15th July 2022
Prevention is better than the cure
From health visiting to Clinical Nurse Specialist and back.
We are delighted to share this Voices blog by Celyn George, Health Visiting Team Lead at the Central Bright Start team in Islington, London on her career journey from health visiting to Clinical Nurse Specialist, and back to health visiting.
My name is Celyn George, and I am a health visiting team lead working within the Central Bright Start team in Islington. I am delighted to have the opportunity to share my reflections in this Voices blog on my varied career which has given me the opportunity to experience both ends of the spectrum of nursing – from hospital-based intensive care, to the equally specialist preventative public health role of the health visitor.
The world of nursing opens the doors to so many varied experiences and opportunities. My experiences include health visiting, V300 prescribing and work as a Clinical Nurse Specialist (CNS) in paediatric pain, and paediatric nursing within a neonatal intensive care unit. I’ve had the opportunity to travel, and I’ve worked across Welsh and English health boards, as well as undertaking an Erasmus exchange programme, working in Hvidore Hospital in Copenhagen, Denmark.
During the pandemic, I made the move from my health visiting role in South Wales and worked as a CNS in King’s College Hospital, London. Although I knew my heart was always (and will always) be in community care, the move to London to be closer to my family happened very quickly, and I decided to apply for a band 5 nursing role until I had found my feet, then ultimately get back in to health visiting. Following my interview, I was offered the band 7 CNS post, an opportunity I am now very grateful for. Undertaking this role for 13 months before returning to health visiting practice has provided me with first-hand experience of the importance of the upstream work of the health visitor – working with families, to address the social determinants of health and improve health outcomes. As an example, with King’s being one of the biggest paediatric hepatology wards in the UK, I witnessed the impact that health visiting had on early identification and referral of Jaundice.
When I was working as a CNS, I cared for families whose children were experiencing pain from surgery, trauma, sickle cell crisis or chronic pain. I observed first-hand the numerous ways that socio-economic factors influenced health and wellbeing, and this developed my insight and interest in this area of healthcare. Often, the cause of the surgery, chronic pain or crisis was something that could have been prevented, had families been provided with the correct tools or support at home. But looking at the ‘causes of the causes’, I was also very aware that healthy choices are not easy choices for some families – as Sir Michael Marmot highlighted in his recent review, “Health is closely linked to the conditions in which people are born, grow, live, work and age and inequities in power, money and resources – the social determinants of health”.
As a health visitor, I am passionate about developing families’ resilience and addressing the social determinants of health to improve the community’s health. I also want to empower and raise the profile of the health visiting workforce by highlighting the importance of the service and the difference that it can make to health outcomes and reducing inequalities. My experience of working as a CNS during the pandemic has highlighted the importance of the health visitors’ work in ill-health prevention, as opposed to treating illness when it occurs – this is described in the current health visiting model for England in High Impact Area 5: Improving health literacy, managing minor illnesses, and reducing accidents.
A big part of my role as a CNS in paediatric pain included getting to the root causes of pain and providing the appropriate advice and guidance for discharge. From my own experience, I found that families from the most disadvantaged areas often faced additional challenges, including having experienced a high number of adverse childhood experiences (ACEs) themselves, which had a knock-on impact on their resilience and ability to recover quickly from illnesses and hospital admissions. I observed that many had longer recovery times and were more likely to report chronic pain – in support of this, a study by Tidmarch (2022) associates ACEs with pain complications, pain catastrophizing and depression, thereby heightening risks of early treatment attrition. I always felt uneasy just treating the pain, and discharging the patient home, with lack of support to change the environment that they lived in – and was making them sick in the first place. As an example, I worked closely with a 8-year-old child to manage post-operative pain following a dental extraction surgery. The child’s growth had historically been plotting above the 99th centile. When engaging in conversation with the parents and the child, it transpired that the child had poor diet, exercise, and sleep habits. I supported the family to ensure they could access dietetic services and liaised with the school health nurse who was able to support the child with healthy weight and healthy nutrition, as well as sleep.
Health visiting is not a system of treating individuals and then returning them to the communities. Health visitors provide extra support when families need it the most, building on their strengths and working with partners to ideally prevent costly problems through early identification and intervention before the situation reaches crisis point.
The pandemic has led to growing health visitor caseloads of families needing extra support, and pressures have been increasing – and this has occurred at a time when the health visiting resource has been at its lowest point. But despite this, health visitors should be empowered to make best use of their Specialist Community Public Health Nursing skills to positively impact the health of populations. I want any health visitors who are feeling unmotivated, or feeling as though they are not making an impact, to know that they are making a difference. This is being seen and their vital work, in reducing ACEs and providing families with the tools to thrive, is valued. I’m very proud to be a health visitor, and I am very humbled to the families who welcome us into their home and open up so much of their lives to us. It is a unique experience to help improve the lives of children and families. I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.