Visits by Nurses Help At-Risk Mothers, Children Live Longer

Jul. 7, 2014
Nurse-Family Partnership is first early intervention shown to reduce maternal and child mortality

Visits by nurses to the homes of economically disadvantaged mothers help reduce premature death of both mothers and their first-born children, a study co-authored by University of Rochester School of Nursing researchers, and published today in JAMA Pediatrics, has found.
The Nurse-Family Partnership (NFP) program—developed by researchers at the University of Rochester School of Nursing and the University of Colorado Department of Pediatrics—today serves more than 29,000 women in 43 states, and has demonstrated numerous positive effects on first-time parents, including fostering healthier pregnancies and deliveries, improving child health and development, and increasing the economic self-sufficiency of families.
But this is the first time the program has been shown to improve survival rates — not only of the children, but of their mothers too.
Lead investigator David Olds, Ph.D., professor of pediatrics at the University of Colorado, together with study co-authors Harriet Kitzman, Ph.D., R.N., F.A.A.N., senior associate dean for research, and Robert Cole, Ph.D., M.S., associate professor of clinical nursing at the UR School of Nursing, have extensively examined the impact of the national program by following the lives of more than 1,000 families over two decades.
“Our findings add to the body of evidence that the program produces improvements in the short- and long-term,” Kitzman said. “Mothers have an innate desire to provide the best care for their babies. When nurses empower mothers with the knowledge and skills to better their families’ lives, it transforms life trajectories.”
The randomized, controlled study found that early intervention through nurse-visits decreased the number of deaths of vulnerable mothers and children, who are at high risk for premature death. The study of 1,138 young mothers was done in Memphis, Tenn., and began in 1990. Most participants were African-American, age 18 or younger, unmarried, unemployed, and did not have high school diplomas.
One group of mothers and babies received standard care. The other participants, in addition to receiving standard care, also were visited in their homes by registered nurses during their pregnancies and for two years after the birth of their first child (averaging 64 planned home visits). With randomization, groups were similar at entry into the study. Over the next 20 years, University of Rochester School of Nursing researchers conducted 11 in-depth interviews with each study participant at structured intervals. This required maintaining the whereabouts of families through frequent phone calls, visits, letters, and even birthday and holiday cards.
The program was found to result in a significant reduction in preventable child deaths from birth until age 20. Children in the control group not receiving nurse-home visits had a mortality rate of 1.6 percent for preventable causes including sudden infant death syndrome, unintentional injuries and homicide. There were zero preventable deaths among nurse-visited children. 
In addition, over the same two-decade period, mothers who received nurse-home visits had significantly lower rates of death from all causes compared to mothers not receiving nurse-home visits. Mothers in the control group who did not receive nurse-home visits were nearly three times more likely to die than were nurse-visited mothers. The relative reduction in maternal mortality was even greater for deaths due to external causes like unintentional injuries, suicide, drug overdose and homicide. Mothers not receiving nurse-home visits were eight times more likely to die of these causes than nurse-visited mothers.  
About Nurse-Family Partnership
NFP nurses begin their visits by focusing on the health and well-being of the mother during pregnancy, the importance of good prenatal care, and the mother’s and family’s plans for life with the baby. After the child is born, nurses and mothers discuss how to read and respond to babies’ subtle cues, how to look for signs of illness, what to expect at certain ages, the health risks of smoking, drinking, and violence, and plans for sustaining socio-emotional and economic stability. Building on the bond of trust created while discussing the baby’s welfare, conversations are planned to branch out to other areas such as continuing the mother’s education, housing needs, employment opportunities, the health of other family members,  the availability of resources, and the involvement of the women’s partners and other family members in caring for the child.     
“Low-income, first-time mothers may have limited access to up-to-date scientific parenting information or role-models,” Kitzman said. “By investing in this critical stage of a woman’s life, we not only improve quality of life at a time of stress, uncertainty, and transition, but help first-time mothers develop decision-making capacities and behaviors that will enhance the health of their child and themselves for years to come.”
The research that laid the foundation for the NFP was developed more than 20 years ago by Kitzman and Olds. Working as a pediatric nurse practitioner in the late 1960s, Kitzman actively engaged in home nursing visits and learned first-hand the challenges in the lives of the families she visited. She then connected with Olds, who was conducting a study of home visits in Elmira, NY. Their research results earned federal support for the program which now serves more than 29,000 women in 43 states, the Virgin Islands and six tribal communities through the NFP National Service Office.
In Monroe County, Visiting Nurse Service (VNS), UR Medicine's home care agency, provides all the nurse visits to these first time mothers. The United Way of Greater Rochester is the primary funder for the NFP, and has provided $2.6 million to the program since 2006.
The researchers’ latest finding of reduced premature deaths for nurse-visited mothers and children is consistent with those of studies at earlier phases of follow up which found that the program improves prenatal health, results in fewer childhood injuries, fewer subsequent pregnancies, and that it increases maternal employment and improves school readiness. Mothers who went through the program were also less dependent on welfare, food stamps and Medicaid.
“Having a trusted relationship with a nurse gives mothers confidence to envision a positive future, the desire and willingness to try new activities, and the competencies to overcome obstacles,” Kitzman said. “The powerful bond created between nurses and first-time mothers can help families break the cycle of poverty and put them on a healthier path.”
Kitzman, Olds and Cole were joined on the study by UR School of Nursing research associate  Elizabeth Anson, M.S., and assistant professor of clinical nursing Joyce Smith, Ph.D., R.N., A.N.P., as well as researcher and biostatistician Michael Knudtson, M.S., with the University of Colorado Department of Pediatrics. The study was funded by the National Institute of Drug Abuse.

The powerful bond created between nurses and first-time mothers can help families break the cycle of poverty.

Harriet Kitzman, Ph.D., R.N., F.A.A.N.