168 Initial preparation and training
When asked about how well prepared they felt by their training, most FNs reported feeling well prepared, although several had worked with group-based programmes previously and felt this contributed to being confident about delivering gFNP. One noted that although the training prepared her for working with a group it did not prepare her for dealing with difficult situations that arose within group, only experience could do that. Another FN reported that, while the training was very good, she had learnt more by working alongside an FN colleague and seeing how she dealt with certain situations. Nevertheless, those who had had previous training outside FNP on facilitating group work commented that the training for gFNP was much better.
FN07: Previously I did parent education and when I think about it the
training was really poor, you were just expected to do it…the training here is really good and working with another colleague I learnt so much from x, how she handles certain things. I think it was really, really positive.
FN10: I think the training we had was good, though it can only prepare you to a certain extent as you can’t cover every scenario in training… there are always going to be situations where something is said and you are floored by it but that’s experience about how you deal with it… what this training did prepare us for was how to deal with it in a group.
FN11: I was involved in group work for teenage parents. When I look back now I think I just expected them to sit there and accept the information I was going to give them. I have learnt loads and it has definitely been transferable. When I do one to one and have parents and grandparents I transfer those communication skills.
Supervision
It was noted that the supervision for FNs delivering group would benefit from taking a different approach to supervision for one-to-one FNP. Specifically, rather than the regular individual supervision (i.e. the supervisor and the FN) which is provided for all FNs, and FNP team supervision, everyone involved in delivering gFNP could attend at the same time so that they would be thinking about the group as a whole, and this would ideally take place fortnightly.
FN14: It didn’t feel right to use individual supervision; even the
169 looking at frequency of supervision…how did we document it - stuff like that... it looked like once a fortnight, both nurses together…so it would be all of us quite often thinking about the group as a whole.
One particular issue was to ensure that all safeguarding responsibilities were well covered.Unlike one-to-one FNP, which takes place in a client’s home and affords FNs ample opportunity to assess potentially high risk situations, the strategy for delivering gFNP does not routinely include home visits. Some FNs remarked that one potential disadvantage of gFNP (compared to FNP) was having less knowledge of clients’
circumstances outside the group. Supervision for the gFNP work was designed to address this difference, discussing the extent to which FNs knew about the individual
circumstances of clients, so that home visits could be made as required in addition to the group sessions.
FN14: The tricky thing for us in gFNP is that you don’t know the clients in the same depth that you know your individual clients… in order to safeguard children…whereas in group FNP you didn’t have that depth of knowledge. FN13: We also dealt with some safeguarding in group. We have got round that, but initially it didn’t feel as safe as we didn’t know the clients quite as well because you were only meeting them in a group, it ended up there were more home visits because the nurses didn’t feel safe.
Staff absence for sickness or leave
The FNs delivering gFNP had received additional training, but this was not available to all team members, usually only to the two FNS who were to be providing the gFNP programme. Nevertheless, staff sickness and leave cover had to be managed and this was approached in a variety of ways.
FN04: It has been problematic, I had one nurse who went off sick…then one of the nurses left because she got another job…so it was a nightmare, I had stepped in to cover one nurse and now there was six months before the programme ends…
There were fewest staffing problems if FN supervisors and FNs who were not part of the team delivering the programme had been able to attend the training. They were able to provide cover when needed although they would not be so familiar to the clients. If this training had not been possible then FNs who were part of the FNP team but had not
170 attended group training came in as replacements. Whether or not they had training they could be perceived as ‘outsiders’ by the clients and it was noted that clients tended to direct their questions to the regular facilitator rather than the temporary replacement. However, it was emphasised that the temporary cover should be by a nurse with FNP training rather than a non-FNP professional because of the FNP ethos and the ‘safe container’ aspect, considered crucial to developing relationships within group. In an instance when a children’s centre worker had been invited to contribute to group on a specific topic the ‘safe container’ aspect had been missing from the session and there was the view that there had been less depth of interaction between group members.
FN10: … what’s important is the basis of this is the relationship, I felt that they felt very safe and secure with us and we did introduce other FNs to cover holiday and they were absolutely fine with that… There was one session where we used a children’s centre worker and she did something around language and the session was fine but there wasn’t that same level, that depth of interaction whereas with the FN I didn’t feel that. It felt like a safe
container with the FN.
FN14: I liked the fact that there were two FNs because if one (of those
trained to deliver group) is not here you still have the FN training and the FN ethos…plus they could prepare together, deliver together and they could look back and reflect together.