Abstract
IntroductionDistinct in their role and functions, health visitors are accountable for the safety, health, and wellbeing of children from birth during the first five years of life. However, to make decisions for children, they must interact with mothers (or the holder of parental responsibility). Noted in the literature as the need to be ‘friendly,’ health visitors must adopt processes that enable them to achieve the mothers’ acceptance.
As the link to the services children need to achieve optimal outcomes for their safety, health and wellbeing, the decisions that health visitors make have far reaching consequences for children. This means that the processes they adopt must be capable of clear explanation and open to scrutiny and challenge. This is challenging in the current situation where absence of a shared vocabulary and explanatory framework makes it difficult to see or explain the decision-making processes adopted. Although impacting the ability of practicing health visitors to learn from real life decision-making experiences, the lack of a shared vocabulary and framework also makes it difficult for student and newly qualified health visitors to prepare for the realities of decision-making practice.
The plethora of exploratory studies which prioritise professional judgement and needs assessment above that for decision-making practice has led to a paucity of research examining the individual nature and the detail of health visitors’ decision-making practice. While research associated with activities like professional judgement and needs assessment can provide useful insights into decision-making, the studies offer insufficient detail to explain the often subtle nuances involved. Although other terms like ‘intuition’ and ‘gut- feeling’ are typically used by health visitors to describe their decision-making activities, they too tend not to supply the level of detail required.
Seeking to understand how health visitors make decisions during real life, authentic situations, this exploratory study addressed the following three key intentions:
• Objective 1: Explore, using participant ethnographic observation, health visitors undertaking daily practice in real time to identify the decision-making processes that happened.
• Objective 2: Explore, using the ‘Think Aloud’ method, how health visitors, while watching recordings of their client consultations, recognise and describe their decision-making processes.
• Objective 3: Examine, using the social judgement theory framework, the discrete behaviours and strategies individual health visitors adopt during decision-making processes.
Methods
Using qualitative methodology and a range of methods for data collection and analysis, the study examined the processes adopted by health visitors undertaking authentic practice in real life consultations with mothers and children. Data were collected prospectively using ethnographic participant observation and the ‘Think Aloud’ method. In so doing the data set comprised,
• ethnographic participant observations of a purposive sample of 13 health visitors,
• video recordings and verbatim transcripts of 39 consultations between the health visitor, the mothers, and children,
• audio recordings and verbatim transcripts of 11 ‘Think Aloud’ events where the health visitor participants, while watching the video recording of their consultation(s), described their thoughts, and behaviours.
Hammond’s social judgement theory and associated framework were also used to guide the exploration of the social, environmental, and behavioural features associated with health visitors’ decision-making activity. Focusing on people this theory also provided a route for observing and reporting their typical behaviours, thoughts, and actions as they happen during the decision-making events.
Data were analysed using Braun & Clarke’s six step Thematic Analysis process to identify themes within the data.
Results
The decision-making evident in the ethnographic observation data has shown that health visitors’ decision-making activity is socially and not medically constructed. Here, the health visitors focus on mothers, children, and the situation to make decisions. Employing informality, using informal strategies for conversation like, ‘chit chat’ and ‘small talk’ the health visitors engaged mothers and children by creating a relaxed and friendly atmosphere. While not sequential, health visitors’ decision-making approaches were organised, systematic and well-considered.
Discussion
By exploring the way health visitors make decisions when responding to clients’ problems and issues during consultations, the study contributes three key aspects of distinct knowledge that will positively influence future understanding and recognition of this crucial area of practice. Firstly, the study has given substance to the expression of health visitors’ decision-making which although an important activity is one that is hidden and poorly understood. In so doing, the study has identified that health visitors’ decision-making processes are socially constructed and incorporate the simultaneous use of conscious and unconscious thought processes.
Secondly, the study has identified and examined the details of the informality health visitors use to create decision-making processes. By permitting social interaction with boundaries, the study has identified that health visitors use informality to create a context of ‘professional friendliness’ where they listen, and mothers naturally share their information. In so doing, they lay the foundations for decision-making processes to take place. Thirdly, by examining authentic decision-making in real life practice, the study has identified the subtle, somewhat nuanced details, of the processes adopted. While systematic and logical, health visitors’ decision-making processes are not sequential. Being situation-specific and individually generated, each health visitor adopts a distinct process.
| Date of Award | 1 Oct 2024 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Lynn Sayer (Supervisor), Patricia Grocott (Supervisor) & Mary Malone (Supervisor) |