Evaluation of the Family Nurse Partnership Programme in NHS Lothian, Scotland - Late Pregnancy and Postpartum

FOOTNOTES

1. The client and Family Nurse interviews conducted for this report focused particularly on preparing for the birth, the birth itself and the support received in the weeks immediately after the birth. This report also includes quantitative monitoring data collected and collated by the FNP team in Edinburgh for the pregnancy period and the period up to 6 weeks post-partum.

2. 'Stretch goals' are goals which the programme aspires to achieve. These are the optimum goals for ensuring the success of the programme. However, they maybe difficult to achieve when first implementing the programme.

3. 10 February 2012, 13 April 2012 and 15 June 2012.

4. For further information, see http://www.scotland.gov.uk/Topics/People/Young-People/Early-Years-and-Family/family-nurse-partnership/training (accessed 10 February 2012).

5. Initially by the NHS Lothian local FNP lead, and from March 2012 by the newly appointed FNP Research and Information officer, based in NES.

6. The evaluation team plans to revisit their strategy for interviewing significant others in advance of the next round of interviews (21-24 months) to consider how the evaluation might more successfully engage with significant others.

7. Cumulative attrition by November 2011 comprised 7 clients who had moved out of the area during pregnancy or infancy, or who were otherwise no longer eligible to participate, and 10 clients who had been inactive (no contact with FNP) for 6 months or more as of November 2011.

8. 'Agenda matching' describes how Family Nurses aim to work with clients; respecting and addressing the clients agenda while balancing the implementation of a manualised programme.

9. Note that the exact visiting schedule for pregnancy will depend on the stage of pregnancy at which clients were recruited to the programme (which obviously affects the time available for visits prior to the birth of the baby). The actual number of visits deliverable during pregnancy will also be affected by the date of the baby's delivery - for babies born early, fewer visits will be possible, and vice versa for late deliveries. Once all clients had delivered their babies, the NHS Lothian, Edinburgh FNP site re-calculated the expected number of visits for each client and compared this with the actual number of visits delivered during pregnancy to give an achieved 'dosage' (the proportion of expected visits actually delivered) for each client.

10. Where a clear decision is made that the baby will be permanently removed, the focus of FNP delivery changes to supporting the mother to move on.

11. As discussed in Chapter 3, 4 clients had left the programme and 6 had been disengaged for 6 months or more by the end of the pregnancy period.

12. See http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/data-tables.asp

13. Although others have noted that use of recommended thresholds on EPDS varies considerably (Matthey et al, 2006).

14. Reasons for missing data were: client disengagement or moving prior to data collection, pregnancy loss, the form not being completed as it was not a clinical priority at that point (n = 1) and missing forms with no specified reason (n = 2).

15. Note this is somewhat lower than the figure for all those who smoked at some point during pregnancy - 62% - reported in the first evaluation report. The higher figure in the earlier report is based on having smoked at any point during pregnancy, while the figure reported in Table 4.3, above, is based on smoking in the previous 48 hours.

16. Note that by the 31^st December 2009, all Health Boards in Scotland offered a second trimester fetal anomaly ultrasound scan, so all FNP clients in this cohort would have been offered a second scan.

17. FNP was launched in Lothian in 2009, with the first clients enrolled in February 2010.