Nurse-Family Partnership

Abstract

The Nurse-Family Partnership is an evidence-informed, community health program that serves mothers in their first pregnancies. The aim of the program is to reduce risks that may impair parenting in families from the prenatal stage until early childhood. The program is based on ecological, and developmental principles as well as notions of self-efficacy. In this program nurses develop therapeutic relationships with specific clients whom they visit at home from the pregnancy stage onwards. Family strengths and needs are identified and resources put in place. Nurses provide support as well as education about child development and limitations. Results of the program indicate that nurse family partnerships enhance parenting and reduce child exposure to maltreatment and associated unintentional injuries. Thus, this program is a relevant source for injury prevention in children.

Appendices

BRIO Model: Nurse-Family Partnership

Group Served: Low-income women, pregnant with their first child.

Goal: Improve pregnancy outcomes, improve child health and development, as well as improve the economic self-sufficiency of the family.

Background	Resources	Implementation	Outcome
High-risk neighborhoods in Baltimore were observed to have poor housing, a lack of safe play spaces, high crime levels, and other threats to children’s safety and well-being. David Olds began developing a nurse home visitation model in 1977 to address problems and improve the health of children Three separate clinical trials were conducted and confirmed positive outcomes regarding child injury rates and other child health and developmental outcomes. Positive effects for parents are also noted Program disseminated to six US sites in 1996. In 2000 the program expanded and became an initiative of the National Centre for Children, Families, and Communities	Developing and sustaining the model with fidelity require considerable time and effort from both the national office and the local site The NFP is often embedded in already existing community agencies, which promotes economies of scale Collaborating agencies are responsible for their own funding sustainability plans The exact means of allocating resources varies from state to state	Currently there are more than 260,000 families served in 42 states A state-based approach to program expansion was selected by Olds and his team after research and consultation The Nurse Home Visitor Act (2000) supports the program in Colorado. Similar legislation has passed in Texas and Tennessee to promote Nurse-Family Partnership program development A bill for the New Healthy Families Act (2007) promotes the Nurse-Family Partnership nationwide	Results of three clinical trials were positive in terms of decreased injury rates and other health and social outcomes Elmira program effects for injuries: 56% reduction in emergency room visits. Reduction in child maltreatment 80% Memphis program effects for injuries: reduction in healthcare encounters for injuries was 23%, and reduction in days hospitalized was 80%. In all, control group had 15 trips to hospital compared to four in intervention group. Significant difference between the two groups Denver trial indicated that the program model was transportable to a variety of community and cultural contexts

Life-Space Model: Nurse-Family Partnership

Sociocultural: civilization/community	Interpersonal: primary and secondary relationships	Physical environments: where we live	Internal states: biochemical/genetic and means of coping
Acknowledge the limited resources of the target population. Strategize with client about a plan for long-term economic self-sufficiency Marshal grassroots support for legislation (e.g., through the nonprofit organization Invest in Kids) Approach program expansion with a state-based financial sustainability plan Embed the program in already established community organizations such as public health agencies and health centers Involve the cultural communities served through consultation and inclusive hiring practices	Educate clients to use safety devices according to program guidelines Engage family members of the client in the program activities Explore supportive social networks with the client. Link the client to community resources Ensure staff has the time and ability to develop a personal relationship with client and her family Meet both expected and unexpected needs of the client and her family through a flexible and individualized service plan	Recognize the unsafe housing and living conditions of the population served Attain appropriate safety devices (e.g., window guards, safety gates, car seats, and smoke detectors) through grants and liaison with community agencies	Assess client’s knowledge, experience, and beliefs around baby care and child development Empower the client, using self-efficacy theory, to impact her environment and problem-solve around child safety issues Enhance the client’s level of responsiveness and ability to read child’s developmental cues through attachment theory Help the client reflect on the impact of her own caregiving experiences on her present child rearing