holistic assessment of mother and her 14 day-old baby. Baby`s skin was obviously yellow and baby was not feeding sufficiently and very sleepy. I discussed Jaundice in newborn with the parents, telephoned the Prolonged Jaundice Clinic in the birth hospital and arranged for baby to be seen for tests to assess the blood level of Bilirubin. Parents were given an appointment later this afternoon and we left them preparing to go to the hospital.
Went to visit a HV team in Tottenham where they have recently changed their boundaries. Their caseload now includes part of Stamford Hill where there are many Hasidic Jewish families. Engaged the team in an interactive teaching session, as we discussed the possible cultural /religious impact of this community`s lifestyle on Public Health Outcomes e.g. access to health visiting services, immunisation uptake and vitamin D.
On my way back to the office, I dropped into a local Muswell Hill primary school to offer my specialist knowledge to a parent support group for children with severe food allergies. Mum running the group on behalf of The Anaphylaxis Campaign has an 8 year old, who I have known since he developed allergy symptoms as a baby. Stayed with the group for a while advising on the changes to local prescribing of adrenaline auto injector from Epipen to Emerade. Facilitated a group discussion on whether children with egg allergy are at risk when helping to feed the school chickens, encouraged the parents to develop suggestions to take to the head teacher regarding health and safety strategies to manage the situation.
Back in the office, made myself a cup of tea and settled down to write up patient notes. My day is already over, so prioritised my notes, some to do now and the rest tomorrow morning. Last look at my emails, answered a quick question to confirm a home visit tomorrow with a mum with postnatal depression, who I am supporting alongside the GP and Parent Infant Psychology Service.
Home to my own family.