Early Home Visiting Experiences of Mothers and Public Health Nurses

Explore how universal and targeted postpartum home visiting programs were organized, delivered and experienced by mothers, public health nurses (PHNs) and managers

• Having a baby and mothering is positive, exciting, difficult, stressful, complex, psycho-social, emotional and physical

• Maternal child health is a priority area and should be available to all who need it.1-2

• Positive health outcomes associated with PHNs’ century long practice with mothers and babies.

• Two home visiting programs in Nova Scotia• Targeted for ‘at risk’ mothers. Enhanced

assessment and support for up to 3 years• Universal available to all mothers

Problem: PHN practices and health outcomes of mothers not well understoodResearch Question: HOW are early home visiting programs socially and institutionally constructed, negotiated and experienced though relations of power?

Feminist postructuralism (FPS).5-7

• Personal experiences (beliefs, values and practices)• Negotiating relations of power• Social and institutional discourses.5-7

Mothers and PHNs in both programs prioritized: confidence, reduced stress, increased self-esteem &

feeling normal

Mothers and PHNs in both programs described how ‘the home’ provided:

• A safe and comfortable space to build trust• An ideal space for comprehensive and accurate assessments

(more conducive than hospital)

I know that feeling when someone…. Makes you feel like you don’t know what you’re doing. But she didn’t make me feel like that (Mother universal)

Semi-structured interviews (30-90 min) conducted in 2011 in participant homes or at the Public Health office.

• 16 PHNs (9 targeted, 5 universal, 2 in both) • 16 mothers (6 targeted, 10 universal)• 4 Public Health managers

Transcripts analyzed using FPS informed by discourse analysis.

• Health care professionals and mothers need to recognize the invisibility and stereotyping of mothering and PHN work

• Building positive relationships is foundational to supporting mothers

• Home visits provide the best environment to conduct a thorough and accurate needs based assessment

• Health outcomes should be prioritized from mothers’ perspectives

• Tension between targeted and universal programs should be acknowledged and examined

Dr Megan Aston RN PhD1, Dr Sheri Price RN PhD1, Dr Josephine Etowa2, Dr Adele Vukic RN PhD1, Linda Young BSc MPA3, Christine Hart RN BA BScN IBCLC3, Emily MacLeod BACS MA4 and Pat Randel BA MSc1

1Dalhousie University School of Nursing Halifax Nova Scotia, 2School of Nursing University Of Ottawa, 3Capital Health Public Health Services Halifax Nova Scotia 4IWK Health Centre Halifax Nova Scotia

Contact Dr Megan Aston megan.aston@dal.ca

Purpose

Background

Methodology

Data Collection and Analysis

FINDINGS

Recommendations

The Power of Trusting Relationships

Relationships Foundational

TrustComprehensive Assessment

I think that’s probably the most important thing we do, is try to establish relationships with our clients (PHN targeted)

She [PHN] was very understanding, and that made me really open up to her (Mother targeted)

Shifting Relations of Power

Challenge hierarchical

relationsShift position of authority

Equitable nurse/client relationship

A chart will rarely come out of my bag during a visit. I’m very cognizant that me sitting with a chart again gives that kind of power authority role and I’m not going to make a relationship with somebody who probably doesn’t trust the health care system (PHN targeted)

Strengths based Relationships

Focus on positives

Build confidence

Removing JudgmentPHN

Personable friendly cheerful

Mothers

Comfortable & relieved

She was very supportive and she used very positive words all the time. There was never any talking down (Mother targeted)

Targeted and Universal: PHNs’ and Mothers’ Stories

Socially and institutionally constructed concepts of risk

To me it’s that whole dichotomy between the Early Visiting piece and looking at the determinants of health and community development. Why can’t they [the two programs] be moved somehow together? They’re being put at odds (PHN)

Targeted’at risk’ mothers

Universal‘lower risk’ mothersdichotomy

Challenging Stereotypes and Stigma

Home: Location Matters

Redefining Health Outcomes

• Mothers and PHNs challenged the process of the traditional hierarchical nurse-patient relationship

• Both mothers and PHNs challenged stereotypes and judgments of ‘at-risk’ and ‘low-risk’ mothers.

• Mothers and PHNs unveiled important health outcomes which challenged a traditional focus on physical health

Acknowledgments: Nova Scotia Health Research Foundation, Dalhousie University, Capital District Health Authority

It was very reassuring, very much positive reinforcement. Like ‘you’re doing a great job’ (Mother universal)

What if she thinks that I’m a horrible mom or doing things completely wrong (Mother universal)

Mothers fearful of being judgedHere I am with this little baby just afraid that somebody outside is going to recognize that I’m struggling and they’re just going to take my baby. (Mother targeted)

Mothers said PHNs were non-judgmental

I always make sure that I tell them we’re here to support you, we’re not here to judge you and that kind of stuff (PHN targeted and universal)

It made me feel much more confident… more secure… that I didn’t have to worry as much. They kind of calmed my mother instincts to the point where I could cope with it. (Mother targeted)

It’s to get good support early and get her feedings, good quality feedings, and get things into a pattern of confidence (PHN universal)

Other health outcomes included: • breastfeeding and mental health (both programs)• food insecurity and housing (primarily targeted)

Everyone can look the same potentially in the hospital. When you go into their home then you see where they live and who’s around them or not around them, and the supports (PHN universal)

Unintentionally constructed stigma about targeted mothers

Conclusions