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The programme goals, underpinning theories and themes are the same as those delivered within FNP but an additional aim of delivering FNP in a group context is to facilitate peer learning and the development of friendships within the group. The idea of peer learning was underlined by one FN who explained that sharing ideas within the group and promoting conversations around specific topics (e.g. weaning) can have a wider impact than perhaps a one to one conversation between a family nurse and a client.

FN01: …if you are talking about it (weaning/immunisations) in a group and sharing ideas you get a much wider impact, and it’s not just the family nurse saying ‘You shouldn’t wean until…’ Peer contact/aspect of learning, the group allows for that to happen, so the group context really promotes these conversations much better than a one to one does.

Across sites FNs observed examples of peer learning leading to behaviour change. For example, a new mother who slept with her baby changed so that after group discussion she told her group that the baby was now sleeping in her own cot due to the advice she had received from them. Another instance cited was at a session on weaning where gFNP clients took part in a food testing activity and gave each other advice based on individual experiences.

FN11: They have definitely changed behaviour through group

discussion…one girl who slept with baby, was on medication and drank, but eventually she talked about it and then other girls would say ‘Well I have done this…’ then she announced ‘the little one is in her own cot, I don’t bring her into my bed… I have only done it through you guys, through listening to group discussion.’

FN08: We did a session on where they tested food, blindfolded, and x (client) came into her own there with the baby led weaning, and they just took advice from each other. One of them would say ‘Well I have tried this, this worked’ … or ‘I tried that and it didn’t work’ so they were very open to sharing.

161 Noting different needs also encouraged empathy among group members, for example with a client who had learning difficulties or if a client was reluctant to take part in activities designed to help prepare for handling a new baby.

FN10: …there was one person in group in pregnancy that was very quiet with some learning difficulties, you could see she was quite embarrassed by contributing but what was interesting was how the rest of the group protected her and how they included her.

FN07: One client who we were quite worried about, when we did PIPE [role play activities designed to promote parent-child interaction] in pregnancy she wouldn’t hold the doll…and she was one of the last to give birth. It really helped, the other mums encouraging her to hold their babies helped her confidence, before she had her baby she wouldn’t necessarily have any experience and so she found that really useful and she ended up handling her baby really well.

Able to observe social interactions

There were numerous comments across sites about the emotional support that participants gave each other as the group dynamic strengthened. For example, there was support for a participant who was extremely anxious as she had previously had a miscarriage and was afraid she would not be able to hear the fetal heartbeat during the antenatal self-care checks. Other members of the group gathered round and held her hand to reassure her while this was being done. At another site the group supported an individual experiencing mental health issues who felt she was not being a ‘good mother’ by pointing out how well her baby was doing and boosting her self-esteem. There were also more general

comments about the practical support that group members gave each other such as picking each other up in their cars so they could attend group. This could contribute to the development of ‘bridging’ social capital in that group members had varying cultural and educational backgrounds.

FN05: There was one girl who was very, very nervous listening to the fetal heart, at the beginning of the MW care, but the group members all supported her, all got round and held her hand. She was just scared of not being able to hear the fetal heart having had a miscarriage previously. The group members all got round very quickly that is one of the ways we found that they were gelling really well, the ways they were supporting her.

162 FN04: We had one client with mental health issues…The other girls really

well supported her. There were times when she felt like she wasn’t being a good mum and they were able to boost her self-esteem and say ‘Well actually, look how much she (the baby) has come on.’

FN010: We had an extremely mixed group educational achievements and culturally it was powerful for us because there were people in the group who would never ever mix socially and were very supportive of each other to the point of picking them up in their cars and bringing them to group and they are they are still in touch and on Facebook groups together, it’s amazing. Facilitating groups gave the FNs opportunity to observe how the babies interacted and developed socially by playing together. An FN who was not a regular gFNP facilitator but who had stepped in to cover absence commented afterwards to the regular group

facilitator on her surprise about how well the babies played together and how interactive they were.

FN05: It was a joy to watch these babies interact together and we have one little one who always wanted to cuddle the other members… all she wanted to do was cuddle them and they just got used to that, they accepted that and that is how they coped. They just played together; shared things had each other’s food, they just got on together really well.

FN11: x was off and I asked another nurse to come along and she said ‘I can’t believe how well these babies are playing together, at the age they are at they should be playing alongside each other but they were more

interactive.

E. Aspects of gFNP that worked well for the practitioners