Digging down and scaling up: a psychosocial exploration of the Family Nurse Partnership

Owens, Rachael (2020) Digging down and scaling up: a psychosocial exploration of the Family Nurse Partnership. Doctoral thesis (PhD), University of Sussex.

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This PhD has been produced through a collaboration between the University of Sussex and the Family Nurse Partnership (FNP). FNP is a public health, preventative, home visiting programme for first-time young parents, delivered by specialist family nurses. It was developed in the 1970s by Professor David Olds in the USA. Several Randomised Control Trials lent the programme international credibility, such that the FNP was introduced into the UK in 2007, overseen by a National Unit hosted by Public Health England. There are now approximately 80 sites across England, commissioned by Local Authorities and delivered by local health (usually NHS) providers.

In contrast to the extant evaluative RCT research on FNP, this explorative study follows a qualitative methodology to ‘dig down’ into phenomenological local practices. The purpose is to provide a conceptualisation of the model which assists the National Unit in their efforts to adapt to the contemporary UK context. Located within a social work department, with a focus on a nursing/health organisation, the study’s interdisciplinary underpinnings have facilitated the asking of broad, existential primary questions about how the FNP model operates, is understood and experienced in practice and about the opportunities and obstacles to operationalising the FNP model which exist for its operationalisation across the micro, meso and macro system levels. From a methodological point of view, the study also asks how psycho-social methods can address such questions. Sub-questions provide a focus for the study on the interplay between the social environment of teenage parents and the FNP model; the role of austerity; FNP’s primary task; the psycho-social development of teenage parents and its links with the FNP model; and the relationship between social policy, the FNP approach and the teenage parents in the study.

Having gained NHS ethical permission via the Health Research Authority, the study deployed psycho-socially oriented research methods to collect data from within a single FNP site. This involved an eight month ethnographic observation of home visiting and office based activity and one-to-one interviews with professional and client participants. To provide triangulation and comparison, further interviews and focus groups were conducted within three additional FNP sites in different areas, which involved FNP clients, family nurses and wider stakeholders.

The analytical process continued the psycho-social focus and utilised an adapted version of the Listening Guide method to produce a multi-focal perspective on the operationalisation of the FNP model. Drawing on critical social policy, sociological, systems, cultural and psychoanalytic theories, the argument develops a contextualised understanding of this highly complex arena, in which there are multiple interests and influences at play. A rare example of organisational and practice orientated research which includes the perspectives of both those who ‘deliver’ (at various organisational levels) and those who ‘receive’ services, the analysis reveals layers of paradox, ethical tension and complex power dynamics within the ‘primary task/s’. It considers how teenage parents, and mothers in particular, are positioned within policy and popular discourses as disempowered, and the implications of this for the FNP model.

The discussion develops an appreciation of the multi-layered contexts of FNP’s work by considering the often unconscious interplay between affective and social contexts, revealing the way that individual and organisational processes intersect one another. The study implications point towards opportunities for the FNP model to expand its systemic roots beyond current manifestations. Bringing the experiences of family nurses and teenage parents to the fore, it asks whether a more collectivist, and less individualistic approach might be a sustainable and ethical route towards realising FNP’s aim of affecting global change and considers diverse ways of valuing and measuring the relational aspects of the work. Providing helpful methodological learning about the nature of empirical psycho-social research into organisations – of which there are few – the study highlights the merits of this approach, which provides rich data, reflective of the complexity of human life and human service organisations. Aligning itself with current critical social policy and qualitative research with teenage parents, the study uses this data to advocate for a more diverse and less deterministic conceptualisation of teenage parents within the policy and practice arena.

Item Type: Thesis (Doctoral)
Schools and Departments: School of Education and Social Work > Social Work and Social Care
Subjects: R Medicine > RT Nursing > RT0089 Specialties in nursing > RT0120.A-Z Other special types of nursing, A-Z > RT0120.F34 Family nursing
Depositing User: Library Cataloguing
Date Deposited: 27 May 2020 10:35
Last Modified: 27 May 2020 10:35
URI: http://sro.sussex.ac.uk/id/eprint/91429

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