Community Outreach: Nurse-Family Partnership

Amber Blankenship

Western Washington University

Nursing 307: Social Justice

Elizabeth Madison, PhD, RN

October 28, 2016

Community Outreach: Family Nurse Partnership

 Nurse-Family Partnership (NFP) is a government funded community

health program that allows nurses to support young, first time mothers

beginning no later than 28 weeks gestation through to the childs second

birthday. Registered Nurses (RN) who have obtained a Bachelor Science in

Nursing (BSN) provide education and emotional support to these clients via

64 planned home visits throughout the two and a half years of service. FNP

is an evidence base program shown to improve outcomes for young families

involved, the child, and community. Program goals are to maintain a healthy

pregnancy and healthy lifestyle postpartum, to attain self-efficiency and

economic independence, and to identify childs developmental milestones.

This past year the program has served 101 families.

Judy Ziels RN, MPH, a public health nurse for the Whatcom County

Health department, who is also the Whatcom county representative and

supervisor for the NFP program. Judy sat with our group to present this

program, answer our questions and provide guidance for our future careers.

I enjoyed our conversation with Judy; she was very informative as a nursing

mentor and I appreciated her pleasant and professional demeanor. The

agency itself felt well organized and was clear they provided compassionate

care to their clients. The plan of care was appropriate and nurturing for both

clients and staff. For example, time is allotted for what is called reflective

supervision which provides weekly one hour sessions with the supervisor,

Judy, to reflect on the RNs caseload and provide quality assurance.

 The agencys website is very thorough and informative and a good

representation of the existent program. Our group was able to answer a

number of questions and develop our own questions prior to meeting with

Judy. The website detailed the model of which the NFP follows as well as

detailed specific theories which provided rational for this model. These

theories are: one, Self-efficiency theroy, which describes how we as humans

tend to commit more desirable behaviors when we believe it will produce a

desirable outcome. Two, Human Ecology theory, which describes how

parents care for their children is influenced by their relationships with other

family members, friends and the community. Three, Attachment theory,

theorizes children who have received nurturing care will grow to be nurturing

parents themselves (Nurse-Family Partnership, n.d.).

The population search was a bit cumbersome and frustrating for

myself. As a group, we decided to divide questions out and each research

our own assigned. I had a challenging time finding out the number of

churches in the county. I went as far as calling the Whatcom County Human

Resources department to find direction. However, even the young lady who

answered my call was unsure where to find an accurate censes. This was

frustrating. Otherwise, the research process, though daunting, was

applicable to our visit and the information retrieved facilitated to detail the

larger picture of the community service program.

The population served would, of course, be that of young woman of

child bearing age. This is 35% of the Whatcom County population. However,
this number represents all women of child bearing age in Whatcom and is

inclusive of those of low income and those of higher income. Thus, it is not a

well-defined representation of the population served.

Currently, as Judy explained, the Whatcom County health department

employs two full time and one part-time RN. There is a goal for each full

time RN to care for 25 clients. However, due to the large geographical

boundaries of the county, many clients are spread apart which increases

travel time. Therefore, at this time, each fulltime RN is able to take on 22

clients. Although it is not clear, my assumption is the part time RN would

care for half of this number. Judy stated that there is a waitlist for their

program and she is working towards hiring a fourth full-time RN within the

months to come.

The average age of mothers served in Whatcom County ranges from

14 to 38 years with a medium age of 20. As previously stated, these

mothers must be of low income to qualify. It was found that higher income

mothers had more resources available and the program did not provide them

as many advantages. The targeted clients are women whom have minimal

resources and as Judy explained that first time mothers feel vulnerable and

more likely to accept help. Although I do not recall asking specifics about

ethnicity, I researched via google and found a Whatcom County Council

Agenda Bill for the FNP program which was dated October 18th, 2016. This

bill describes the dominant population served as having risks including:

Hispanic culture, geographic isolation, history of depression, under age 21,

and familial substance abuse (Whatcom County Council Agenda Bill, 2016,

p.1). However, a handout received from Judy reads client demographics to

be 77% white, 25% Hispanic/Latino, 9% American Indian/Alaskan native and

5% African American (Nurse-Family Partnership, 2016).

Concerns for which these populations may seek assistance come to

reality once the young mother faces parenthood for the first time and enters

possible crisis. Concerns are due to a lack of income, knowledge and social

support. All of which can be intimidating to any young first time mother and

may create feelings of aghast and fear. The Nurse-Family partnership

provides support to the mother and family by building an emotional bond,

encouraging goal setting and educating on healthy practices and avoiding

risky behaviors.

Minority groups statistically experience higher rates of poverty and are

faced with challenges in receiving employment. Even when employed,

minorities statistically earn less income than those of dominate groups such

as white males. This challenge, coupled with gender differences (sexism)

places increase turmoil on these first time mothers which can lead to further

disparities. Poor working environments welded by debt can lead to increased

strain which is related to prevalence of domestic violence. Such combination

of disparities is known to lead to increased incidence of depression, chronic

disease, and alcohol and substance abuse (Sensoy & DiAngelo, 2012).

Healthy and safe working conditions can lead to financial security and
improved self-esteem as well as create an improved sense of social status in

the community.

Living within a lower income community creates invisible sociocultural

pressures on families and perpetuates a cycle of poverty and psychological

distress. Family and cultural practices which result from living in low income

neighborhoods where there is a low employment rate and limited jobs

available within the community itself, creates social isolation. This

perpetuates social practices and lifestyles opposing steady employment and

education (Klebanov, Brooks-Gunn, & Duncan, 1994). Poverty itself creates

psychological stresses and depression which may cause poor parenting and

possible abuse.

This community outreach assignment has helped to open my mind and

better visualize the barriers to healthcare which each individual may

possess. It has always been my personal vision that each one of us has the

ability to attain goals so long as we are determined enough to do the work

and jump the hurdles. Hardships are present in every life. I am presently

able to see more clearly how some barriers are less possible to break down

due to the invisible sociocultural walls that have been built over hundreds of

years. Williams, Costa, Odunlami, & Mohammed (2008, para 6) stated:

Cost-benefit analysis of the NFP reveals that there is a $17,000 return to society for each

family served by the program. These benefits were calculated based on the programs

impact on societal outcomes such as crime, substance abuse, teen pregnancy, child abuse

and neglect, and domestic violence.

 FNP is an evidence based program to support young, first time mothers

of low income and few social resources in hopes to improve outcomes for the

family and child involved. It is a great investment for the community as well.

Investing into community members, by providing education and resources to

build their futures and attain goals, will deliver positive impact on the county

as well. Community leaders could expect to see an increase employment

rate, a reduction in poverty per capita, decrease crime rate, and an overall

improved economy.

Myself, as an emergency room nurse, can use this knowledge while

participating in patient care from admission to discharge. Some

considerations at discharge is the patients ability to fill prescribed

medications or ability to travel to follow up appointments as well as language

and cultural differences.

Applying theories of social determinants of health will help better guide

my personal practice to view the broader picture of patient circumstances to

better advocate for these populations. In understanding sociocultural

differences, we, as nurses, can begin to focus care further upstream which

will direct our practices toward prevention and provide better outcomes for

our patients and overall community.

Resources

Klebanov, P. K., Brooks-Gunn, J., & Duncan, G. J. (1994). Does neighborhood

and family poverty

 affect mothers parenting, mental health, and social support? Journal of

Marriage and

Family, 56(2), 441455. https://doi.org/10.2307/353111

Nurse Family Partnership-NFP (2016). Whatcom county nurse-family

partnership [handout].

Whatcom County Public Health, Bellingham, WA.

Nursing theory | Nurse Family Partnership - NFP. (n.d.). Retrieved October 31,
2016, from

http://www.nursefamilypartnership.org/nurses/nursing-theory

Sensoy, O., & DiAngelo, R., (2012). Is everyone really equal? An introduction
to key concepts in

social justice education. New York, NY: Teachers College Press.

Whatcom County Council Agenda Bill. (2016, October). Agreement Between

Whatcom

County and Thrive Washington. (Publication No. RCW 2016-315).

Retrieved from:

http://www.whatcomcounty.us/DocumentCenter/View/22907

Williams, D. R., Costa, M. V., Odunlami, A. O., & Mohammed, S. A. (2008).

Moving upstream:

How interventions that address the social determinants of health can

improve health

and reduce disparities. Journal of Public Health Management and

Practice: JPHMP,

14(Suppl), S8-17.

https://doi.org/10.1097/01.PHH.0000338382.36695.42