The Nurse Family Partnership (NFP) program is a home visitation program that targets low income parents expecting their first child. With the nurse delivering services, the program is designed to facilitate positive changes that improve health outcomes for the woman and her baby. Despite successful program implementation in mostly urban communities across the United States, obstacles exist to implement Nurse Family Partnership in rural communities. The purpose of this practice inquiry was to collaborate with Pima County Health Department and Nurse Family Partnership to evaluate the feasibility of implementing the Nurse Family Partnership program in Pima County rural communities. As part of this practice inquiry collaboration, the first aim completed a community assessment of Arivaca to identify rural community strengths and potential barriers to implementation and thus serve as an implementation prototype for Pima County Health Department. Descriptive statistics were utilized from the Arizona Department of Health Services Arizona Vital Statistics, U.S. Census Bureau, and Arizona Department of Health Services needs assessment data sets to assess population characteristics and the Nurse Family Partnership eligible population in Arivaca. Additionally, a windshield survey was conducted to assess community referral capacity and/or program champions, existing public/community health programs or services linkages, and issues due to rurality such as transportation challenges and driving time/distances. The second practice inquiry aim developed an implementation plan, including an evaluation component, alongside Pima County Health Department that expands Nurse Family Partnership into additional rural communities in Pima County. The Nurse Family Partnership implementation plan template was utilized to identify community need and population characteristics, Pima County Health Department mission and culture, organization capacity, nursing practice and support, community linkages, sustainability, and financing and fiscal policy support. Descriptive statistics were utilized from the Arizona Department of Health Services Arizona Vital Statistics, U.S. Census Bureau, and Arizona Department of Health Services needs assessment data sets to describe a community profile to complete the Nurse Family Partnership implementation plan template. This practice inquiry demonstrated that completion of a windshield survey and review of descriptive data sets in the proposed service areas helps to identify community referral capacity and/or program champions, existing public/community health programs or services linkages, and issues due to rurality. This process can be used as a prototype for Pima County Health Department prior to implementation in the entire proposed service area.

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Background: To date, little is known about the perspectives of healthcare and social service providers on the acceptability of long-term home visiting programs serving low-income, first-time mothers within a community. The present study reports on the experiences and perspectives of community professionals who participate in program referrals or deliver auxiliary services to these mothers who are enrolled in the Nurse-Family Partnership (NFP), a targeted nurse home visitation program. Methods: The present study comprised two phases. In phase one, a secondary qualitative data analysis was conducted to analyze a purposeful sample of 24 individual interviews with healthcare and social service providers, which was part of a larger qualitative case study examining adaptations required to increase the acceptability of NFP for families and service providers in Hamilton, Ontario, Canada. In phase two, identified themes from phase one were further explored and confirmed through individual, semi-structured interviews with service providers using a qualitative descriptive approach. Findings: Healthcare and social service providers recognized the added value of NFP to existing community services for low-income, first-time mothers. The public health nurses (PHNs) who delivered the NFP intervention were perceived as playing a crucial role in connecting the first-time mothers to community services, preparing them for motherhood, and for preventing or ending the involvement of child protection services. NFP services were not perceived as interfering with the logistics of existing services being delivered; they were viewed as addressing an important service gap. Discussion: This is the first qualitative study to examine the acceptability of a home visiting intervention from the perspectives of healthcare and social service providers in a community context. The study findings have relevance for policymakers by informing the general understanding of how a new early childhood prevention program is integrated among existing community-based supports servicing low-income, first-time mothers. / Thesis / Master of Health Sciences (MSc)

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Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. Adolescent girls and young women who are pregnant or 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. In the context of a large-scale process evaluation, I posed the question: “In what ways do Canadian public health nurses explain their experiences with delivering this program across different geographical environments?” This thesis represents a purposeful attempt to examine the experiences of public health nurses as they deliver the Nurse-Family Partnership program across different geographical settings in British Columbia, Canada. The qualitative methodology of interpretive description guided study decisions and data were collected through focus groups and semi-structured interviews with public health nurses delivering the Nurse-Family Partnership program and their supervisors. Consisting of three studies linked by their focus of evaluating Nurse-Family Partnership in British Columbia, this thesis explores influences on program delivery across the rural-urban continuum, including issues related to nurse recruitment, retention, and turnover. Overall, the findings from these analyses suggest that the nature of clients’ place and their associated social and physical geography emphasizes that geography has a significant impact on program delivery for clients who were living with multiple forms of oppression and it worked to reinforce disadvantage. In manuscript one, exploration and description of factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada are presented. Then manuscript two reflects the factors and challenges of providing the NFP program in rural communities. The final manuscript applies an intersectional lens to reveal how the nature of clients’ place and their associated social and physical geography emphasizes inadequacies of organizational and support structures that create health inequities for clients. The collective work of this thesis emphasises the importance of location as a factor affecting home visitation programs. In rural environments, public health nurses are resourceful and can provide insight into important considerations for program delivery. These may include enhanced use of technology for communicating with supervisors, nurses, or clients through cell phone/videoconferencing or experiencing rugged terrain and extreme weather conditions. Public health nurses practicing in urban areas also have geographical considerations that are location specific, including precariously housed clients whose locations are transient and providing care to clients living in unsafe conditions. Across all environments, time was a valued commodity and effective communication was essential. Supporting nurses as they deliver Nurse-Family Partnership in Canadian communities can help nurse retention in a program with many positive attributes. Working with vulnerable populations, building relationships with clients, regular reflective supervision and team meetings were among the top reasons public health nurses enjoyed being involved in Nurse-Family Partnership. Reasons leading to turnover are also discussed. / Dissertation / Doctor of Philosophy (PhD) / Living in social or economic disadvantage is associated with negative health outcomes for Canadian families. Young mothers and their children are one such group at risk for suboptimal health outcomes, creating a significant public health concern. The Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. As this program is evaluated for uptake in Canada, this thesis examines the delivery within the context of Canadian geography. Factors that influence program delivery for public health nurses in Canada are explored.

The Nurse-Family Partnership (NFP) is an evidence-based public health initiative targeted to young, pregnant, first-time mothers impacted by social and economic disadvantage. This study is part of an embedded qualitative process evaluation from a larger cluster RCT trial. The purpose of this study was to understand NFP supervisor roles, responsibilities, and experiences associated with the uptake of a new IPV intervention by nurse home visitor into existing NFP practice. / The Nurse-Family Partnership® (NFP) is a home visitation program for young pregnant and first-time mothers affected by social and economic disadvantage. In response to intimate partner violence (IPV) experienced by women and children involved in the program, a nursing intervention was developed to support nurse home visitors identify and respond to IPV. Within each participating NFP team, supervisors were accountable for facilitating the implementation process of the IPV intervention for uptake into nurse home visitor practice. To understand the functions of NFP supervisors involved with the facilitation of the implementation process for the IPV intervention, an interpretive description approach was utilized involving primary data collection from interviews with 11 supervisors and 2 managers, and triangulated with secondary data from 7 focus groups (n=35 nurses). From this analysis, an NFP supervision framework was developed that included 4 domains, 7 roles, 3 sub-roles and multiple responsibilities. Supervision was found to involve roles and sub-roles functioning in oversight of implementation and others that functioned in the direct implementation of the IPV intervention, forming levels of supervision, and creating a hierarchy. A comprehensive appreciation of NFP supervisor domains, roles, sub-roles and responsibilities enacted during the implementation process is important to help identify the best alignment of human resources, recognize how the NFP can best support supervisors, and to champion achievement of current and future innovation implementation goals. Recommendations of support for supervisors include facilitating educational opportunities, creating transparency of the implementation process, developing a quality improvement strategy, providing supervisor mentorship, improving standardization, and recognizing the competing NFP priorities for supervisors and nurse home visitors. / Thesis / Master of Science (MSc) / The Nurse-Family Partnership® (NFP) is a home visitation program targeted to young mothers, pregnant with their first child. To support nurse home visitors identify and respond to intimate partner violence (IPV) experienced by NFP mothers and children, an IPV intervention was developed. Within the NFP implementing agencies, supervisors were instrumental in ensuring the IPV intervention was delivered as intended, forming what is known as the implementation process. This qualitative interpretive descriptive study involved interviews with 11 supervisors and 2 managers, as well as a secondary analysis of 7 focus groups (n=35 nurses) to understand and describe the roles and responsibilities supervisors had within this process. From the analysis of these data, an NFP supervision framework was developed that included articulation of 4 domains, 7 roles, 7 sub-roles and multiple responsibilities affiliated with this position. This framework offers a new language for supervision which may become a first step to better understanding, communicating, and developing supervision in home visitation, and in particular, articulating the functions supervisors are required to lead when faced with the responsibility for implementing a new innovation within their program. It is important to understand NFP supervisor functions of the implementation process to enable NFP strategies that will best support supervisors, ensure responsibilities belong to the right person, and meet implementation goals when adopting evidence into NFP nurse home visiting practice.

<p>The 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 context of the US, and is currently being evaluated in the Canadian public health care system, little has been done to document how work of this nature influences or impacts public health nurses (PHNs), an essential component of this program delivery model, on both professional and personal levels. This qualitative interpretive descriptive study explored PHNs’ experiences of long-term home visiting a targeted population of young, vulnerable mothers in a Canadian NFP program. The study was conducted in two phases beginning with a secondary analysis of five focus groups conducted with public health nurses (N = 6) who delivered the NFP intervention as part of the feasibility and acceptability pilot in Hamilton, Ontario. This was followed by further exploration of identified themes and a practice, problem and needs analysis through individual, semi-structured interviews with the original focus group participants and all PHNs who have since delivered the NFP (N =10). Relationships formed with clients, the NFP program and support of NFP colleagues were rewarding factors while workload and workplace factors were significant contributors to stress. The study findings have implications for the identification of strategies to minimize staff turnover, PHN burnout, secondary traumatic stress and compassion fatigue, and improve program delivery.</p> / Master of Science in Nursing (MSN)

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