Queen’s Nurses Share Ideas in Cyprus

I recently had the pleasure of visiting Cyprus and received a very warm welcome from fellow Queen’s Nurse Craig Johnson, Professional Lead for School Health within British Forces Cyprus for SSAFA.

SSAFA, the Armed Forces charity, is a trusted source of support for serving personnel, veterans and their families. They also provide Community Health Services to the military and entitled population within British Forces Cyprus. We are both SCPHN (Specialist Community Public Health Nurse) trained so inevitably we were both excited to discuss services home and overseas.

It quickly became obvious that two Queen’s Nurses with a shared interest can assess, rationalise, reflect and learn together very quickly. We are both keen to share how great community health services can be and the nurse’s role. The comparison of services, the ideal service and what work is still needed were all topics we explored.

I was totally inspired by Craig’s passion, and we had shared ideas of the role of Public Health Nurses. Craig was able to share the level of contact he has with children and most importantly the rapport building element of the role. Caseloads are smaller than in the UK and the focus of care is quality rather than quantity.

The first positive was the lack of traffic at rush hour (picture below). No traffic jams and beautiful scenery on the commute. The sun was shining the whole time.

I was amazed to hear that health visitors will have a minimum of six direct contacts with a baby in their first year, including antenatal and immunisations. I had to check is this a health visitor or a nursery nurse? It is indeed a fully qualified Health Visitor! This is amazing because it really does allow the back to basics rapport building to take place and promotes trust from the families. This is not something that Health Visitors in England can now provide, with current staffing challenges*.

It was also great to learn that the School Nurses support with immunisations; they also use the Solihull Approach. I was delighted to hear the passion about baby brain development from a School Nurse and this really did evidence the value of fully integrated Public Health teams. Although many UK services describe themselves as integrated, the reality is they are separately functioning teams. School aged immunisations, for example, are often commissioned to separate teams and joint working is restricted to safeguarding practice. Baby immunisations in the UK are usually administered by Practice Nurses.  I was delighted to discuss how Newborn Observation (NBO) is applied in practice and incorporated into many health visitor conversations such as safety, domestic abuse, development etc.

The Public Health team works closely with the dietician on a range of health promotion projects, particularly the National Child Measurement Programme which has excellent uptake. To have a dietician able to work with families and support at an early stage empowers families to make positive choices, with a range of evidenced based options available. There is a CAMHS service available which the school nursing team can refer to and again they are co-located. These services are offered across all British Forces Cyprus which spans the whole island, covering bases with significant miles between them. The School Health Team employs one SCPHN and utilises a skill mix of child health nurses who cover the whole population of children.

SSAFA offers a range of community health and specialist services such as speech and language, Dietetics, Community Children’s Nurses, and Midwives. Dental Care, including Orthodontics, are also accessible.

Engaging the Community

We are both passionate about public health services and the need for these services to be visible and accessible. Engaging with the communities we serve is an essential element of effective Public Health Nursing.

Craig is able to do this by spending time in the schools within his caseload each week, working closely with partners in education and Defence. Work within schools may involve an assembly, playground, teaching a lesson, drop-in, critical debate, 1-1, group work, supporting sports day etc. But the key theme is the visibility and accessibility of the School nursing Service. By being an integral part of the community, there is the opportunity to search for health needs and engage the young people in so many ways. This level of engagement epitomises the gold standard of Public Health Nursing. This is not something that all services in the UK are able to provide now, due to how they are commissioned, but as Queen’s Nurses we can inspire others by sharing what can be achieved and educating future Public Health Nurses about non-task based nursing care.

The challenges of living and working in a close-knit community were explored, particularly how to maintain the usual professional distance. Families will often work together, and children share schools and social activities. There are however benefits to this. Community nurses are an integral part of the community here. I witnessed this first hand on the base when a child saw Craig in a cafe, he knew the child’s name and had a brief interaction. The visibility of the community nurses can only be a positive; Craig has so many opportunities to give young people a positive first experience of health/nursing. Young People can reach him via school, medical centre, youth club, café, football pitches, gym, or café.

Life for Service Children

Service Children are not on a vulnerable list in the UK, but we must acknowledge that although they have varied and unique experiences, for some Young People these experiences may not all be positive.

The children have a different lifestyle to many in the UK. Many form relationships and friendships that only last a short period of time. In the UK we would be questioning a child attending 7 different schools by the time they are 10, but this can be normal for some military families. How does this impact on them emotionally? What consistent service is there to support them?

Environmentally, children of UK service personnel in Cyprus benefit from a safe, low traffic community to play and explore. Crime levels are low and they are protected from wider risks such as knife crime. The children can play outside, building dens, riding bikes, etc., as well as spending less time on devices. It poses additional challenges for teenagers who would, in a ‘normal’/civilian town, typically engage in risk taking behaviour and explore relationships in multiple friendship groups. Integrating back into UK society can therefore be problematic. This is where Public Health nurses can provide guidance and support, and the regular drop-in clinic is well attended. Craig was also able to expand on life skills education that he is providing for this exact reason, something that would be beneficial for all young people.

Change and relationships can also pose additional challenges for children living within a military setting. As an Army regiment moves, so do most of the children within this regiment, and they will usually move together to another military area. The RAF and Navy may have more singular postings, where a child may move numerous times without the support of an established battalion. In addition to this there are many long stay children living on bases whose parents are civilians. They have to constantly get used to making friends, then watch their friends leave and start again, which is not something we would see in the average child population in the UK.

We explored the caring roles and responsibilities the children have, particularly when one parent is posted overseas, or deployed to the other side of the island, on training or in the UK. The emphasis on the community supporting each other is essential in these circumstances and reminds me of the saying, “It takes a village to raise a child”. Again, the support from Public Health for both parents and children is essential.

Safeguarding

Safeguarding was a huge topic and, although similar, there are some unique differences. First the GP and every health professional having involvement with the family will be invited to attend the child protection conferences: I can count on one hand how often I have had a GP attend a conference in the UK, but here it is standard practice for every case, which adds to the conference and provides another perspective. It is not unusual to see the Senior Medical Officer (the senior GP) at the conference.

Some of the safeguarding themes highlighted appear to be as a result of the unique circumstances of almost every family living away from their extended family; children being left unsupervised, for example. A range of factors could influence parents’ decisions about this, such as a lack of family support and a feeling of safety on the base. Alcohol is cheap and the sun is usually shining, making the lifestyle more sociable than we may see in England. This can obviously have an impact on children.

Learning and the Future

Processes are in place for children transitioning between UK schools and MOD Schools (such as the common transfer file between schools), but as with any transition, good communication is required between all involved.

From a nurse’s perspective there are differences too. Craig’s opportunities for training can involve flying around in an open-door helicopter.

We both left feeling rejuvenated and inspired, full of ideas. I would love to see our Public Health services in England return to core principles, where the nurses can search for health needs and focus on quality care with less of a focus on task-based care.

Craig is looking forward to sharing information about the service with the next generation of Public Health Nurses so that they have the opportunity to see gold standard public health nursing practice. There is potential for Craig to explore work with universities in the UK, allowing the opportunity to advocate for service families and raise greater awareness for this group of people who have such unique experiences. As a Nurse Mentor and Practice Facilitator, he is willing to offer bespoke seminars or workshops face to face or online with future Public Health Nurses.

We are both unified in our passion to share what good quality community Public Health nursing looks like for SCPHN’s so that they can aim for this as their careers progress. The current UK provision of Public Health Nursing is no longer consistent nationally. By raising awareness of quality care, we can demonstrate that community nursing is more than a series of tasks that can be achieved by ticking a box. As Queen’s Nurses we can be role models and share the passion and enthusiasm that we have with others.

Community Nursing is a service that must be driven by the needs of a community and we must recognise that every community is different, some with specific unique challenges. Public Health Nurses can empower the community to improve long term health outcomes and this is not always measurable by standard metrics. Measurements should be about quality of service rather than quantity.

The greatest learning of all is that as Queen’s Nurses we are a family with shared passion and drive and distance is not a barrier. We are always learning and to be able to learn from those who set the highest standards is a true privilege for us all. We have also realised that two determined Queen’s nurses working together can achieve so much.

I am certainly looking forward to returning, and who knows I may be lucky enough to join the mandatory training next time!

Thank you, Craig, for being such a wonderful host.

Catherine McArevey

Professional Nurse Advocate Lead and Specialist Safeguarding Practitioner

NOTES

More information can be found at:  SSAFA Cyprus Service Hub | SSAFA.

* Scotland and Wales provide more intensive services. Scottish Health Visitors are recognised as Band 7’s.