Many definitions of "health" recognize that it is not only about the absence of disease, but also about the presence of wellness. Within the County of San Diego Health and Human Services Agency, the Healthy Works chronic disease prevention program has partnered with Public Health Nursing (PHN) to ensure the presence of physical, social and emotional wellness for hundreds of vulnerable families through the PHN home visitation programming.
PHN programs have a goal to protect and support pregnant women, children, families and communities, especially at-risk, low-income mothers and their families. These PHN programs, Maternal and Child Health (MCH) and Nurse-Family Partnership (NFP), accomplish this goal through home visits, where the nurses interact with new families in their own environments. This model allows nurses to establish a bond with these families, which in turn, empowers these families to shape goals for healthier living.
Through the Community Transformation Grant (CTG) from the Centers for Disease Control and Prevention, Public Health Nursing developed a CTG Training Policy that establishes additional training standards for public health nurses related to motivational interviewing and Nursing Child Assessment Satellite Training practices. These practices promote social and emotional wellness among pregnant and postpartum women, infants and children. The policy also ensures that during home visits, all public health nurses will offer education to clients to address tobacco/substance abuse, poor nutrition and physical inactivity.
This comprehensive and holistic policy approach to health coaching aligns with Live Well San Diego, the County's long-term initiative for healthy, safe and thriving communities.
There are roughly 70 public health nurses in San Diego County working through this model. Each nurse has between 25 to 35 cases (i.e., expecting or new moms, or, the whole family) at a time. Each year, PHN programming like MCH and NFP impacts close to 2,000 families per year.
Linda Lake, PHN Supervisor at North Coastal Public Health Center, explains that motivational interviewing techniques strengthen the impact that nurses have with their clientele that are unsure about what to do with certain healthy behaviors, such as breastfeeding and smoking cessation.
"Having the idea for change come from the client is a powerful way to develop a good relationship with a client, which is the foundation of our work," she says. Each nurse typically works with each family between two and two-and-a-half years.
Lake also explained that although counseling techniques like motivational interviewing have been used for many years to help people improve their health behaviors, it is not always easy to adopt a new technique. Constraints such as training new staff in a timely manner and differing requirements for the programs within PHN have both been challenging in the past. However, with support from Healthy Works, public health nurses were able to receive these new and effective trainings.
The CTG Training Policy has enhanced Public Health Nursing's success in promoting not only social and emotional wellness and parenting skills, but also physical health promotion for prevention of chronic disease.
Today, San Diego County's public health nurses are telling some powerful stories of change that they have seen in the mothers and families they serve. Below is an account of an inspiring mother who was supported by a PHN.
Dianne Bourque, Senior PHN with Central Region, shared her story about working with Mary.* Mary is a 20-year-old expecting mother who was 16 weeks pregnant when she received her first home visit, and very excited about her first baby. She was taking college classes at a local community college, and working toward an associate degree in English Literature. Mary shared with her nurse that she was raped a few years ago by a male friend and has been traumatized ever since with diagnosis of PTSD. She also shared that she had been involved in the past with counseling and therapy but didn't follow through. Mary had frequent anxiety attacks, and her methods of coping with her depression and anxiety were trying to relax and smoking cigarettes.
With motivational interviewing techniques, the public health nurse asked Mary open-ended questions and discovered that she really wanted a healthy pregnancy and baby. When asked what could help her to do just that, "change talk" occurred about wanting to quit smoking, but she wasn't ready quite yet to explore her options. Dianne reassured her that "when you are ready, we could come up with a plan of action together."
Dianne and Mary developed a trusted bond and utilized the motivational spirit in their communications during visits. Over the course of several months, Mary began seeing a therapist again, and took a series of classes on behavior modification techniques through Kaiser. She subsequently signed up for "Partnership for Smoke Free Families" and quit smoking.
Today, Mary has a healthy baby boy. She experienced challenges during her pregnancy, but because of the trusted relationship she had with Dianne, Mary was able to share and overcome them.
"No one is perfect," Dianne shared with her, "but we can evaluate and come up with other ways to cope and reduce stress [so that you are not tempted to turn to smoking again]."
Mary graduated from the NFP program in November 2013 and is now enrolled at Arizona State University, studying for her Bachelor of Science in Family and Human Development. She is thinking of going on for her Master's in Social Work once she completes her Bachelor degree. Her son is now 30 months old, enrolled in Early Head Start, healthy and developmentally on target. Today, Mary states she is still smoke-free.
This is just one of many stories with a happy, healthy ending. As programs like the Community Transformation Grant move efforts like this forward, the hope is for many more.
*Client's name is replaced with a pseudonym to protect confidentiality.