Maternal involvement and outcomes in nurse home visiting

Publication Date21 Dec 2015
AuthorTara Flemington,Donna Waters,Jennifer A Fraser
SubjectHealth & social care,Vulnerable groups,Children's services
Maternal involvement and outcomes
in nurse home visiting
Tara Flemington, Donna Waters and Jennifer A. Fraser
Tara Flemington is a PhD
Candidate, Donna Waters is
Dean and Jennifer A. Fraser is
Associate Professor, all at the
Faculty of Nursing and
Midwifery, University of Sydney,
Sydney, Australia.
Purpose Home visiting is a strategy widely implemented to support families following the birth of a baby.
There is a broad consensus that home visiting programmes are successful. But there is little understanding of
factors moderating this success. The purpose of this paper is to examine the relationship between maternal
involvement in a nurse home visiting programme, maternal depression, and adjustment to the parenting role.
Design/methodology/approach A retrospective design was employed in which the medical records of
40 mothers who had been enroled in a nurse home visiting programme were examined. The number of nurse
home visits from birth to six months, maternal depressive symptoms, Home Observation for Measurement of
the Environment (HOME) and responsivity scores were examined. Mothers had been selected for the
programme if they had a history of mental illness, were in a violent relationship, or reported drug or
alcohol problems.
Findings A significant, positive relationship was found between maternal involvement, positive HOME
environment and maternal responsivity scores. Furthermore, the mothers with the highest scores for
HOME environment and responsivity to their infants cues at six months were mothers experiencing
deteriorating symptoms of depression. These mothers had the highest levels of involvement with the
programme. Despite their mothersdeteriorating mental health, infants whose mothers received the greatest
number of visits from a nurse received the greatest benefit ameliorating their risk for developing poor
attachment and impaired behavioural, emotional and cognitive development.
Originality/value This is the first study to examine the relationship between changes in maternal
depression and programme outcomes in a home visiting programme. It is one of the first explorations
of the relationship between maternal involvement and programme outcomes in a targeted nurse home
visiting programme to prevent child maltreatment. The findings from this study are critical to future
home visiting programme development and evaluation.
Keywords Child abuse, Retention, Child maltreatment, Community nursing, Health visiting, Home visiting
Paper type Research paper
The infant of a depressed mother is exposed to sadness, helplessness, hopelessness, irritability
and confusion, and the degree to which these symptoms affect the maternal-infant relationship
depends on the severity and chronicity of these symptoms of depression (Murray et al., 2014).
Impaired maternal behaviour is important because women have a threefold increase in
the relative risk of depression in the postnatal period (OHara and McCabe, 2013). It is
unclear whether the three forms of disorder the blues, postnatal depression and postnatal
psychosis are each a distinct entity, or whether they lie along a spectrum of severity (Harding,
1989; Riecher-Rössler and Steiner, 2005). The importance of maternal psychopathology on
attachment and the healthy development of children has received a lot of research attention, as
the long-term impact of postnatal depression on the mother, her infant and the entire family has
become convincingly established (OHara and McCabe, 2013).
Received 11 February 2015
Revised 20 August 2015
Accepted 20 August 2015
DOI 10.1108/JCS-02-2015-0006 VOL. 10 NO. 4 2015, pp. 311-323, © Emerald Group Publishing Limited, ISSN 1746-6660
PAG E 31 1

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