Nurse-Family Partnership and Geography: An Intersectional Perspective.
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ABSTRACT:
SUBMITTER: Campbell KA
PROVIDER: S-EPMC6974751 | biostudies-literature | 2020 Jan-Dec
REPOSITORIES: biostudies-literature
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Project description:We examined visit attendance patterns of mothers enrolled in the Nurse-Family Partnership (NFP) home visitation program and associations between these patterns and characteristics of the families and sites, with the goal of increasing participant engagement. We utilized repeated measures latent class analysis to identify attendance patterns among 66,967 mothers in NFP sites across the USA. Mothers enrolled from 1996 to 2010. Data were collected by home visitors and aggregated by the NFP National Service Office. Five visit attendance patterns were identified. Consistent attenders (22%) remained engaged for the full program and attended 51.3 visits on average. Inconsistent attenders (9%) remained engaged but missed many visits, with an average of 36.4 visits. The remaining patterns were characterized by when participants left the program: early (28%; 6.7 visits), gradually (27%; 19.4 visits), or late (15%; 35.3 visits). Consistent and inconsistent attenders were less likely to use English as their primary language than other participants (R = 0.12; p < .001). Participants with more nurse changes per visit attended were more likely to drop out early (R = 0.11; p < .001). Sites with a higher percent of missing data had smaller portions of mothers who remained consistently engaged in the program over time (b = - 0.032; p < .01) and greater portions in the late (b = 0.007; p < .04) and gradual attrition classes (b = 0.018; p < .01). The large number of participants who dropped out early is concerning. Further exploration of this group may optimize use of resources by improving either retention or targeting of potential participants.
| S-EPMC5826902 | biostudies-literature
Project description:We examined visit attendance patterns in the Memphis trial of the Nurse-Family Partnership and associations between these patterns and family characteristics, outcomes, and treatment-control differences in outcomes.We employed repeated measures latent class analysis to identify attendance patterns among the 228 mothers assigned to receive home nurse visits during pregnancy and until the child was aged 2 years, associated background characteristics, outcomes, and treatment-control differences by visit class. Home visits were conducted from June 1990 to March 1994. We collected outcome data from May 1992 to April 1994 and July 2003 to December 2006.We identified 3 visit attendance patterns. High attenders (48%) had the most visits and good outcomes. Low attenders (33%) had the most education and the best outcomes. Increasing attenders (18%) had the fewest completed visits during pregnancy, the poorest intake characteristics, and the poorest outcomes. Treatment-control group differences varied by class, with high and low attenders having better outcomes on some measures than did their control group counterparts.Three patterns were associated with distinct groups of mothers with different long-term outcomes. Further examination and use of patterns to classify mothers and prioritize resources may improve efficiency in the Nurse-Family Partnership.
| S-EPMC4161640 | biostudies-literature
Project description:Nurse-Family Partnership (NFP) targets intensive prenatal and postnatal home visitation by registered nurses to low-income first-time mothers. Through 2013, 177,517 pregnant women enrolled in NFP programs. This article projects how NFP will affect their lives and the lives of their babies. NFP has been evaluated in six randomized trials and several more limited analyses of operational programs. We systematically reviewed evaluation findings on 21 outcomes and calculated effects on three more. We added outcome data from the NFP national data system and personal communications that filled outcome data gaps on some trials. We assumed effectiveness in replication declined by 21.8 %, proportionally with the decline in mean visits per family from trials to operational programs. By 2031, NFP program enrollments in 1996-2013 will prevent an estimated 500 infant deaths, 10,000 preterm births, 13,000 dangerous closely spaced second births, 4700 abortions, 42,000 child maltreatment incidents, 36,000 intimate partner violence incidents, 90,000 violent crimes by youth, 594,000 property and public order crimes (e.g., vandalism, loitering) by youth, 36,000 youth arrests, and 41,000 person-years of youth substance abuse. They will reduce smoking during pregnancy, pregnancy complications, childhood injuries, and use of subsidized child care; improve language development; increase breast-feeding; and raise compliance with immunization schedules. They will eliminate the need for 4.8 million person-months of child Medicaid spending and reduce estimated spending on Medicaid, TANF, and food stamps by $3.0 billion (present values in 2010 dollars). By comparison, NFP cost roughly $1.6 billion. Thus, NFP appears to be a sound investment. It saves money while enriching the lives of participating low-income mothers and their offspring and benefiting society more broadly by reducing crime and safety net demand.
| S-EPMC4512284 | biostudies-literature
Project description:BackgroundNurse turnover is a significant issue and complex challenge for all healthcare sectors and is exacerbated by a global nursing shortage. Nurse-Family Partnership is a community health program for first-time pregnant and parenting girls and young women living in situations of social and economic disadvantage. In Canada, this program is delivered exclusively by public health nurses and only within a research context. The aim of this article is to explore and describe factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada between 2013 and 2018.MethodsInterpretive description was used to guide sampling, data collection and analytic decisions in this qualitative component drawn from the British Columbia Healthy Connections Project mixed methods process evaluation. Semi-structured, individual interviews were conducted with 28 public health nurses who practiced in and then exited Nurse-Family Partnership.ResultsNurses were motivated to join this program because they wanted to deliver an evidence-based program for vulnerable young mothers that fit with their personal and professional philosophies and offered nurse autonomy. Access to program resources attracted nursing staff, while delivering a program that prioritizes maintaining relationships and emphasizes client successes was a positive work experience. Opportunities for ongoing professional development/ education, strong team connections, and working at full-scope of nursing practice were significant reasons for nurses to remain in Nurse-Family Partnership. Personal circumstances (retirement, family/health needs, relocation, career advancement) were the most frequently cited reasons leading to turnover. Other factors included: involuntary reasons, organizational and program factors, and geographical factors.ConclusionsPublic health organizations that deliver Nurse-Family Partnership may find aspects of job embeddedness theory useful for developing strategies for supporting recruitment and retention and reducing nurse turnover. Hiring nurses who are the right fit for this type of program may be a useful approach to increasing nurse retention. Fostering a culture of connectivity through team development along with supportive and communicative supervision are important factors associated with retention and may decrease turnover. Many involuntary/external factors were specific to being in a study environment. Program, organizational, and geographical factors affecting nurse turnover are modifiable.
| S-EPMC7478534 | biostudies-literature
Project description:Introduction"Big data" - including linked administrative data - can be exploited to evaluate interventions for maternal and child health, providing time- and cost-effective alternatives to randomised controlled trials. However, using these data to evaluate population-level interventions can be challenging.ObjectivesWe aimed to inform future evaluations of complex interventions by describing sources of bias, lessons learned, and suggestions for improvements, based on two observational studies using linked administrative data from health, education and social care sectors to evaluate the Family Nurse Partnership (FNP) in England and Scotland.MethodsWe first considered how different sources of potential bias within the administrative data could affect results of the evaluations. We explored how each study design addressed these sources of bias using maternal confounders captured in the data. We then determined what additional information could be captured at each step of the complex intervention to enable analysts to minimise bias and maximise comparability between intervention and usual care groups, so that any observed differences can be attributed to the intervention.ResultsLessons learned include the need for i) detailed data on intervention activity (dates/geography) and usual care; ii) improved information on data linkage quality to accurately characterise control groups; iii) more efficient provision of linked data to ensure timeliness of results; iv) better measurement of confounding characteristics affecting who is eligible, approached and enrolled.ConclusionsLinked administrative data are a valuable resource for evaluations of the FNP national programme and other complex population-level interventions. However, information on local programme delivery and usual care are required to account for biases that characterise those who receive the intervention, and to inform understanding of mechanisms of effect. National, ongoing, robust evaluations of complex public health evaluations would be more achievable if programme implementation was integrated with improved national and local data collection, and robust quasi-experimental designs.
| S-EPMC10476150 | biostudies-literature
Project description:IntroductionAlmost 20 000 babies are born to teenage mothers each year in England, with poorer outcomes for mothers and babies than among older mothers. A nurse home visitation programme in the USA was found to improve a wide range of outcomes for young mothers and their children. However, a randomised controlled trial in England found no effect on short-term primary outcomes, although cognitive development up to age 2 showed improvement. Our study will use linked routinely collected health, education and social care data to evaluate the real-world effects of the Family Nurse Partnership (FNP) on child outcomes up to age 7, with a focus on identifying whether the FNP works better for particular groups of families, thereby informing programme targeting and resource allocation.Methods and analysisWe will construct a retrospective cohort of all women aged 13-24 years giving birth in English NHS hospitals between 2010 and 2017, linking information on mothers and children from FNP programme data, Hospital Episodes Statistics and the National Pupil Database. To assess the effectiveness of FNP, we will compare outcomes for eligible mothers ever and never enrolled in FNP, and their children, using two analysis strategies to adjust for measured confounding: propensity score matching and analyses adjusting for maternal characteristics up to enrolment/28 weeks gestation. Outcomes of interest include early childhood development, childhood unplanned hospital admissions for injury or maltreatment-related diagnoses and children in care. Subgroup analyses will determine whether the effect of FNP varied according to maternal characteristics (eg, age and education).Ethics and disseminationThe Nottingham Research Ethics Committee approved this study. Mothers participating in FNP were supportive of our planned research. Results will inform policy-makers for targeting home visiting programmes. Methodological findings on the accuracy and reliability of cross-sectoral data linkage will be of interest to researchers.
| S-EPMC7239518 | biostudies-literature
Project description:BackgroundChild maltreatment is a great public health concern that has long-term mental and physical health consequences and can result in death. We studied the effect of a nurse home visiting program on child maltreatment among young disadvantaged families in The Netherlands. This study is the first to investigate the effects of this program outside of the United States.MethodsWe conducted a single blind, parallel-group, randomized controlled trial that compared usual care with the nurse home visitation program, which began during pregnancy and continued until the children's second birthdays, in 460 disadvantaged women who were pregnant for the first time and <26 years of age. The primary outcome was the existence of a report about the child from a child protecting services agency (CPS reports). Secondary outcome measures included home environment and child behavior.ResultsTwo hundred twenty-three participants were assigned to the control group, and 237 were assigned to the intervention group. Three years after birth, 19% of the children in the control group had a CPS report. The 11 percent of children in the intervention group with CPS files was significantly lower (relative risk 0.91, p-value 0.04). At 24 months, the intervention group scored significantly better on the IT-HOME. At 24 months after birth, the children in the intervention group exhibited a significant improvement in internalizing behavior (relative risk 0.56, p-value 0.04) but no evidence of a difference from the control group in externalizing behavior (relative risk 0.71, p-value 0.12).ConclusionThe number of CPS reports for the intervention group was significantly lower than that of the control group. Additionally, the long-term home environments were improved and internalizing behaviors of the children were lower in the intervention group.Trial registrationDutch Trial Register NTR854.
| S-EPMC4382107 | biostudies-literature
Project description:Background:Pregnant girls/young women and new mothers living in situations of social and economic disadvantage are at increased risk for poor health. Rural living may compound marginalization and create additional challenges for young mothers. Public health nurses (PHNs) delivering the Nurse-Family Partnership (NFP) to mothers living in rural communities may help to improve maternal and child health outcomes. The purpose of this analysis, grounded in data collected as part of a broader process evaluation, was to explore and understand the influence of rural geography on the delivery of NFP in British Columbia, Canada. Methods:For the analysis of this qualitative data, principles of inductive reasoning based on the methodology of interpretive description were applied. A total of 10 PHNs and 11 supervisors providing the NFP program in rural communities were interviewed. Results:The results of this analysis reflect the factors and challenges of providing the NFP program in rural communities. PHNs noted the importance of NFP in the lives of their rural clients, especially in the face of extreme financial and social disparity. Remaining flexible in their approach to rural nursing and protecting time to complete NFP work supported nurses practicing in rural environments. Rural PHNs were often the sole NFP nurse in their office and struggled to remain connected to their supervisors and other NFP colleagues. Challenges were compounded by the realities of rural geography, such as poor weather, reduced accessibility, and long travel distances; however, these were considered normal occurrences of rural practice by nurses. Conclusions:PHNs and NFP supervisors are well-positioned to identify the modifications that are required to support the delivery of NFP in rural geography. NFP nurses need to articulate what classifies as rural in order to effectively determine how to best provide services to these populations. Environmental conditions must be considered when offering NFP in rural communities, particularly if they impact the time required to deliver the program and additional services offered to young mothers. Regular NFP meetings and education opportunities address common problems associated with rural nursing but could be enhanced by better use of technology.
| S-EPMC6498595 | biostudies-other
Project description:BackgroundThe appropriate nurse staffing reflects the situation of nursing management of human resources. Nurse managers have a pivotal role in determining a competent and sufficient number of nurses. It is important to understand the factors influencing nurse staffing to promote appropriate staffing levels. The study aimed to explore the factors affecting nurse staffing from the perspective of nursing managers.MethodsPurposive sampling was adopted to recruit 14 nurse managers from secondary and tertiary hospitals located in the central region of China, and semi-structured interviews via telephone were conducted from April to May 2022. Interview transcripts were analyzed and collated using thematic analysis.ResultsThis research identified four themes and ten subthemes influencing nurse staffing. Extracted themes include: government level (inadequacy of mandatory policies, budgetary constraints), hospital level (hospital characteristics, the control of nurse labor costs, inadequate support on nursing), patient level (patient characteristics, increasing care needs), and nurse level (nurse shortage, skill-mix, individual high-level needs).ConclusionThe findings indicate that it is crucial for decision-makers or policymakers to legislate for safe nurse staffing and establish effective supervision and funding incentives. Tailored interventions are also needed to improve the organizational context, address the nurse workforce and balance the structure of nurse staff.
| S-EPMC10829222 | biostudies-literature
Project description:IntroductionGlobal ophthalmology opportunities are becoming increasingly popular, and international partnerships are becoming more common among academic training institutions in the United States. There is need for training in the complex relational, motivational, ethical, and logistical issues that may arise in these partnerships.MethodsWe developed a 3-hour case-based session featuring four characters in a fictitious international ophthalmology partnership scenario. Facilitators used structured questions for each of the four parts to foster interaction and discussion among learners. After the activity, participants completed an evaluation/questionnaire consisting of Likert-scale and open-ended questions.ResultsA total of 23 ophthalmology residents and seven medical students underwent the activity over four iterations. The activity was well received, with 100% of learners either strongly agreeing (90%) or agreeing (10%) when asked if the session was worthwhile and 100% of learners either strongly agreeing (87%) or agreeing (13%) when asked if the format was conducive to achieving the learning objectives. Answers to questions on how learners would change how they practice ophthalmology in their residency and in their future careers revolved around the following topics: consideration of other perspectives, humility, self- and situational awareness, complexities of partnerships, reciprocity and exchange, importance of communication, and connection of principles between international and domestic medical practice.DiscussionWhile this case study explores an international ophthalmology partnership scenario, the principles and themes presented can be applicable to other fields of medicine, and can be applicable to the practice of medicine both internationally and domestically.
| S-EPMC11310288 | biostudies-literature