Coronavirus (COVID-19) Family Nurse Partnership insights: evaluation report

5. Conclusions

This evaluation examined how FNP is being currently delivered during the COVID-19 pandemic in order to assess how the current mode of delivery has impacted family nurses, clients and partnership working. It also investigated the types of challenges facing the service at the moment, and what lessons can be learned for the future delivery of the service.

It was clear that both family nurses and clients were not fully in favour of the current remote delivery when compared to the pre-covid in home visiting. Many family nurses felt strongly that FNP was developed as a home visiting programme and its success is largely dependent on it being delivered as such. Family nurses felt that FNP thrives on family nurses building therapeutic relationships with their clients. However, relationship building was found to be negatively impacted by remote delivery of the programme. Family nurses reported that it took longer and required more effort to establish a strong therapeutic relationship with clients remotely.

It was apparent that supportive settings contribute to the uptake and successful use of telehealth. Aside from few initial issues with equipment at the outset of COVID-19 pandemic, family nurses generally felt well equipped and supported to conduct their work remotely. Organisational and team-level support are particularly key to this. Organisational level support and training were accessible and available in a range of formats (e.g., local software leads or contacts, training webinars, online resources). Team-level support can provide opportunities for peer-learning and training which family nurses may find more accessible and specific to their roles. External support resources were also effective and valued by family nurses. These included international guidance documents from the Nurse Family Partnership (NFP) and organisations such as UNICEF.

However, telehealth is not a one-size fits all solution for clients. While remote delivery allowed family nurses to continue to provide essential and invaluable support to clients during the COVID-19 pandemic it is clear that this type of service delivery is not a sustainable option for some clients. Some clients were uncomfortable with video calls and felt anxious or self-conscious on camera. Family nurses felt that clients were becoming fatigued with ongoing telehealth contacts in place of home visiting and were expressing stronger preferences for face-to-face contact over time.

For more vulnerable clients, it was perceived that they were at increased risk of having undetected concerns, becoming disengaged or feeling unsupported from telehealth contacts. Groups most at risk likely include clients with poor mental health or mental illness, those at risk of domestic violence, families with child protection concerns, minority groups such as migrants, and clients who speak English as a second language. There were concerns among family nurses about the impact of digital literacy and digital exclusion and potential inequalities emerging in the access to the service for many of their clients, especially the most vulnerable.

Another aspect of FNP that was most affected by remote delivery was child assessment and observation of the home environment. Survey, focus group and interview findings all highlighted a significant negative impact on the ability of family nurses to effectively conduct assessments and observations using telehealth.

External partnership working also appeared to have been impacted by the COVID-19 pandemic. Many agencies were reported to have limited operation, which created challenges for onward referrals. This meant family nurses had to provide more support to clients. In spite of the challenges of remote delivery, both family nurses and clients expressed the desire that telehealth could play some role in future delivery, for instance, to fill gaps in communication or follow-up concerns and that mixed model (hybrid) programme delivery could be appropriate in certain instances.

5.1 Limitations

Data collection of both qualitative and survey data were undertaken remotely due to COVID-19. It is possible that this approach to data collection might have excluded the perspectives of the most vulnerable clients of the FNP programme because of digital exclusion. Also, online recruitment challenges during COVID-19 meant the sample size used for the evaluation was lower than originally anticipated. Information governance requirements also prevented personal level data and demographics from being captured, this information could have been used to further contextualise the findings.