Understanding the Influence of Geography on the Delivery of the Nurse-Family Partnership Program in British Columbia, Canada
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.023 | 0.005 |
| Scholarly communication | 0.006 | 0.001 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".