Using observations from practice, describe the qualities and skills used by health visitors and school nurses to successfully engage families or colleagues in difficult conversations.

Part A: Scenario – 50 marks in total

Read the scenario carefully and complete each of the three questions

Family Members

Ms A      Mother     Age 23 years

Mr B       Father     Age 30 years

Child C   Son          Age 6 years

Child D   Son          Age 4 years

Ms A had her first baby (Child C) after an uneventful pregnancy and the baby was born at term (40 weeks).  Ms A presented for antenatal care when she was 28 weeks pregnant with Child C. At the time of the birth Ms A and Child C were living with Ms A’s foster parents but they quickly moved to the home of Mr B, who was Child C’s father. Child D, the second child of Ms A and Mr B, was born two years later. Once again, Ms A presented for antenatal care at an advanced stage in the pregnancy. In the case of each pregnancy Ms A said that she had not realised she was pregnant until the pregnancy was well advanced and at that point sought medical advice. When Child D was born the family acquired a home of their own. Both children had their six-week developmental assessment and primary immunisations.

When Child C began nursery the nursery workers expressed concern about his speech, growth and general development. Child C had very few words and his play was violent and destructive. The health visitor was contacted. She assessed Child C’s development and a referral for speech therapy was made. At the home visit the health visitor also noticed that Child D was not vocalising and had poor weight gain. Although born on the 50th centile Child D’s weight was, when weighed by the health visitor, on the 0.4th centile.

The home environment was cluttered and there were few toys and little safe play space. Ms A seemed unaware of the children’s difficulties and was most concerned with the health of Mr B who, she said, had epilepsy that was gradually becoming worse. The health visitor completed a CAF and a family support worker was appointed to help within the home and to support Ms A in therapeutic play with the family.

In the year Child C started primary school he was taken with minor injuries to the local accident and emergency department, on 4 separate occasions. Ms A gave an appropriate explanation on each occasion. That same year, Child D attended nursery with a cut on his head that required sutures. Child D said to the school nurse and to his teacher that ‘Dad did it’. A referral was made to Children & Young People services.

Part A: Questions

Using the scenario above answer all the following questions

Describe two factors in this family that place these children at increased risk, identifying the research evidence to support this view.

If you were working with this family, what additional information would help you assess the wellbeing of these children and how could you access this information?

Were there any missed opportunities and if so, what were they?

(Part A – 50 marks in total)

 Part B: Answer ONE of the following questions.

Children who live in neglectful or emotionally impoverished households can present with a range of behavioural and developmental difficulties. Describe some of these difficulties in children or young people and your role in identifying appropriate support services.

Using observations from practice, describe the qualities and skills used by health visitors and school nurses to successfully engage families or colleagues in difficult conversations.

(Part B – 50 marks in total)

Using observations from practice, describe the qualities and skills used by health visitors and school nurses to successfully engage families or colleagues in difficult conversations.