Kearney M H, York R, Deatrick J A
School of Nursing, Boston College, Chestnut Hill, MA, USA.
J Nurs Scholarsh. 2000;32(4):369-76. doi: 10.1111/j.1547-5069.2000.00369.x.
Nurses' home visits to new parents have been replaced in many high-need communities by nonprofessional visits without clear evidence of effectiveness. Previous reviews of home visiting research have combined nurse and non-nurse interventions and have pooled studies from the US, where home visiting is mainly limited to low-income families, with those from nations where home visiting is a universal service. This integrative review was focused on nurse-delivered interventions in the US and Canada to identify the nursing-specific models with the greatest effect in this cultural context. Evaluation of support for social ecology theory was a secondary aim.
The sample consisted of 20 experimental and quasi-experimental studies of home nursing interventions for families of newborn infants who were vulnerable because of poverty, social risks, or prematurity.
Each report was examined systematically using specific rules of inference and a scoring system for methodological quality. Intervention effects on five outcome domains were described.
Maternal outcomes, maternal-infant interaction, and parenting were more often influenced than was child development, except in preterm infants. Well-child health care did not improve. Effective programs generally began in pregnancy, included frequent visits for more than a year, had well-educated nurses, and were focused on building a trusting relationship and coaching maternal-infant interaction. Social ecology theory was partially supported.
Future nurse home-visiting research should test a combination of these effective components. Nurses can use this information to seek funding of nurse-delivered interventions for vulnerable families.
在许多高需求社区，护士对新生儿父母的家访已被非专业家访所取代，而后者的有效性尚无明确证据。以往对家访研究的综述将护士和非护士干预措施合并在一起，并将来自美国（在家访主要限于低收入家庭）和家访是一项普遍服务的国家的研究汇总在一起。本整合性综述聚焦于美国和加拿大由护士提供的干预措施，以确定在这种文化背景下效果最佳的特定护理模式。对社会生态理论支持情况的评估是次要目的。
样本包括20项针对因贫困、社会风险或早产而处于弱势的新生儿家庭的家庭护理干预的实验性和准实验性研究。
使用特定的推理规则和方法学质量评分系统对每份报告进行系统审查。描述了干预对五个结果领域的影响。
除早产儿外，产妇结局、母婴互动和育儿比儿童发育更常受到影响。儿童健康护理并未改善。有效的项目通常在孕期开始，包括为期一年多的频繁家访，有受过良好教育的护士，并侧重于建立信任关系和指导母婴互动。社会生态理论得到了部分支持。
未来护士家访研究应测试这些有效组成部分的组合。护士可利用这些信息为弱势家庭寻求由护士提供的干预措施的资金。
