This report was commissioned to explore the experiences of family nurses and clients in Scotland during the COVID-19 Pandemic. This includes findings on service delivery, mode of delivery, dosage, materials and resources.

It was felt that it was important to get a deeper understanding of the impact following the rapid move to remote delivery of a long term, intensive home visiting programme. The study was carried out from June to December 2020. The findings will help to explore what further adaptations to the FNP programme model may be of benefit in the future, particularly in the delivery of this programme in remote and rural areas.  

It should be noted, that despite best efforts by the evaluation team, the sample size of nurses (n=31) and clients (n=15) were lower than originally anticipated and findings should be considered in light of these numbers.  

Key Findings:

• Family nurses felt that remotely assessing home environments was extremely difficult, or ‘impossible’ in some cases. Key challenges related to being unable to identify who else might be present in a room with a client and being unable to detect the overall condition of a home as well as more subtle signals including, family dynamics, body language, smells, and potential hazards;

• When asked to rank most preferable delivery formats, ‘in person visiting only’, was most preferred by surveyed family nurses (55%). This was followed by ‘mixed-mode (face-to-face and telehealth) delivery’ (42%) with ‘telehealth delivery only’ being the least preferred option (77%);

• While clients felt supported overall by the programme, a number felt slightly less supported by virtual and distanced communication. Clients’ reflections on the impact of COVID-19 on their relationship with their family nurse demonstrated a preference for face-to-face communication, which they agreed had lessened during the pandemic;

• Family nurses reported that opportunities provided by different telehealth modes helped them achieve dosage with some clients who were busy with work or education commitments. Clients also mentioned that they appreciated this flexibility and the convenience afforded by remote contacts when trying to manage responsibilities and commitments;

• While many family nurses felt able to engage a proportion of their caseload in the programme remotely, particular challenges were reported for certain groups of clients such as those with complex vulnerabilities, migrants and clients who spoke English as a second language. Family nurses generally perceived that it was not feasible to engage their most vulnerable clients remotely and felt strongly that home visiting was the most appropriate form of engagement in these instances;

• A few family nurses mentioned that clients were beginning to struggle with fortnightly telehealth engagement over time and began requesting more home visits and face-to-face contact. This was often described in reference to lockdown restrictions re-introduced towards the end of 2020 and early 2021. Family nurses perceived that clients were becoming fatigued with ongoing virtual contacts and were expressing preferences for face-to-face contact;

• Toddlerhood was reported to be the most challenging phase for both clients and family nurses when conducting contacts using telehealth. Clients found looking after a small child was difficult while also trying to maintain focus on a video call with their family nurses. Likewise, family nurses found it challenging to engage clients remotely due to increased distractions at this stage.