When I arrived in Lancaster County to speak with the nurses about the Nurse Family Partnership (NFP), Theresa Whitesel (nurse supervisor) asked me – Why Lancaster?
I replied that when I was planning my study tour, I came across a newspaper article that described President Obama’s administration as being the first to implement evidence-based health interventions, and named three of these, including the Nurse Family Partnership program in Lancaster County. So of course, I wanted to know more about what they were up to.
Therese and her husband Rick offered for us to stay with them for the duration of our visit. My first thrill of the trip was to be welcomed to the house by Rick in his traditional Scottish kilt. We learnt so much from Rick as he described the political and cultural scene, giving us a vivid understanding of the complexities of administering such a large country, both in population and size. We had just spent the weekend in Washington, so we were keen to know more about US politics.
While Verity attended two of the local schools, I had the pleasure of meeting the NFP team of nurses. I observed some individual nurse supervision sessions, and also attended some home visits, with Beth and Kendra.
The individual supervision is an intrinsic element of the program, with a nurse supervisor providing weekly supervision for up to 8-9 nurses, reviewing the client case-load, providing space for debriefing, and skill development. There is also a weekly team meeting.
A nurse working in the NFP program has a full-time caseload of up to 25 clients. The women are engaged prior to 28 weeks of pregnancy, but preferably around 16 weeks. The nurse offers home visits, initially weekly, and then every two to three weeks, as the child approaches two years of age. Then the family graduates from the program.
Each visit is client-led, however, there is series of topics to be covered. These include health promotion, child development and safety, maternal health and well-being, child attachment and play, and also support in achieving the mother’s employment and educational goals. The nurses have a wealth of resources – and they can be modified to suit the language and educational level of the mother.
This a young mother and her baby whom I met on a home visit with Kendra.
I am constantly reminded that the aim of the program is for the mother to achieve her heart’s desire. The NFP nurse is the facilitator and coach.
I was struck by the similarities to our maternal and child health (MCH) program, the preoccupations of the families, the strength-based approach, and the curriculum which supports and nurtures the mother, so that she can support and nurture her child.
I was also struck by the potential to extend and improve our MCH program, tailoring the delivery and content for vulnerable families. I reflected on how satisfying this work would be for our MCH nurses, with the focus on the relationship between the nurse and mother as the key therapeutic intervention.
The nurses of the Nurse Family Partnership – Lancaster county are highly skilled, dedicated, and I could not have asked for a better opportunity to see this program in practice.
Thanks to Theresa and her team, for the inspiration and generous sharing of your time and expertise.