Abstract
BackgroundThe Nurse-Family Partnership (NFP) is a targeted, nurse home visitation program for young, low-income, first-time mothers. While the effectiveness of the NFP has been established in the United States, and is currently being evaluated in the Canadian public health care system, we have minimal understanding of how work of this nature impacts public health nurses (PHNs), an essential component of this program delivery model, on both professional and personal levels.MethodsThis two-phase study consisted of a qualitative secondary analysis of data from five focus groups conducted with PHNs (N = 6) who delivered the NFP intervention as part of a pilot study assessing feasibility and acceptability conducted in Hamilton, Ontario. The second phase, an interpretive description of individual interviews with the PHNs (N = 10) who have delivered the NFP in this context, further explored themes identified in the first phase. A practice, problem and needs analysis was conducted to describe and understand the phenomenon and promote sustainability of PHNs in this practice environment. Conventional content analysis was used to code and categorize data in the two datasets.ResultsThe nurse-client relationship, the core elements and structure of the NFP program and support of NFP colleagues were described as rewarding factors, while workload and workplace factors were identified as significant contributors to stress. PHNs described transforming their nursing practice through redefining success and shifting to a philosophy where the client is the expert of her own life. PHNs described the personal impact of worry about clients and doubt about their effectiveness in addressing client concerns. High levels of satisfaction were described in relation to the depth and intensity of relationships with clients and seeing them succeed over time.ConclusionsPHNs are impacted in multiple ways by their work with vulnerable, young mothers. The study findings have implications for identification of strategies to support PHNs in reducing staff turnover, PHN burnout, secondary traumatic stress and compassion fatigue, and improving program delivery.
Highlights
The Nurse-Family Partnership (NFP) is a targeted, nurse home visitation program for young, low-income, first-time mothers
The first phase was a secondary analysis of five 90–120 minute focus groups conducted with public health nurses’ (PHN) (N = 6) who delivered the NFP intervention as part of a pilot study assessing the feasibility and acceptability of the NFP conducted in Hamilton, Ontario between 2009–2011
Themes identified from the focus group data analysis were explored or clarified in the second phase: single, 60–90 minute individual, semi-structured interviews with the initial PHNs (N = 6) and NFP PHNs (N = 4) who were hired by Hamilton Public Health Services after the pilot study was completed
Summary
The Nurse-Family Partnership (NFP) is a targeted, nurse home visitation program for young, low-income, first-time mothers. There is limited research focusing on the potential impacts and consequences for nurses who practice in community-based settings. Many home visiting programs focus service provision on vulnerable members who have less access to financial resources and social support such as young, socially disadvantaged mothers and their infants [7,8,9,10]. These families are at risk for a range of health problems including substance abuse and poor mental or physical health. Home visiting programs can facilitate access to families who are less likely to seek out medical care or use early intervention services [8]
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