Re: engaging with new ideas

[Guest guest]

I am very interested but not surprised that you found like minds at BERA,

Robyn. The idea of a combination of educational knowledge, combined with

sound psychology, as underpinning theories for health visiting practice came

out very strongly in my PhD. I know that risks the wrath of every nurse

out there who feels that health visiting is based in nursing and only nursing

(hence the disbanding of our health register).

However, even though my PhD is now quite old, it showed clearly that understanding

educational knowledge (e.g., that which underpins personal development, community

development, health education/promotion, facilitation, not to mention child

development and learning) was at least as important as nursing, which included

the kind of 'therapeutic caring' (actually, therapeutic prevention in health

visiting) that nursing has borrowed from various branches of humanistic psychology.

Robyn Pound wrote:

, Delay in my reply was caused by two groups of southern hemisphere

visitors who were more interested in, 'why are all the houses exactly the

same and joined together here?' than alongside epistemology. Just try answering

that one in a way that can be understood by people from a different world

view!

You are right that some research words may risk creating feelings

of being excluded for some readers and I apologise if anyone feels alienated.

I am in the position of trying to balance explanations for two audiences,

HV practitioners and academic researchers, and am uncertain where to place

my focus. There should not be too many more research words than those you

have already identified. It is the nature of this thesis that the emerging

theories of my health visiting practice and the alongside epistemology underpinning

the method are so closely interdependent that they are each hard to explain

without reference to the other. Findings come both from the practice-as-collaborative

enquiry with clients, and the research process grounded in and tested in

practice. I believe it is the cohesiveness of the two that is a strength

of this method of exploring and explaining professional relationships. By

alongside epistemology I mean a relational way of knowing, being

and generating personal theories of relationships in practice.

I bother to speak about alongside epistemology here because it is

fundamentally different from the epistemological stance that usually underpins

health care research. This is not to say other epistemologies are no good -

just that they do a different job. It is the reason finding funding was

difficult and the Ethics committee did much head scratching before approval. I also

believe it is timely in offering possible key to a new scholarship of enquiry

for health visitors. I suppose I wanted to be upfront that the thinking

about all these issues has been taking place and that this is not a maverick

or risky venture that got through academic examination by some freak mistake.

Today, I have come from a day long BERA (Britsh Educational Action

Research) conference of practitioner researchers and feel fired-up with the

energy created as people shared and valued each other's ideas by talking

about what is important from our unique perspectives. It was a place for questioning,

exploring and synthesising possible meanings for tackling dilemmas we face.

There were remarkable similarities across the several disciplines represented.

Thanks for your inviting questions . Robyn

[Guest guest]

,

Have you any good references for therapeutic caring and therapeutic prevention?

Ann

Re: engaging with new ideas

I am very interested but not surprised that you found like minds at BERA, Robyn. The idea of a combination of educational knowledge, combined with sound psychology, as underpinning theories for health visiting practice came out very strongly in my PhD. I know that risks the wrath of every nurse out there who feels that health visiting is based in nursing and only nursing (hence the disbanding of our health register). However, even though my PhD is now quite old, it showed clearly that understanding educational knowledge (e.g., that which underpins personal development, community development, health education/promotion, facilitation, not to mention child development and learning) was at least as important as nursing, which included the kind of 'therapeutic caring' (actually, therapeutic prevention in health visiting) that nursing has borrowed from various branches of humanistic psychology. Robyn Pound wrote:

, Delay in my reply was caused by two groups of southern hemisphere visitors who were more interested in, 'why are all the houses exactly the same and joined together here?' than alongside epistemology. Just try answering that one in a way that can be understood by people from a different world view!

You are right that some research words may risk creating feelings of being excluded for some readers and I apologise if anyone feels alienated. I am in the position of trying to balance explanations for two audiences, HV practitioners and academic researchers, and am uncertain where to place my focus. There should not be too many more research words than those you have already identified. It is the nature of this thesis that the emerging theories of my health visiting practice and the alongside epistemology underpinning the method are so closely interdependent that they are each hard to explain without reference to the other. Findings come both from the practice-as-collaborative enquiry with clients, and the research process grounded in and tested in practice. I believe it is the cohesiveness of the two that is a strength of this method of exploring and explaining professional relationships. By alongside epistemology I mean a relational way of knowing, being and generating personal theories of relationships in practice.

I bother to speak about alongside epistemology here because it is fundamentally different from the epistemological stance that usually underpins health care research. This is not to say other epistemologies are no good - just that they do a different job. It is the reason finding funding was difficult and the Ethics committee did much head scratching before approval. I also believe it is timely in offering possible key to a new scholarship of enquiry for health visitors. I suppose I wanted to be upfront that the thinking about all these issues has been taking place and that this is not a maverick or risky venture that got through academic examination by some freak mistake.

Today, I have come from a day long BERA (Britsh Educational Action Research) conference of practitioner researchers and feel fired-up with the energy created as people shared and valued each other's ideas by talking about what is important from our unique perspectives. It was a place for questioning, exploring and synthesising possible meanings for tackling dilemmas we face. There were remarkable similarities across the several disciplines represented.

Thanks for your inviting questions . Robyn

[Guest guest]

Ann, I unravelled the concept of therapeutic prevention, in my paper called

"In health visiting, the routine visit is one that has passed," which was

published in the Journal of Advanced Nursing in 1995: 22: 2 276-284

The term is a bit contradictory and was the only new jargon term that I coined

from my PhD analysis, because the only term used by health visitors to describe

what they were doing was simply 'health visiting.' It was when I realised

that health visitors use that term as a verb, as when nurses talk of nursing

or teachers talk of teaching: this form of practice is called 'health visiting.'

However, it seemed necessary to find a term to describe what that particular

kind of 'health visiting' included. It describes a combination of activities

that appear distinctive to health visiting, when they are working (as they

so often are) in situations which are unpredictable, ambiguous or anomalous.

Often there is no medical label for what is happening to the client or in

the family, but the situation is demonstrably risk-filled and complex; there

is both suffering and uncertainty. The approach to health promotion described

by the health visitors who were my informants included a form of 'holding'

the situation to prevent things from getting worse (which might be just an

explicit expression of caring and comfort, and a recognition of the distress

being experienced, which would be 'therapeutic' in itself) whilst uncovering

and unravelling more information and providing support and education to help

clients cope with these complex, potentially risk-filled situations. The

paper explains why outcomes are so difficult in health visiting, as some

of these situations resolve, because the 'prevention' bit was enough to stop

the risk, whatever it was, from becoming manifest. Alternatively, the unravelling

and uncovering of issues may reveal a prevously undiagnosed problem. So,

just counting problems gives you no clue as to whether it is good to look

for more or fewer problems!

There are quite a few references to caring in that paper; more up to date

was a concept analysis on caring published with an MSc student:

on K & Cowley S (1999) Idealised caring: the heart of nursing

In The Changing Nature of Nursing in Managerial Age Blackwell Science,

Oxford (eds. Norman I & Cowley S) 21-35

That same book has another excellent chapter by Ann Bergen, in which she

traces the range of claims to 'professional caring,' within and beyond nursing.

I hope this helps. best wishes

Ann Girling wrote:

,

Have you any good references for therapeutic

caring and therapeutic prevention?

Ann

[Guest guest]

That was why I put the two words together: the health visitors included

both in one action. bw

Robyn Pound wrote:

Ann, I am sure has but can i suggest almost anything by Carl

-His Reader or On Becoming a Person (1961) are useful.

Belenky et al. (1896) Women's ways of knowing have useful

insights.

Egan (1990) The Skilled Helper.

Fox (1995) Postmodern perspectives on care: The vigil and the gift.

Critical Social Policy. Issue 44/45 15. 2/3. pp107-125.

I am not sure I can distinquish between therapeutic caring and prevention.

Robyn

[Guest guest]

Dear and Ann,

I am reminded of Terry Wogan on Experience:

'Ah, experience - that's something you get,

just after you needed it!'

Woody.

Re: engaging with new ideas

> Ann, I unravelled the concept of therapeutic prevention, in my paper

> called

> " In health visiting, the routine visit is one that has passed, " which

> was published in the Journal of Advanced Nursing in 1995: 22: 2

276-284

>

> The term is a bit contradictory and was the only new jargon term that I

> coined from my PhD analysis, because the only term used by health

> visitors to describe what they were doing was simply 'health visiting.'

> It was when I realised that health visitors use that term as a verb,

> as when nurses talk of nursing or teachers talk of teaching: this form

> of practice is called 'health visiting.' However, it seemed necessary

> to find a term to describe what that particular kind of 'health

> visiting' included. It describes a combination of activities that

> appear distinctive to health visiting, when they are working (as they

> so often are) in situations which are unpredictable, ambiguous or

> anomalous. Often there is no medical label for what is happening to the

> client or in the family, but the situation is demonstrably risk-filled

> and complex; there is both suffering and uncertainty. The approach to

> health promotion described by the health visitors who were my informants

> included a form of 'holding' the situation to prevent things from

> getting worse (which might be just an explicit expression of caring and

> comfort, and a recognition of the distress being experienced, which

> would be 'therapeutic' in itself) whilst uncovering and unravelling more

> information and providing support and education to help clients cope

> with these complex, potentially risk-filled situations. The paper

> explains why outcomes are so difficult in health visiting, as some of

> these situations resolve, because the 'prevention' bit was enough to

> stop the risk, whatever it was, from becoming manifest. Alternatively,

> the unravelling and uncovering of issues may reveal a prevously

> undiagnosed problem. So, just counting problems gives you no clue as to

> whether it is good to look for more or fewer problems!

>

> There are quite a few references to caring in that paper; more up to

> date was a concept analysis on caring published with an MSc student:

>

> on K & Cowley S (1999) Idealised caring: the heart of nursing

> In The Changing Nature of Nursing in Managerial Age Blackwell Science,

> Oxford (eds. Norman I & Cowley S) 21-35

>

> That same book has another excellent chapter by Ann Bergen, in which she

> traces the range of claims to 'professional caring,' within and beyond

> nursing.

>

> I hope this helps. best wishes

>

>

>

> Ann Girling wrote:

>

> > ,

> >

> > Have you any good references for therapeutic caring and therapeutic

> > prevention?

> >

> > Ann

> >

>

>

[Guest guest]

Thanks ,

I knew i had read it in something you had written and that is an article i often quote because it says a lot about what happens in health visiting but thanks for the other references too.

Ann

Re: engaging with new ideas

Ann, I unravelled the concept of therapeutic prevention, in my paper called "In health visiting, the routine visit is one that has passed," which was published in the Journal of Advanced Nursing in 1995: 22: 2 276-284The term is a bit contradictory and was the only new jargon term that I coined from my PhD analysis, because the only term used by health visitors to describe what they were doing was simply 'health visiting.' It was when I realised that health visitors use that term as a verb, as when nurses talk of nursing or teachers talk of teaching: this form of practice is called 'health visiting.' However, it seemed necessary to find a term to describe what that particular kind of 'health visiting' included. It describes a combination of activities that appear distinctive to health visiting, when they are working (as they so often are) in situations which are unpredictable, ambiguous or anomalous. Often there is no medical label for what is happening to the client or in the family, but the situation is demonstrably risk-filled and complex; there is both suffering and uncertainty. The approach to health promotion described by the health visitors who were my informants included a form of 'holding' the situation to prevent things from getting worse (which might be just an explicit expression of caring and comfort, and a recognition of the distress being experienced, which would be 'therapeutic' in itself) whilst uncovering and unravelling more information and providing support and education to help clients cope with these complex, potentially risk-filled situations. The paper explains why outcomes are so difficult in health visiting, as some of these situations resolve, because the 'prevention' bit was enough to stop the risk, whatever it was, from becoming manifest. Alternatively, the unravelling and uncovering of issues may reveal a prevously undiagnosed problem. So, just counting problems gives you no clue as to whether it is good to look for more or fewer problems! There are quite a few references to caring in that paper; more up to date was a concept analysis on caring published with an MSc student: on K & Cowley S (1999) Idealised caring: the heart of nursing In The Changing Nature of Nursing in Managerial Age Blackwell Science, Oxford (eds. Norman I & Cowley S) 21-35 That same book has another excellent chapter by Ann Bergen, in which she traces the range of claims to 'professional caring,' within and beyond nursing. I hope this helps. best wishes Ann Girling wrote:

,

Have you any good references for therapeutic caring and therapeutic prevention?

Ann

[Guest guest]

I read your article when undertaking my MSc and felt an instant identification with it. Thank you for that. Ruth

Re: engaging with new ideas

Ann, I unravelled the concept of therapeutic prevention, in my paper called "In health visiting, the routine visit is one that has passed," which was published in the Journal of Advanced Nursing in 1995: 22: 2 276-284The term is a bit contradictory and was the only new jargon term that I coined from my PhD analysis, because the only term used by health visitors to describe what they were doing was simply 'health visiting.' It was when I realised that health visitors use that term as a verb, as when nurses talk of nursing or teachers talk of teaching: this form of practice is called 'health visiting.' However, it seemed necessary to find a term to describe what that particular kind of 'health visiting' included. It describes a combination of activities that appear distinctive to health visiting, when they are working (as they so often are) in situations which are unpredictable, ambiguous or anomalous. Often there is no medical label for what is happening to the client or in the family, but the situation is demonstrably risk-filled and complex; there is both suffering and uncertainty. The approach to health promotion described by the health visitors who were my informants included a form of 'holding' the situation to prevent things from getting worse (which might be just an explicit expression of caring and comfort, and a recognition of the distress being experienced, which would be 'therapeutic' in itself) whilst uncovering and unravelling more information and providing support and education to help clients cope with these complex, potentially risk-filled situations. The paper explains why outcomes are so difficult in health visiting, as some of these situations resolve, because the 'prevention' bit was enough to stop the risk, whatever it was, from becoming manifest. Alternatively, the unravelling and uncovering of issues may reveal a prevously undiagnosed problem. So, just counting problems gives you no clue as to whether it is good to look for more or fewer problems! There are quite a few references to caring in that paper; more up to date was a concept analysis on caring published with an MSc student: on K & Cowley S (1999) Idealised caring: the heart of nursing In The Changing Nature of Nursing in Managerial Age Blackwell Science, Oxford (eds. Norman I & Cowley S) 21-35 That same book has another excellent chapter by Ann Bergen, in which she traces the range of claims to 'professional caring,' within and beyond nursing. I hope this helps. best wishes Ann Girling wrote:

,

Have you any good references for therapeutic caring and therapeutic prevention?

Ann

[Guest guest]

Robyn, sorry to take so long to reply to this message. You are so right

in your analysis. I try not to get too despondent about what is happening

to health visiting, although 'heart sink' is what happens on many occasions,

when looking at the enormous hurdles. One way of overcoming the slough of

despond is to look at the excellence that continues despite these, so it

is wonderful and cheering to read all the good examples that have been coming

through on to Senate recently.

The 'contradictions in practice' is a fascinating theme, because it is so

difficult to explain to anyone who is not immersed within the practice field.

When Lesley and Maureen did their wonderful review of

literature and policy initiatives for the UKCC in 2001, to inform development

of the new standards for pre-registration health visitor programmes that

came out in 2002, coping with contradiction was the one important area of

knowledge that was left out. We commented on that from Senate; as did UK

Standing Conference, so we were able to highlight it a bit at that time.

I think it has got lost in the latest round of standard setting, but we

need to keep recalling it and making sure that both qualified and student

health visitors get a chance to reflect on coping with that kind of complexity

and confusion. kind regards

.

Robyn Pound wrote:

, From

your reply I soaked up a heart sink feeling about a job too big when we have

an idea about what is necessary but meet heart cramping constraints. Health visitors are resilient as a profession and containing

and managing crisis and despair is a big part of what we do. I recognise

the contradictions you identify between Kate Billingham’s optimism that this

is the ‘best of times’ for families and health visitors who support them

and another view that it is ‘the worst of times’ because of economic constraints,

short-termism and reliance on traditional ways of finding out and accounting

for things. Maybe this illustrates what is unique

about health visiting.

What is required when working

to nurture healthy families, communities and their children is the balancing

of so many different aspects of what makes a healthy life.

We look at the big picture of what is necessary and beaver away

at all the bits that are essential to achieving it. I

really do believe that it is that skill of holding the parts and the whole

of our intentions and process in view at the same time that is so special

about what we do. This happens to be the function

of living theory action research too. Another feature

of this approach to enquiring is the identification of ‘living’ contradictions

such as the one you show here. It is through examination

of contradictions that prevent intentions being realised in practice that

expanded understanding of what we are trying to do can be discovered and

perhaps find new understanding about how the contradictions can be accommodated

or challenged. By exploring what ‘the best of times’

means for health visiting practice and how ‘the worst of times’ hinders that

possibility we might increase our shared understanding of what both mean

and increase our ability to explain why ‘the worst of times’ is a problem

for the future health of the nation.

My research has been grounded

in my own grass roots practice because that is what I have been most interested

in and it seemed important to me to take time understanding the easy (but

actually complex!) before approaching the really complex.

That maybe just says something about me. One

most difficult contradiction for me was in understanding the ‘preventing

or promoting’ dilemma which manifested itself in practical questions about

how to balance different relationships required of both in order to do right

by children in families. Confronted by this one I

came to understand a lot more of what is needed in really grown-up relationships

that hold the parts and the many together in actions. Well

that was the insight. I remain a ‘living contradiction’

quite often but hopefully a more thoughtful one! It is my guess that thinking about these kinds of relationships

may resonate for people working in other arenas because it seems to me that

mutually rewarding relationships don’t differ too much if you are a parent,

a health visitor or a researcher.

There is no reason why practitioners

working in different capacities throughout the structure shouldn’t look at

what they are doing from their own practical place in the big picture. We are all practitioners in our different ways but I bet

the values that act as guiding principles for what we do aren’t massively

different if we got down to looking. It would mean

encouraging practitioners to ‘walk the walk as well as talking the talk’

so to speak. By enabling practitioners to ask questions

about their practice at whatever level they work (management, supervisor

etc.) could some of the contradictions you have identified be better understood/addressed?

By identifying motivating values for practical action and producing evidence

of how they are ‘lived’ in practice (that’s the powerful bit because it

closes the theory-practice gap and produces explanations of it) it is hard

to see how tired old unhelpful practices can endure and remain resistant

to explanation.

Recently I had email contact

with a South African Professor who was thinking about how he could research

his own practice as he supervised a PhD student researching parenting in

the townships (if my memory is correct).

I wondered why the names on

your Senate list where frequently incomprehensible and your last letter explains

I may now be open to spam. Do I deregister and register

again or just put up with it I wonder?

Thanks for giving me

space to think explore ideas. Robyn

[Guest guest]

I am on leave until Monday July 26th . Please address queries to our

administator 002078158059. Specifically school nurse queries should go to

Anne Akamo 02078158396 and HV and programme issues to n Frost

02078158461. Val Thurtle