Understanding the Influence of Geography on the Delivery of the Nurse-Family Partnership Program in British Columbia, Canada
Notice bibliographique
Résumé
Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. Adolescent girls and young women who are pregnant or living in situations of social and economic disadvantage are at increased risk for poor health. Rural living may compound marginalization and create additional challenges for young mothers. In the context of a large-scale process evaluation, I posed the question: “In what ways do Canadian public health nurses explain their experiences with delivering this program across different geographical environments?” This thesis represents a purposeful attempt to examine the experiences of public health nurses as they deliver the Nurse-Family Partnership program across different geographical settings in British Columbia, Canada. The qualitative methodology of interpretive description guided study decisions and data were collected through focus groups and semi-structured interviews with public health nurses delivering the Nurse-Family Partnership program and their supervisors. Consisting of three studies linked by their focus of evaluating Nurse-Family Partnership in British Columbia, this thesis explores influences on program delivery across the rural-urban continuum, including issues related to nurse recruitment, retention, and turnover. Overall, the findings from these analyses suggest that the nature of clients’ place and their associated social and physical geography emphasizes that geography has a significant impact on program delivery for clients who were living with multiple forms of oppression and it worked to reinforce disadvantage. In manuscript one, exploration and description of factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada are presented. Then manuscript two reflects the factors and challenges of providing the NFP program in rural communities. The final manuscript applies an intersectional lens to reveal how the nature of clients’ place and their associated social and physical geography emphasizes inadequacies of organizational and support structures that create health inequities for clients. The collective work of this thesis emphasises the importance of location as a factor affecting home visitation programs. In rural environments, public health nurses are resourceful and can provide insight into important considerations for program delivery. These may include enhanced use of technology for communicating with supervisors, nurses, or clients through cell phone/videoconferencing or experiencing rugged terrain and extreme weather conditions. Public health nurses practicing in urban areas also have geographical considerations that are location specific, including precariously housed clients whose locations are transient and providing care to clients living in unsafe conditions. Across all environments, time was a valued commodity and effective communication was essential. Supporting nurses as they deliver Nurse-Family Partnership in Canadian communities can help nurse retention in a program with many positive attributes. Working with vulnerable populations, building relationships with clients, regular reflective supervision and team meetings were among the top reasons public health nurses enjoyed being involved in Nurse-Family Partnership. Reasons leading to turnover are also discussed.
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Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,023 | 0,005 |
| Communication savante | 0,006 | 0,001 |
| Science ouverte | 0,003 | 0,004 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».