Nurse-Family Partnership Program Research Articles

A Partnership for Health: 11th Street Family Health Services of Drexel University

Background: Like many inner-city areas, North Philadelphia lacked health care providers, leaving the many low-income residents with unmet physical and mental health needs. Residents were often exposed to violence, crime, and other traumatic events that can have a negative impact on physical and mental health. The center created a model of care and an array of services based on the community's needs. It provides access to clinical services, including primary care, behavioral health and dental services, Centering Pregnancy, and the Nurse Family Partnership program. In addition, it offers a range of health promotion and chronic disease management programs, physical fitness programs, nutrition services, integrative and complementary therapies, a law clinic, and urban farm. Purpose: The 11th Street Family Health Services of Drexel University is a comprehensive, nurse-managed health center run by the College of Nursing and Health Professions in collaboration with the Family Practice and Counseling Network. Its vision is to decrease health disparities by providing transdisciplinary clinical services and health promotion programs in partnership with the local community. Methodology: Key elements of the patient centered model include: 1) transdisciplinary care teams, 2) integration of primary care and behavioral health, 3) open access scheduling, 4) a trauma-informed model of care, and 5) a no wrong-door policy. Findings: While experiencing a steadily increasing patient volume the center has documented improvements in key outcome measures. These include improved diabetes management with a 20% reduction in HbA1c; hypertension control with 68% of pateints under control, and a 30% increase in breast cancer screening rates. The number of preterm births has decreased along with the prevalence of depression in vulnerable adults with chronic illness. Summary Concluding Statement: The center continues to innovate and evolve, working to remain responsive to the community's current and future needs. It has become a hub for community activities that improve residents' quality of life.

Reflective Practice Enhances Public Health Nurse Implementation of Nurse‐Family Partnership

Reflective practice is defined as a cyclical process involving a series of phases in which an individual describes a salient event, attends to his/her positive and negative feelings about the event, and ultimately reexamines the experience in an effort to understand and to plan how he or she would act in a similar situation in the future. This paper describes how the concept of reflective practice is integrated into the evidence-based Nurse-Family Partnership (NFP) program. The pivotal role of the nursing supervisor in guiding nurses to engage in reflection on their work with families is emphasized. Exemplars drawn from the experience of 2 NFP nursing supervisors are presented to illustrate how reflection in the NFP program is operationalized. The benefits as well as the challenges to the use of reflective practice are also discussed. While anecdotal comments from NFP nurses and supervisors are cited to suggest how the regular use of reflective practice has the potential to improve implementation of the program with families, the authors further propose that research is needed to more rigorously examine the benefits that reflective practice may have on the quality of program implementation, family outcomes, and the retention of nurses working in the NFP program.

Long-term Effects of Prenatal and Infancy Nurse Home Visitation on the Life Course of Youths

To examine the effect of prenatal and infancy nurse home visitation on the life course development of 19-year-old youths whose mothers participated in the program. Randomized trial. Semirural community in New York. Three hundred ten youths from the 400 families enrolled in the Elmira Nurse-Family Partnership program. Intervention Families received a mean of 9 home visits (range, 0-16) during pregnancy and 23 (range, 0-59) from birth through the child's second birthday. Youth self-reports of educational achievement, reproductive behaviors, welfare use, and criminal involvement. Relative to the comparison group, girls in the pregnancy and infancy nurse-visited group were less likely to have been arrested (10% vs 30%; relative risk [RR], 0.33; 95% confidence interval [CI], 0.13-0.82) and convicted (4% vs 20%; 0.20; 0.05-0.85) and had fewer lifetime arrests (mean: 0.10 vs 0.54; incidence RR [IRR], 0.18; 95% CI, 0.06-0.54) and convictions (0.04 vs 0.37; 0.11; 0.02-0.51). Nurse-visited girls born to unmarried and low-income mothers had fewer children (11% vs 30%; RR, 0.35; 95% CI, 0.12-1.02) and less Medicaid use (18% vs 45%; 0.40; 0.18-0.87) than their comparison group counterparts. Prenatal and infancy home visitation reduced the proportion of girls entering the criminal justice system. For girls born to high-risk mothers, there were additional positive program effects consistent with results from earlier phases of this trial. There were few program effects for boys.

Women hold up half the sky

Women hold up half the sky

Breastfeeding and WIC Enrollment in the Nurse Family Partnership Program

Recent studies have raised the issue of lower breastfeeding rates for mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). We wanted to explore this association of WIC and lower breastfeeding in Nurse Family Partnership Program (NFP), a national representative group of mother-baby pairs on which extensive background data are available. Our aim was to compare breastfeeding rates at 6 and 12 months in NFP high-risk mothers who were enrolled in WIC to those who were not enrolled in WIC. We conducted a retrospective secondary analysis in mothers and infants from this cohort for 2000-2005 (n = 3,570). We found that at 6 months of age, 87.8% of mothers who were not breastfeeding were enrolled in WIC as compared to 82.6% of mothers who were breastfeeding (p < 0.001). However, in the multivariate analysis, WIC was no longer a significant predictor of breastfeeding. Prospective evaluation of this issue is warranted particularly with the implementation of changes in the WIC Food Package and Breastfeeding Promotion.

Estimated State and Local Fiscal Effects of the Nurse Family Partnership Program

Estimated State and Local Fiscal Effects of the Nurse Family Partnership Program

WITHDRAWN: Home-based support for disadvantaged adult mothers.

Babies born to socio-economically disadvantaged mothers are at higher risk of a range of problems in infancy. Home visiting programs are thought to improve outcomes, both for mothers and children, largely through advice and support. To assess the effectiveness of home visiting programmes for women who have recently given birth and who are socially or economically disadvantaged. We searched the following electronic databases: The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3, 2006); MEDLINE (1966 to March 2006); EMBASE (1980 to 2006 week 12); CINAHL (1982 to March week 4 2006); PsycINFO (1872 to March week 4 2006); ASSIA (1987 to March 2006); LILACS (1982 to March 2006); and Sociological Abstracts(1963 to March 2006). We searched grey literature using ZETOC (1993 to March 2006); Dissertation Abstracts International (late 1960s to 2006); and SIGLE (1980 to March 2006). We also undertook communication with published authors about ongoing or unpublished research. Included studies were randomised controlled trials investigating the efficacy of home visiting directed at disadvantaged adult mothers. Two reviewers (EC and JP or CB) independently assessed titles and abstracts identified in the search for eligibility. Data were extracted and entered into RevMan (EC, JP and CB), synthesised and presented in both written and graphical form (forest plots). Outcomes included in this review were established at the protocol stage by an international steering group. The review does not report on all outcomes reported in included studies. We included 11 studies with 4751 participants in this review. Data show no statistically significant differences for those receiving home visiting, either for maternal outcomes (maternal depression, anxiety, the stress associated with parenting, parenting skills, child abuse risk or potential or breastfeeding) or child outcomes (preventive health care visits, psychosocial health, language development, behaviour problems or accidental injuries. Evidence about uptake of immunisations is mixed, and the data on child maltreatment difficult to interpret. This review suggests that for disadvantaged adult women and their children, there is currently no evidence to support the adoption of home visiting as a means of improving maternal psychosocial health, parenting or outcomes for children. For reasons discussed in the review, this does not amount to a conclusion that home visiting programmes are ineffective, but indicates a need to think carefully about the problems that home visiting might influence, and improvements in the conduct of outcome studies in this area.

Nurse home visiting: Perspectives from nurses.

Nurses working in the Nurse Family Partnership (NFP) program provide intensive home-visitation services for first-time, low-income mothers. The goals are to improve maternal health outcomes, child health and development outcomes, and to enhance maternal life-course development; however, many of the families face significant psychosocial and mental health issues that can impede progress achieving their goals. Because of the importance of the nurse-client relationship in achieving positive outcomes, these non-mental-health nurses must shift their approaches and techniques from a medical to a psychosocial model. In this article, we examine the role of the nurse in the NFP and present results of focus groups with experienced NFP nurses regarding their perspectives, challenges, and rewards in conducting this work.

The process and promise of mental health augmentation of nurse home-visiting programs: Data from the Louisiana Nurse-Family Partnership.

The Nurse-Family Partnership (NFP) model is a well-studied and effective preventive intervention program targeting first-time, impoverished mothers and their families. Data documenting the negative impact of maternal depression and partner violence on the developing young child can be used to make a strong case for augmenting NFP programs to focus on mental health problems impacting the mother-child relationship. This article reviews the rationale for and process of augmenting an NFP program in Louisiana. Data on the prevalence of depression and partner violence in our sample are presented alongside a training protocol for nurses and mental health consultants designed to increase the focus on infant mental health. The use of a weekly case conference and telephone supervision of mental health consultants as well as reflections on the roles of the mental health consultant and the nurse supervisor are presented.

Reflection on Caring for a Home Care Client Using Kristen M. Swanson’s Theory of Caring

After attending a class on caring and the Boulder, Colorado Caring Conference in 2003, the author and graduate student applied Swanson’s Caring Theory to an at-risk family receiving nursing care in the Nurse Family Partnership program of La Salle’s Neighborhood Nursing Center. She used the theory as a lens to analyze her care of the family.