Listening with care: using narrative methods to cultivate nurses’ responsive relationships in a home visiting intervention with teen mothers

Abstract

Effective public health nursing relies on the development of responsive and collaborative relationships with families. While nurse-family relationships are endorsed by home visitation programs, training nurses to follow visit-to-visit protocols may unintentionally undermine these relationships and may also obscure nurses’ clinical understanding and situated knowledge. With these issues in mind, we designed a home visiting intervention, titled Listening with Care, to cultivate nurses’ relationships with teen mothers and nurses’ clinical judgment and reasoning. Rather than using protocols, the training for the intervention introduced nurses to narrative methods and therapeutic tools. This mixed-method pilot study included a quasi-experimental design to examine the effect of the intervention on teen mothers’ depressive symptoms, self-silencing, repeat pregnancy, and educational progress compared to teens who received usual care. Qualitative data was collected from the nurses to evaluate the feasibility and acceptability of the intervention and therapeutic tools. The nurses endorsed the therapeutic tools and expected to continue using them in their practice. Despite the lack of statistically significant differences in outcomes between groups, findings suggest that further study of the intervention is warranted. Future studies may have implications for strengthening hidden aspects of nursing that make a difference in the lives of teen mothers.

Design matters in home visiting improvement

“…With a small sample size, it is difficult to assist true statistical significance. 30 Attrition has also been studied. Women conveyed they are too busy, have housing issues, or they don't feel the program is helpful, and these are the top several reasons for leaving home visiting in NFP.…”

From Particularities to Context: Refining Our Thinking on Illness Narratives

“…Importantly, the physicians also did not take into account the parents' knowledge of how each medication was affecting Lia. Rather than reading this moment of "noncompliance" as the failure of treatment comprehension by an immigrant family, the moment should be read with attention to economics, access, and the clinician's ability to listen with care [16].…”

Being there and being with families: Family understandings of public health nurse-family relationships.

“…The precariousness of relationships between PHNs and families is well documented in the literature (Byrd, 1995;MacLeod et al, 2005;Moules et al, 2010;SmithBattle, 1997;SmithBattle et al, 2012). Relationships are tenuous, particularly in the beginning where there is "a careful testing of boundaries, rules, and conditions of the relationship" (Moules et al, 2009, p. 3).…”

“…The nurse essentially connects with the family through the shared feelings associated with anxiety. More important to developing empathic links is how the nurse responds to these feelings (SmithBattle et al, 2012). If the nurse is attuned to their own ways of being and acting in relationship, and has taken the time to observe how the family responds, then theoretically her response should be congruent with the experience of the family.…”

“…Studies that have explored the relational processes involved in developing, maintaining, and ending relationships have found that underlying most good working relationships is a need for nurses to be highly attuned and in synchrony with families (Appleton, 1996;Briggs, 2006;Chalmers, 1992;de la Cuesta, 1994;DeMay, 2003;Moules et al 2010;SmithBattle, 1997;SmithBattle, Lorenz, & Leander, 2012). MacLeod et al (2005) liken the process to a "tip toe dance"; "a precarious interaction full of tentative advances and retreats" (p.32).…”