Implementing Nurse Home Visitation Programs

Abstract

Nurse home visitation has been an important component of public health for over 100 years. Recent reports of large clinical trials have provided a convincing body of evidence of the cost-effectiveness of home visitation. The findings from these studies have helped to renew policy interest in nurse home visitation as a means of improving health and quality of life for low-income families. Reimplementing home visitation on a large scale, however, will require using nurses with little or no home-visiting experience. Sponsoring organizations must delegate, and nurses from hospitals or clinics must accept, responsibility for both increased autonomy and discretion of home visitors. Case study analysis of observational and interview data from the implementation of a large demonstration home visitation program carried out in a health department in a mid-South city from 1989 to 1994 provides evidence that the bottom-up perspective of Hanf and Toonen (1983) best describes how such programs can be put in place. Nurses with little community experience were able to create appropriate strategies to help families achieve the broad program goals in the context of resource constraints associated with a poverty-level lifestyle and the existing health and human service system. Furthermore, nurses were able to establish an organizational culture and job structure in a city/county health department to support their work.

Development of the role of public health nurses in addressing child and family poverty: a framework for action

“…The benefits of PHN‐managed home visitation to vulnerable and at‐risk families in early childhood are well‐documented (Ciliska et al. 1999, Hanks & Smith 1999, MacLeod & Nelson 2000, Rains & Carroll 2000, Barnes‐Boyd 2001, Olds et al. 2002, Kemp et al.…”

An Evaluation of a Volunteer‐Support Program for Families At Risk

“…Family‐support home visitation programs involving trained volunteer workers or paid professionals in ongoing relationships with families have long been advocated as a strategy for improving maternal and child health and as a child protection initiative (Hanks & Smith, 1999;Monteiro, 1985;Scott, 1997).…”

Does Public Health Nurse Home Visitation Make a Difference in the Health Outcomes of Pregnant Clients and Their Offspring?

“…The goal at the outset was to establish a baseline of information that would guide the Home and Community‐based Nursing section to answer the questions, “Does PHN home visitation make a difference in health outcomes of clients and their families?” (Holtze et al, 2001) and “If so, how can effects be measured?” It was recognized that answering these questions would eventually enable us to ask even more specific questions, such as, “What are the positive results, both health and other, observed in the lives of clients visited by PHNs?”“How much of a difference is made in the health outcomes of clients?” (Barnes‐Boyd, Norr, & Nacion, 2001; Korfmacher, O'Brien, Hiatt, & Olds, 1999), and “How many times should clients be visited in order to ensure the best results?” (Hanks & Smith, 1999).…”