In many ways, historical context and modern scientific knowledge formed the approach to the role of the child and family health professional. At the beginning of the 20th century, Australia experienced a terrible wave of child mortality. Therefore, there is a special attitude to maternal, child, and family healthcare in the state and national policies. The first CFH professionals, “trained visitors,” were volunteers who saw it their duty to improve the living conditions for as many children and mothers as possible. Today the scope of practice of CFH nurses is very wide, and their role implies plenty of responsibilities. This paper aims to study the historical development of the CFH professional role, examine the scope of practice and the policies having the greatest impact on CFH nurses.
Historical Development of CFH Professional Role
Australia has over 100 years of history of medical practice in childcare. The state is particularly attentive to this nursing practice area because of the sad events in the late 19th and early 20th centuries. In 1880, Australians faced a wave of infant mortality due to the mass migration of the population to cities. In the 1880s, only 100 out of 1,000 babies passed the one-year age threshold. Most often, the cause of death was infectious diseases associated with unsanitary urban conditions. A second major cause was sexual violence against women; many abandoned their illegitimate children and took them to orphanages such as the Sydney Foundling Hospital.
Therefore, at the beginning of the 20th century, nurses and doctors caring for children first discovered that children who did not receive adequate nutrition due to their mother’s absence showed a failure to thrive. Remarkably, during the Second World War, scientists discovered that babies left in shelters for up to a year did not survive without their mothers, even with adequate nutrition. The reason was a lack of empathic contact with the mother or another significant adult between 0 and 12 months of age. Another common cause of infant mortality was diarrhea caused by unsanitary conditions and lack of clean drinking water.
Because of such acute problems, the Infant Protection Bill was released in 1904, which stressed the mother’s critical role in the early part of the infant’s life. At the beginning of the 20th century, scientists did not yet know about the importance of emotional contact for infants. The Royal Commission on the birth rate called for the education of mothers on proper feeding. In 1904, the position of a “trained visitor” appeared, who visited families with newborns and advised mothers on care. Margaret Ferguson was the trained visitor, and she became a role model for future specialists on maternal, child, and family care. The responsibilities of the trained visitor also included tracking down all births.
Therefore, some mothers could feel relieved and uplifted for receiving personalized care, while others living in the violent environment could face threats from their abusive husbands. It was probably difficult for women to get used to the fact that the doctor took the initiative to visit their homes, which should be perceived as personal space. However, these visits could only be beneficial since the responsibilities associated with the trained visitor’s role were focused on improving the health and wellbeing of children and families. Noteworthy, a rained visitor had to visit each family with a newborn in the term of two weeks after birth.
The historical context influenced the fact that the CFH professional’s role was autonomous – nurses did most of the work without management control. The reason could be that such a position appeared due to the goodwill of medical workers and was not determined within bureaucratic management. The public health care system was not as developed as it is today, and individuals like Dr. Truby King, who converted his home to the infant care clinic, set out the rules and regulations for healthcare. Dr. Truby King was the founder of the Australian Mothercraft Society, which opened in 1923, and the first Baby Clinic, which became the first services provided by Karitane. During the following 100 years, the Karitane became a diverse health-affiliated non-governmental agency.
Scope of Practice
CFH professionals’ goals have changed little over the past century, while the approach to practice has been revised many times. National Standards of Practice for Maternal, Child and Family Health Nurses in Australia or MCaFHN standards is a comprehensive document issued in 2017, which has passed several scientific evidence-based approvals and is considered a compulsory guideline for CFH practitioners along with general requirements for RNs (MCaFHN, 2017).
National Standards of Practice provide a comprehensive definition of the role of a CFH as a nurse, which includes professional performance in seven areas. These areas include critical thinking, engaging in therapeutic and professional relationships, maintaining professional capacity and engaging in life-long learning, conducting comprehensive nursing assessments, developing plans for nursing practice that promotes maternal, child and family health and wellbeing, providing safe, appropriate and responsive nursing practice, and evaluating outcomes.
Some of these nursing practice directions could be described in more detail. For example, critical thinking includes using evidence-informed knowledge and skills, developing practice based on an advanced understanding of child health and development, understanding the social determinants of health, population health, and issues impacting children, mothers, fathers, and families. The scope of nursing analytical advice covers feeding and nutrition, sleeping, nurturing, injury prevention, growth, learning, behavior, discipline, communication, language development, and mental health (MCaFHN, 2017). Nurse practitioners should also ensure health promotion, disease prevention, provide individualized family care, use partnership approaches, work following national legislation and relevant professional standards, produce and maintain accurate clinical documentation, complete mandatory reports, and engage in reflective practice to increase self-awareness.
Being engaged in therapeutic and professional relations means maintaining interpersonal relations with children, mothers, and families, communicating using sophisticated skills and, if needed – interpreters, establishing therapeutic relations with children, mothers and families, engaging and building ties in the communities (MCaFHN, 2017). Maintaining capacity for practice implies engaging in professional development, participation in clinical supervision, leading decisions that improve systems, contributing to research and evidence, using and contributing to local and state policies and guidelines, supervising students, engaging with professional associations, ensuring health and wellbeing of self concerning the capacity for nursing practice.
Responsibilities related to nursing assessments include using interviewing styles and communication skills to gather health histories from children, mothers, fathers, and families, using specialty health nursing knowledge, evidence-informed tools, assessment methods, and screening tools. Duties also include assessing maternal lactation, conducting physical and psychosocial assessments, observing relationships within families, assessing social determinants of health, health literacy, environmental risk, and assessing clinical practice environments for professional safety of self.
Policies that Impact CFH Professional
Since 1904, plenty of policies that regulate the practice of CFH professionals have appeared. Today, key frameworks and principles of CFH practice are covered in multiple documents that provide comprehensive guidelines for nurses. These are the national Framework for Universal Child and Family Services, the first National Standards for Maternal, Child, and Family Health Services, The First 2000 Days Framework, Healthy Safe and Well: A Strategic Health Plan for Children, Young People and Families 2014-24, The Supporting Families Early Package. These are also Child Health – Child Development: the first 3 years, Parenting and Child health website with many policies, The Maternal and Child Health Service Guidelines, and the Children’s Health Queensland Hospital and Health Service 2020-2024 (MCaFHN, 2017).
The First 2000 Days Framework is a particularly efficient policy since it provides evidence on why the first 1000 and first 2000 days of life are important. The policy includes three strategic objectives, namely that all staff in the NSW health system should promote the importance of the first 2000 days, that the NSW health system provides care to all children during the first 2000 days, including migrants, refugees, and aboriginal people, and that NSW health system provides additional services for those who need special help when they need it. This policy is focused on prevention since it says that the first 2000 days are critical to a child’s future life, including a propensity for chronic illnesses such as diabetes or heart failure, smoking, and drug and alcohol use.
The First 2000 Days is considered a powerful prevention program aimed to grow a healthy nation because, according to many studies conducted during the last 30 years, early and prenatal experiences determine a person’s health and longevity. This information is still not entirely accepted in the medical community, as some scientists still believe that life expectancy is related to genes and a healthy lifestyle. However, research suggests that people who had an unfavorable environment and were exposed to external risks in early childhood have a significantly higher propensity to develop various diseases, which are less likely to respond to treatment, compared to people who grew up in a favorable environment. Such people acquire bad habits to drown out childhood traumas, which are rarely discussed openly with anyone.
The First 2000 Days program embodies a scheme to protect children’s health and works in two directions – reducing environmental risks and developing positive resistance. Particular attention is paid to the quality of food, water, cleanliness, and family relationships, especially between the child and the mother. One of the most critical pieces of evidence in favor of the importance of the first 2000 days is the “powerful relationship between emotional experiences as children, and adult physical and mental health and mortality” (NSW Health, 2019, p. 19). Other evidence says that the first 1000 days have the highest developmental plasticity and that it is never too late to make changes to improve health and wellbeing. There are also data proving that families’ social and environmental conditions have a direct impact on child development.
The main areas of work within the program are Community Health, Mental Health, Healthy Lifestyles and Nutrition, Aboriginal Health, Surgery, Maternity, Child and Family Health, Medicine and Emergency Medicine.
The main interventions proved to make a significant improvement to personal life experience include “access to comprehensive antenatal care, regular child health and development check-ups from birth until age five, sustained nurse home visiting for targeted populations, breastfeeding support, supporting women to complete their school education to Year 12, immunization, oral health services, population parenting programs, attending 600 hours of quality early childhood education in the year before school, school engagement, specialized programs for Aboriginal people, refugees, and migrant populations” ( NSW Health, 2019, p. 10). Noteworthy, the program expands and redefines the responsibilities and role of the CFH professional.
Clinical Supervision for CFH Professionals
Clinical supervision is vital for CFH professionals because their wellbeing is the key to quality treatment. The CFH professional’s job can be exhausting given that they have to work in an ever-changing environment and spend a lot of time in a demanding environment. Guidelines for Clinical Supervision for Child and Family Health Nurses imply that CFH nurses have additional responsibilities related to their roles (CAFHNA, 2019). The supervision also has the purpose of providing emotional support around professional issues, enhancement of professional skills, effective processing of emotional reactions of nurses to their practice, prevention of burn-out, and the opportunity to develop a proactive approach rather than the reactive one.
Conclusion
Thus, the historical development of the CFH professional role was studied, and the scope of practice and the policies having the greatest impact on CFH nurses were examined. Australia has a special approach to child and maternal health care due to historical events. There are plenty of national and regional policies that regulate the duties and determine the roles of CFH nurses. Adhering to MCaFHN standards and The First 2000 Days program is particularly important to provide adequate care for all children and their mothers during the first 2000 days of life and beyond.
References
CAFHNA (2019). Guidelines for Clinical Supervision for Child and Family Health Nurses. Web.
Maternal Child and Family Health Nurses (2017). Association National Standards for Maternal, Child, and Family Health Nursing in Australia. Web.
NSW Health (2019). The First 2000 Days Framework. Web.