24th July 2020
A Voices blog by iHV Fellow Bridget Halnan, Senior Lecturer on the SCPHN Programme at Anglia Ruskin University, raising the question on how HVs keep up to date.
NICE guidelines, Trust policies and procedures, PHE publications, let alone iHV GGPs; how do you stay current and up to date with all aspects of health visiting?
Teaching student health visitors, I find myself in a very privileged position of having both the time, the head space and the access to latest findings and recommendations for evidence-based practice. With this past year’s changes, in supervision of student health visitors and the loss of the Clinical Practice Teacher role, I was interested to find out from the practice areas that I visit as Academic Assessor, some of the challenges that students may have in gaining experience and practice knowledge.
As the Module leader at the University for the Baby Friendly Initiative (BFI) SCPHN course, I thought I would garner the thoughts of practitioners around current and up-to-date practice on one of the Universal elements of the Healthy Child programme, namely feeding infants.
The survey I undertook in 2019 was not scientific in any true research sense, in that I just spoke to practitioners that I came across about the change in recommendations of how to prepare eggs for the under 5s. In a week, I asked 20 practitioners ranging from students, newly qualified health visitors, up to practitioners with over 20 years of experience.
I asked them
- How healthy and safe they thought eggs were for infants
- If they encourage their use as a cheap and nutritious meal
- Where they get their evidence from
- What CPD is provided for them
- Are there any particular groups they would have additional concerns about, such as parents following a Vegan or vegetarian diet
Just over half the responses were correct, as in only recommending Eggs with the Lion Mark stamped on them although there was some confusion with the Red Tractor symbol found on Meat products. Concerns regarding Salmonella were still expressed and a fair number of respondents did not appear to be aware of the change of now recommending serving “runny” eggs. They did promote eggs as a good (and cheap) source of protein and, very encouragingly, all were aware of trusted sources of evidence, many citing the First Steps Nutrition website.
However, when discussing how their employers support them with their professional development, it appeared from this very small sample that they did not always have feeding advice as part of their remit. This area was often tasked to the Nursery Nurse within a team and, as such, some respondents confessed that they had forgotten about the change in recommendation, or even would still tell new parents that runny eggs were unsafe.
The second issue that arose was to do with allergy – six practitioners still expressed fears about this being a problem in some families. In the light of new evidence from Australia (Rekima 2020) that giving eggs to breastfeeding mothers may lower the chance of egg allergy in babies, Health Visitors do still need to keep abreast of research and any change in practice in infant feeding.
Vegan or families following a vegetarian diet were commonly referred to the First Steps Nutrition website again.
How this happens, and how health visitors “use it or lose it” if not working so frequently with “Universal families” needs to be considered by those teaching student health visitors, the health visitors themselves and their employers. One of the ways we try to bridge that gap between theory and practice is to bring practitioners in to help with the assessment process of students. One initiative we have here at Anglia Ruskin University is to bring practitioners in to help with Objective Structured Clinical Examination (OSCE) for BFI. The closer we work, I would argue, would be one way to help all concerned to stay up to date.
I have now repeated this unscientific survey with my current health visitor students, and happily, except for one, all know the current recommendations and quality marks. No confusion this year between the logo for British Lion eggs and the Red Tractor. No mention as well about Salmonella or allergy.
I suspect they are all too young to remember the 1980’s issue around Salmonella and, as I was delivering all their lectures on feeding, they did not appear to be concerned with any issues around allergy.
Bridget Halnan (FiHV), Senior Lecturer on the SCPHN Programme, Anglia Ruskin University
Rekima, A., Bonnart, C., Macchiaverni, P., Metcalfe, J., Tulic, M.K., Halloin, N., Rekima, S., Genuneit, J., Zanelli, S., Medeiros, S. and Palmer, D.J., 2020. A role for early oral exposure to house dust mite allergens through breastmilk in IgE-mediated food allergy susceptibility. Journal of Allergy and Clinical Immunology.