Date of Publication


Project Team

Faculty Advisor: Carol Buck-Rolland EdD, APRN; Site Mentor: Magdalene CR Miller, RN, BSN, CLC


  1. 1. Abstract
    1. a. Background: A Wisconsin Population Health study indicates that Orleans County Vermont ranks thirteenth out of fourteen Counties in health outcomes and socioeconomic risk factors, and fourteenth in quality of life (Foundation, 2018). Research in the United States shows that eight to fifteen percent of children live with a parent with a diagnosis of depression, and depression has been associated with a two to three times greater risk for inflicting physical abuse, neglect, and psychological aggression on a child (Sampson, Duron, Mauldin, Kao, & Davidson, 2017). Depression levels, stress levels and coping skills can be identified through home visiting (Fraser, Armstrong, Morris, & Dadds, 2000), and pregnancy risk factors have been found to be modifiable with early home visiting intervention, at a significantly high intensity with increased exposure to antenatal education (Goyal, Folger, Hall, Teeters, Van Ginkel, & Ammerman, 2016).
  1. b. Objectives: Establish a schedule for one of the three home visiting nurses to be present in the North Country Ob/gyn (NC OBGYN) office one day a week to increase referral rates and acceptance rates from 27% to 40% for the home vising nurses program for Medicaid eligible mothers in rural Vermont.
  1. c. Methods: Utilize the Clinical Nurse Leader role to coordinate and collaborate within the health care system by using a systems theory approach to provide delivery of care for patients and families as a series of processes extending from the home to the primary care practice and other community health and social services (Margolis, et al., 2001). Increase the acceptance rates for the home visiting nurse program from 27% to 40% for patients at the NC OBGYN office by establishing a schedule for the home visiting nurses to be present at the NC OBGYN office one day per week anticipating that patients may be more likely to engage in the home visiting nurse program after meeting with one of the nurses for a face to face referral meeting.
  1. d. Results: There were 15 patients that agreed to see the home visiting nurse at the OBGYN office during the project period and five of these patients agreed to a referral to the home visiting nurse program. All five patients who agreed to a referral to the home visiting nurse program accepted the services. The referral rate declined during the project period, but the acceptance rate increased from 27% to 100%.
  2. e. Implications: The implementation of the Clinical Nurse Leader (CNL) role to support the NC OBGYN office and North Country Hospital Maternal Child Health (NCHMCH) unit will provide a comprehensive microsystem assessment of the patient population and use this knowledge and further problem identification to make action recommendations for these pregnant mothers. The highest risk mothers continue to be the most difficult to engage in home visiting services so opportunities should be explored for supporting patients through education and care coordination in neutral environments through group education sessions or fairs. There is also the potential to expand this project model to provide home visiting nurses at the Women Infant Children (WIC) office, or the pediatrician offices to meet with patients postpartum to provide education regarding the home visiting nurse program. This model could also be expanded and utilized at the primary care office by Vermont Chronic Care Initiative (VCCI) nurses to meet with patients in conjunction with medical appointments to provide in home case management for patients with chronic conditions.

Document Type


Included in

Nursing Commons