Gráficas de los datos

This first concept regarding incongruence in delivery of care relates to the amount of work that is needed to be done and the actual number of midwives or child health nurses employed to do the work. It highlights how there was inadequate

acknowledgment in workforce education regarding how mental health issues affected how midwives and child health nurses carried out mental health promotion. Both midwives and child health nurses described how a limited workforce (staffing) impacted on their own workloads and thus the amount of time they had available for mental health promotion. They also identified that there needed to be more

recognition of how mental health promotion actually affected the midwives and child health nurses themselves, sometimes to the point where they were unable to discuss mental illness with parents. Both midwives and child health nurses recognised that the health promotion they desired to impart was impeded by these issues.

Participants argued that not having enough workforce (midwives/child health nurses) to support parents left them frustrated that the best care was not being delivered. One child health nurse described that our core business is, and our KPIs (key

performance indicators) are, all around child health assessments and we've got a workforce that barely covers that. Furthermore, she maintained that when needing to do child surveillance with a parent who couldn’t attend the clinic that we haven't got the flexibility to do home visits for every check. So that is a constraint. She went on to notethat if we did (a) we would hopefully engage more, and (b) we'd have more opportunity for health promotion, whether it was mental health promotion or physical (3CHN). A midwife noted that with there was a push for early discharge as

and probably a lack of staffing (2M). She was concerned that such a small amount of time on the ward meant that little mental health promotion took place.

This concept was a significant barrier as it affected whether a parent was able to gain access to a child health nurse or midwife due to constraints around staffing. Child health nurses were also limited in their ability to engage with the community, requiring for the most part the community (where possible) to access them in the clinics. This barrier has implications for access to these important services when parents are at their most vulnerable. It is difficult to say whether this non access and pressure for discharge contravenes duty of care, but it is certainly worth considering as a form of potential neglect.

There was inadequate acknowledgement in workforce education regarding how the topic of mental health promotion could have a detrimental effect on midwives and child health nurses. Participants argued that there was inadequate recognition for how certain practices/protocols affected those who implemented them.

One participant reflected a number of responses about the two services needing to acknowledge more how staff feel about some areas of their practice, including mental health promotion: you know if people (midwives or child health nurses)

haven’t dealt with some of their own issues then it’s very hard to be open and listen to other people’s and so I don’t really think the service has dealt with that fact. She claimed that it’s just assumed, you would do this, it’s part of your job, you do it.

Not really individually asking people, can you manage this? Is this okay for you to do?(9CHN).

This concept, within the subtheme of workforce barriers, of a non-acknowledgment of personal issues highlights how both midwives and child health nurses are required to raise a number of areas within their assessment forms with parents such as mental illness, intimate partner violence and child abuse. In particular, this concept

illustrates that midwives and child health nurses have little access to debriefing about such confronting issues. It therefore questions whether individual midwives and child health nurses are asked about their abilities to raise these issues and when they do, are they coping with doing so. An inability to discuss mental illness would have implications for mental health promotion in that (as discussed in Chapter Four and

stigma) this construct may not be attempted and thus parents will not receive promotion of wellbeing.

Inadequate access by parents to important services due to workforce constraints and discharge from hospital imperatives are serious limitations for the two services examined in this study. These limitations are serious as they impinge on parental access to services when they are potentially needed most and could imply that these constraints confer on midwives and child health nurses an inability to promote mental health. Mental health promotion is also a possible topic of anguish and worry for some midwives and child health nurses and this concept of personal issues raises the question whether in-servicing education regarding mental health promotion in the two services needs to acknowledges potential anguish or concern. Certainly, this non-acknowledgement could in turn potentially affect the delivery of care to parents if child health nurses and midwives avoid more than a token engagement with mental health promotion.