A Home as Well as a House – Family Nursing and Housing
27 November 2019 | Ailsa Swarbrick, Director, FNP National Unit
The ache for home lives in all of us, the safe place where we can go as we are and not be questioned.Maya Angelou
Maslow’s hierarchy of needs identifies shelter as a primary, physiological need to be met before other needs can be properly addressed. But of course housing is about more than just physical shelter. It’s a social determinant of health, affecting for example children’s respiratory conditions, physical safety, mental health and development.
And it’s about home, a word which carries a powerful charge, signifying emotional as well as physical safety, our place in the community, the base from which children grow and explore the world, an expression of identity and often creativity. It follows that the impact of a person feeling threatened, isolated or restricted at home can be profound.
Housing often poses a real challenge for many Family Nurse Partnership (FNP) clients, mostly highly disadvantaged young families. Lucy’s story illustrates just how complex the issue of housing is.
Lucy lived in emergency accommodation with her baby, Milly, in a single room with a shared kitchen and bathroom and felt scared of some of the other tenants. She didn’t cook much because the kitchen wasn’t baby-proof and food often went missing. It was also hard to go out, because she lived on the second floor, up a spiral staircase which was difficult to manoeuvre with a buggy; and when she did get out there was rubbish and broken furniture in the garden. All this affected Lucy’s mental health, her ability to form social connections, and both her and Milly’s diets. The confined living space, with little room to move and explore, also appeared to be having an impact on Milly’s physical and cognitive development.
So what’s the role of nursing here? FNP is at its heart about prevention, working with clients so that they can build a better life for themselves and their babies. However, and uniquely, nurses care; and care means attending to the whole person. Therefore, family nurses often need to work with parents to address basic needs before other work can be effective.
Although it’s not what all of us would consider nursing, a first task is often to support clients to secure reasonable accommodation – helping to navigate difficult and complex systems, building alliances and relationships with other services to access the specific housing support that clients need.
Family nurses then often also need to respond to the health conditions homelessness can cause or exacerbate, perhaps as a result of poor hygiene, nutrition and anxiety. This centres on working with clients to identify how they can mitigate against these, as well as robust assessment of physical and emotional well-being.
Finally, there’s the critical work to build capacity and resilience, so that parents can have a better chance of improving their lives and those of their babies. This is at the heart of FNP – prevention, realising potential and working with local and family assets to embed long-term, sustainable change; and nurses take a structured approach both to identifying client needs and strengths, and then planning specific interventions.
Their work is informed by theory, and Bromfenbrenner’s Human Ecology Theory is relevant here, helping the nurse and family to think through the influence of the environment on the client and vice versa, and how small changes can be made to improve that dynamic (and in the process build the client’s sense of self-efficacy, increasing her confidence that she can also make other changes to her life).
That might mean supporting her to try new ways to influence her physical environment, ranging from organising the home space safely for a growing child to being able to make safe choices about where to live. Alternatively, it might mean thinking about how to ensure consistency in routines if the child is regularly moving from one setting to another; how the client might access community support to help her feel less scared and isolated; or even how she might take the initiative and create some local change with others.
Finally, back to Lucy.
The work nurses and clients do together is irreplaceable, but situations like Lucy’s are simply not acceptable in a wealthy, 21st century country and are the responsibility of government, society and communities. Lucy bravely told her story at her local multi-agency FNP Board meeting and this has led to a renewed impetus to find creative solutions to local housing needs, despite real difficulties and challenges.
So, a final task for family nurses can sometimes be to help change the conversation with those in power, enabling different stories to be heard.
Director, FNP National Unit