Laying the Groundwork for Academic-Practice Partnerships: Insights from a Needs Assessment with Nurse-Family Partnership Stakeholders

Low-income, first-time mothers face significant challenges, including limited healthcare access, inadequate social support, and high stress levels, which contribute to persistent health disparities, especially in rural and minority populations. The Nurse-Family Partnership (NFP) program, established in 1977, provides evidence-based support through home visits by registered nurses from pregnancy until a child's second birthday to improve maternal and child health outcomes. Integrating graduate nursing students into the NFP program through an Academic-Practice Partnership (APP) offers opportunities to enhance nurse training while expanding NFP's capacity to serve vulnerable families and reduce health disparities. Local Problem: Utah faces unique challenges in addressing maternal and child health due to its high birth rate-13 live births per 1,000 residents in 2023, compared to the national average of 10.7 live births. This elevated birth rate, coupled with significant health disparities among minority and low-income populations, highlights the urgent need for targeted interventions to improve outcomes for vulnerable families. Expanding evidence-based programs, like NFP, is critical to addressing these issues. Methods: A needs assessment was conducted to evaluate the feasibility of integrating graduate nursing students into the NFP program through an APP. Semi-structured interviews were held with key stakeholders, including academic leaders, NFP administrators, nursing directors, students, and healthcare system representatives. Interviews explored perceived benefits, challenges, readiness, resource needs, and impacts on client care. Responses were transcribed and analyzed using thematic content analysis. Interventions: Interventions included a literature review and semi-structured stakeholder interviews to assess the feasibility of integrating graduate nursing students into the NFP via an APP. The literature review established an evidence-based context. Stakeholder interviews explored barriers, facilitators, sustainability, and resource needs, informing the development of evidence-based recommendations for APP implementation. Interviews with nine participants-students, faculty/leadership, and NFP national service office directors-were analyzed using thematic content analysis. Key themes, organized into Background, Obstacles/Compliance, Supporting Progress, Program Development, and Performance Metrics. The "Background" category explores academic-practice partnerships from established programs and NFP perspectives. "Obstacles and Compliance" highlights barriers and legal considerations. "Supporting Progress" encompasses resources and facilitators for successful implementation. "Program Development" focuses on curriculum, skills, and training for implementation. Finally, "Performance Metrics" includes sustainability measures and success indicators. Three key points emerged consistently across the interviews: concern regarding potential student interference in nurse-client relationships, emphasis on systemic support for the program, and the importance of integrating NFP concepts into nursing curricula. These recurring themes underscore the critical areas of focus for successful implementation of an APP. By addressing these key considerations, the NFP and colleges of nursing can effectively implement APPs to improve outcomes for vulnerable populations.

1 Laying the Groundwork for Academic-Practice Partnerships: Insights from a Needs Assessment with Nurse-Family Partnership Stakeholders Grace Jordan, Shawna Sisler, and Carolyn Scheese College of Nursing, University of Utah NURS 7703: DNP Scholarly Project III March 17, 2025 2 Abstract Background: Low-income, first-time mothers face significant challenges, including limited healthcare access, inadequate social support, and high stress levels, which contribute to persistent health disparities, especially in rural and minority populations. The Nurse-Family Partnership (NFP) program, established in 1977, provides evidence-based support through home visits by registered nurses from pregnancy until a child’s second birthday to improve maternal and child health outcomes. Integrating graduate nursing students into the NFP program through an Academic-Practice Partnership (APP) offers opportunities to enhance nurse training while expanding NFP’s capacity to serve vulnerable families and reduce health disparities. Local Problem: Utah faces unique challenges in addressing maternal and child health due to its high birth rate—13 live births per 1,000 residents in 2023, compared to the national average of 10.7 live births. This elevated birth rate, coupled with significant health disparities among minority and low-income populations, highlights the urgent need for targeted interventions to improve outcomes for vulnerable families. Expanding evidence-based programs, like NFP, is critical to addressing these issues. Methods: A needs assessment was conducted to evaluate the feasibility of integrating graduate nursing students into the NFP program through an APP. Semi-structured interviews were held with key stakeholders, including academic leaders, NFP administrators, nursing directors, students, and healthcare system representatives. Interviews explored perceived benefits, challenges, readiness, resource needs, and impacts on client care. Responses were transcribed and analyzed using thematic content analysis. Interventions: Interventions included a literature review and semi-structured stakeholder interviews to assess the feasibility of integrating graduate nursing students into the NFP via an 3 APP. The literature review established an evidence-based context. Stakeholder interviews explored barriers, facilitators, sustainability, and resource needs, informing the development of evidence-based recommendations for APP implementation. Results: Interviews with nine participants—students, faculty/leadership, and NFP national service office directors—were analyzed using thematic content analysis. Key themes, organized into Background, Obstacles/Compliance, Supporting Progress, Program Development, and Performance Metrics. The "Background" category explores academic-practice partnerships from established programs and NFP perspectives. "Obstacles and Compliance" highlights barriers and legal considerations. "Supporting Progress" encompasses resources and facilitators for successful implementation. "Program Development" focuses on curriculum, skills, and training for implementation. Finally, “Performance Metrics” includes sustainability measures and success indicators. Conclusion: Three key points emerged consistently across the interviews: concern regarding potential student interference in nurse-client relationships, emphasis on systemic support for the program, and the importance of integrating NFP concepts into nursing curricula. These recurring themes underscore the critical areas of focus for successful implementation of an APP. By addressing these key considerations, the NFP and colleges of nursing can effectively implement APPs to improve outcomes for vulnerable populations. Keywords: Academic practice partnership, Nurse Family Partnership, maternal child health, health disparities, nursing curriculum, colleges of nursing 4 Laying the Groundwork for Academic-Practice Partnerships: Insights from a Needs Assessment with Nurse-Family Partnership Stakeholders Problem Description Low-income, first-time mothers and their children face significant challenges that adversely affect maternal and child health outcomes, including limited healthcare access, inadequate social support, and high stress levels. These factors contribute to persistent health disparities, particularly in rural areas and among minority groups (Centers for Disease Control and Prevention, 2023). The Nurse-Family Partnership (NFP) program emerged in 1977 initially as a randomized clinical trial (Olds et al., 1986) and evolved into an effective evidence-based intervention to address these problems, offering support to expectant mothers through pregnancy and the first two years of their child’s life through regular home visits by registered nurses (Department of Health and Human Services, 2024). The NFP Program is particularly important in Utah due to the state’s high birth rate. Utah has one of the highest birth rates in the United States at 13 live births per 1,000 residents in 2023, compared to the national average of 10.7 live births (Hamilton et al., 2024). The high birth rate combined with significant health disparities in minority populations makes addressing maternal child health a priority (Office of Health Equity, 2021). For example, Native Hawaiian and Pacific Islanders (NHPI) face the highest rate of severe maternal morbidity in Utah with 204.3/100,000 pregnancy related hospitalizations (Utah Department of Health, 2021). NFP is a home-visiting program designed to support young, first-time, low-income mothers from early pregnancy until their child turns two years old. The program aims to improve maternal and child health outcomes, enhance family economic self-sufficiency, and foster positive parenting practices (Olds, 2006). Mothers enroll in the NFP program as early as possible in their pregnancy, ideally by the 28th week of gestation. They can enroll either through 5 provider referral or on their own by contacting NFP directly. The program is then delivered via one-on-one visits by specially trained registered nurses who provide tailored support based on the individual needs of each family. The program typically includes around 60 home visits that each last 60-75 minutes. Initially, visits occur weekly for the first month after enrollment and then transition to bi-weekly or as needed, for a total of approximately 30 months. This structure allows nurses to build strong therapeutic relationships with mothers, which is crucial for effective support and behavior change (Olds et al.,1986). During these visits, NFP nurses provide guidance across several key domains, including personal health, environmental health, life course development, maternal role, family and friends, and health and human services. They focus on a variety of topics such as prenatal health practices, parenting skills, and educational and career planning. Nurses employ evidence-based strategies such as motivational interviewing to empower mothers to set and achieve personal goals while addressing challenges they may face (Olds, 2006). Available Knowledge The NFP program’s impact and effectiveness is supported by extensive research, including multiple randomized controlled trials (RCTs) and long-term follow-up studies. These studies consistently demonstrate NFPs’ effectiveness in improving outcomes for low-income, first-time mothers and their children. Three major RCTs have been conducted to evaluate the NFP program: the initial trial in Elmira, New York, in 1977 (Olds et al., 1986), which laid the foundation for the program's evidence-based interventions; a subsequent trial in Memphis, Tennessee, in 1987 (Kitzman et al., 1997), which further validated its effectiveness in a different population; and a third trial in Denver, Colorado, in 1994 (Olds et al., 2002), which provided additional evidence of the program's impact. These trials targeted first-time, low-income mothers 6 and were followed up at five (Olds et al., 1997) and fifteen years (Olds et al., 2004) respectively, to evaluate long-term outcomes. The findings from these studies highlight numerous positive outcomes associated with NFP participation, including improved prenatal health, fewer childhood injuries, reduced rates of subsequent pregnancies with increased intervals between births, increased maternal employment, improved school readiness for children, and a decrease in incidents of child abuse and neglect (Miller, 2015). Ongoing research and evaluation are integral to the NFP program; data from all home visits conducted by network partners are continuously collected. This data is stored on NFP’s national service office web-based data collection system, analyzed and then returned to local NFP partner sites (NFP, 2024). This ongoing evaluation serves multiple purposes: it provides local partners with information on their progress, assesses trends in outcomes, and supports program evaluation and quality improvement efforts (Olds et al., 1997). Moreover, comprehensive analyses of NFP's predicted outcomes indicate that by 2031, enrollments in the program from 1996 to 2013 will have prevented 500 infant deaths, 10,000 preterm births, 13,000 closely spaced second births that can pose health risks, 42,000 incidents of child maltreatment, and 36,000 cases of intimate partner violence. Additionally, it is projected that the program will prevent 90,000 violent crimes and 594,000 property and public order crimes committed by youth. These projections underscore the substantial long-term impact of the NFP program not only on maternal and child health but also on broader societal outcomes (Miller, 2015). An Academic-Practice Partnership (APP) is a collaborative relationship between an academic institution and a clinical practice setting that aims to develop opportunities for continuing education, clinical training, and provide students with competency-based education 7 (AACN, 2012). An APP could offer several significant benefits. Graduate nursing students can gain valuable practical experience in advanced maternal and child health assessment, health education, and home visitation techniques, enhancing their learning and skill development. Through this hands-on experience, students can develop a deeper comprehension of how social factors impact maternal and child well-being, improving their understanding of the social determinants of health (Wang at al., 2023). This proposed APP between an academic nursing institution and a regional healthcare system aims to integrate graduate nursing students into the NFP program. This partnership has the potential to enhance nurse preparation while simultaneously improving health outcomes for vulnerable populations. By participating in the NFP program, nursing students can develop essential skills in cultural competence, client-centered care, and community resource navigation (Wang et al., 2023). The partnership also has the potential to expand the reach and effectiveness of the NFP program, increasing its capacity to serve more families in need. Perhaps most importantly, by improving the quality of care for vulnerable populations, the APP can contribute significantly to reducing geographical, socioeconomic, and racial health disparities. This multifaceted approach not only enhances nursing education but also addresses critical public health challenges, making it a potentially transformative initiative in maternal and child health care (Knight et al., 2020). The proposed APP aligns with current research on effective strategies for addressing health disparities in maternal and child health. Studies have shown that integrating nursing education with community-based programs can lead to improved health outcomes for vulnerable populations (Knight et al., 2020). Furthermore, the emphasis on cultural competence and 8 understanding social determinants of health in the NFP program is consistent with best practices in reducing health inequities (HHS, 2023). In conclusion, the development of an APP between an academic nursing institution and a regional healthcare system to integrate graduate nursing students into the NFP program has the potential to positively impact both nursing education and maternal-child health outcomes. Implementing a phased training approach for graduate nursing students within the NFP program requires careful planning to maintain the quality of care provided to NFP clients (Wang, et al., 2023). A comprehensive needs assessment is crucial to evaluate the readiness of both the academic nursing institution and the regional healthcare system for an APP, to integrate students into the program, identify potential barriers, and determine resource requirements. Rationale The proposed APP between an academic nursing institution and regional healthcare system aims to integrate graduate nursing students into the Nurse-Family Partnership (NFP) program, addressing critical gaps in nursing education and public health. This initiative has the potential to enhance the training of future nurses while simultaneously improving health outcomes for vulnerable populations, particularly low-income, first-time mothers (Gustin et al., 2024). The NFP program has a proven track record of effectiveness in supporting these mothers, who often encounter multiple challenges that adversely affect maternal and child health outcomes (Department of Health and Human Services, 2024). To effectively address these identified gaps, the APP will utilize theoretical models that guide quality improvement in healthcare settings (Gustin et al., 2024). The NFP model is grounded in attachment theory and social-cognitive theory, emphasizing a client-centered approach that fosters goal-setting and 9 personal development among participants (NFP, 2024). Evidence from multiple randomized controlled trials (Miller, 2015) demonstrates that NFP significantly enhances pregnancy outcomes, child health, and maternal economic self-sufficiency (Miller, 2015). To implement this needs assessment effectively, the Johns Hopkins Evidence-Based Practice Model will be used. This model uses a three-phase approach to develop recommendations for practice based on evidence (Dang et al., 2022). The three phases of this model are ‘Practice’, which involves developing and refining the question and team, ‘Evidence’ which includes searching, appraising, and synthesizing evidence), and ‘Translation’ which is the creating and implementing of an action plan, evaluating outcomes, and disseminating findings. By involving graduate nursing students in this evidence-based intervention, the partnership is expected to yield several benefits. Students will gain practical skills in addressing social determinants of health and health disparities (Knight et al., 2020). Additionally, their cultural competence, client-centered care abilities, and community resource navigation skills will be enhanced; the capacity of the NFP program will increase, allowing more families to be served; and improved care quality and access for underserved populations will contribute to reducing health inequities (Knight et al., 2020). Specific Aims To ensure the successful implementation of this partnership, a comprehensive needs assessment will focus on four primary aims aligned with the finalized objectives. The first aim is to identify initial requirements for successful establishment of the NFP program. This will be achieved with a literature review focused on pinpointing the skills required for effective implementation of the NFP program. 10 The second aim is to assess the resources and skills needed to implement a training program for nursing students as part of an APP, in collaboration with a regional healthcare system and the NFP National Service Office to ensure their perspectives and needs are incorporated into the partnership framework. This will be done by identifying and interviewing key stakeholders from the academic nursing institution, regional healthcare system, and the NFP National Service Office, identifying skills needed for preparing nurses for the specific requirements of the NFP model, and compiling a list of recommended resources needed to implement a comprehensive training program that aligns with the NFP's requirements (NFP, 2024). The third aim is to evaluate the potential benefits of an APP on client outcomes, with a focus on improving the three main NFP goals: pregnancy outcomes, child health and development, and maternal economic self-sufficiency. The final aim is to develop recommendations for a collaborative partnership between the nursing education institution and the regional healthcare system that incorporates NFP's fidelity measures, data collection system, and reflective practice elements to ensure alignment with NFP's mission to serve low-income, first-time mothers. Expected outcomes included a clear understanding of stakeholder perspectives on readiness and resource needs, identification of key skills required for nursing students in the NFP program, insights into potential challenges and solutions, and preliminary recommendations for integrating graduate nursing students into the NFP program. These interventions were designed to provide a comprehensive assessment of the feasibility and requirements for the proposed APP, laying the groundwork for informed decision-making and potential implementation. 11 Ultimately this needs assessment aims to provide a pathway to enhance graduate nurse preparation, improve maternal and child health outcomes, and evaluate the program's effectiveness in supporting low-income, first-time mothers. By achieving these aims, this needs assessment will provide a foundation for implementing an APP that has the potential to improve nursing education while improving health outcomes for vulnerable populations. Methods Context This needs assessment for an APP was conducted within the framework of a prominent academic medical institution and a regional healthcare system in the Intermountain West, focusing on their NFP program in a major city in the western United States (US). The NFP program is designed to support low-income, first-time mothers through regular home visits by registered nurses, addressing critical maternal and child health needs (Department of Health and Human Services, 2024). The assessment encompassed both urban and rural areas across the US served by the NFP program, providing a diverse setting for understanding the challenges and opportunities of implementing an APP across various community health environments. The nursing academic institution is recognized as a leader in nursing education, while the healthcare provider is well-established in the region. The NFP program serves low-income, firsttime mothers through regular home visits by registered nurses, and the proposed APP aimed to integrate graduate nursing students into this existing program structure. Interventions The primary interventions for this needs assessment used a dual pronged approach to identify possible gaps in available knowledge. This approach included completing a literature review, conducting interviews, and developing recommendations based on the findings. First, the 12 literature review provided a strong evidence-based context, offering insights into best practices and areas for improvement when integrating students into community health programs. This evidence-based foundation helped identify theoretical needs based on current knowledge. Next, qualitative interviews were conducted to collect contextual data from key stakeholders involved in the national NFP service office, an academic nursing institution, and a regional healthcare system. The interview process was designed to elicit insights into the feasibility, potential benefits, and challenges of integrating graduate nursing students into the NFP program and establishing an APP. These interviews were designed to add real world perspective, uncover practical challenges, and identify opportunities that may not be readily apparent in the literature. The evidence-based context from the literature and practical insights from stakeholder interviews allowed for identification of critical needs and the holistic approach ensured that recommendations for implementation of an APP were grounded in both theoretical knowledge, and real-world applicability. A semi-structured interview protocol was employed with standardized interview scripts used for each group of participants. The participants were contacted via email with standardized email scripts that described the project and requested their participation (see Appendix D, E, and F). Three interview scripts (see Appendix A, B, and C) were developed with the target interview pools being NFP administrators, DNP students, and academic leadership and faculty from the target academic nursing institutions and other nursing institutions across the United States that have successful partnerships with the NFP program. The scripts were developed by identifying common themes from the literature review and using them to synthesize questions. The questions were open ended and focused on barriers, facilitators, sustainability, and resources needed for the 13 successful implementation of the proposed APP. Interviews lasted 30-60 minutes and were conducted in-person or via video conferencing. All interviews were either transcribed with recording software or by hand to accurately capture participant responses. All transcription was done with the consent of the participants. Data was stored on a personal computer and in a shared Box folder both of which were password protected. Data was only available to the authors. The data collected through stakeholder interviews was analyzed using a thematic content analysis approach. This approach allowed us to trace how the information gathered from stakeholders directly informed our recommendations, establishing a clear link between the intervention (interviews) and the outcome (evidence-based recommendations). Measures The measures for studying the processes and outcomes of our interventions focused on quantitative and qualitative data collection and analysis. For the stakeholder interviews, we developed three semi-structured interview guides that addressed key areas of interest, including organizational readiness, resource requirements, potential barriers, and anticipated benefits and challenges of the proposed APP. The interview guides were informed by findings of a thorough literature review and were evaluated to ensure their validity in capturing relevant information. Additionally, the Plan-Do-Study-Act (PDSA) cycle was used to iteratively refine the guides before interviews took place, ensuring that they were focused on eliciting the most important and relevant data from participants. We used a systematic approach to measure the effectiveness of our recommendationmaking process. Qualitative data was collected from the open-ended survey and questions during the interviews. We assessed contextual elements by including questions in our interview guides 14 that specifically addressed organizational culture, existing partnerships, and resource constraints. The interviews, which took place over the course of 2.5 months, were recorded, transcribed into text, coded, categorized, and evaluated for common themes. Data completeness was ensured through comprehensive documentation and review of all interviews and analysis processes. Analysis The analysis of data collected through stakeholder interviews employed a thematic content analysis approach. This method employed a combination of inductive and deductive coding using the interview script as a guide. The process included transcribing interviews either by hand or using transcribing software through the virtual meeting software Zoom (Version: 1.10.0.2464). The analysis focused on identifying key factors related to the feasibility of integrating graduate nursing students into the NFP program, potential barriers and facilitators, and recommendations for implementation of an APP. Following data collection, a combination of inductive and deductive coding was used via the qualitative coding software Dedoose, jointly by the authors, categorizing codes into broader themes. A codebook was developed by both authors based on the interview questions. Each interview script was coded using the mutually crafted codebook. Additional codes were added as needed throughout the coding process. Four out of nine transcripts were coded concurrently by the student and the project chair with consensus and the additional five were coded independently by the student with a secondary review by the project chair. Ethical Considerations The project was submitted to the University of Utah IRB for exemption. It fell under the category of non-human subject’s research and was deemed exempt from human subject’s review. This project did not require IRB oversight. This needs assessment adhered to fundamental ethical 15 principles governing nursing research. Informed consent was obtained from all participants, including the recording and transcribing of the conversation, ensuring they understood the voluntary nature of their participation, the study's purpose, and their right to withdraw at any time without consequences. To protect participant confidentiality, all data were stored securely. Original data was only accessible to the author and the second coder. Throughout the study, the team adhered to the American Nurses Association Code of Ethics, (ANA, 2015). Results The data collection involved a total of 9 participants, grouped into three distinct categories: students specializing in midwifery, women's health, or family practice concentrations; faculty members and leadership from academic institutions; and national service office directors and site managers from NFP. In-depth interviews were conducted with each participant, and the resulting transcripts were generated to capture the qualitative data. The transcripts were coded using Dedoose, a qualitative data analysis software, which enabled the systematic identification of common themes across the data. Using the raw data from Dedoose, a table was created to clearly highlight the most frequently occurring themes from the codebook, along with detailed descriptors and notable quotes associated with each theme. This table was subsequently reviewed by the authors, during which some codes were refined, collapsed, or regrouped. The key themes from the data were organized into five descriptive categories: Background, Obstacles and Compliance, Supporting Progress, Program Development, and Performance Metrics. The "Background" category explores academic-practice partnerships from established programs and NFP perspectives. "Obstacles and Compliance" highlights barriers and legal considerations. "Supporting Progress" encompasses resources and facilitators for successful implementation. "Program Development" focuses on curriculum, skills, and training for 16 implementation. Finally, “Performance Metrics” includes sustainability measures and success indicators (see Appendix G). Among the most salient findings, three key points emerged consistently across the interviews: concern regarding potential student interference in nurse-client relationships, an emphasis on systemic support for the program, and the importance of integrating NFP concepts into nursing curricula. These recurring themes underscore the critical areas of focus for successful implementation of academic-practice partnerships. Additionally, several visual representations of the data were generated within Dedoose to further illustrate the common themes. A Code Co-occurrence Table was produced to demonstrate how often specific themes were coded together (see Table 1) and a Code Application Table provided insights by showing how frequent each theme appeared within individual transcripts (see Table 2). Additionally, a code occurrence chart was created (see Table 3) which illustrated how often each individual theme appeared in the transcripts. A Word Cloud was generated (see Appendix H) to provide a visual representation of the most frequently occurring codes. These tools effectively highlight the prominence of key themes within the data, offering a clear and engaging illustration of the findings. Collectively the results represent a thorough and nuanced analysis of the data. The analysis of the data revealed that each theme was represented in the transcripts at least once. Notably, the theme "Models" emerged as the most prevalent, with 104 instances of coding. The themes "Academic-Practice Partnership" and "Barriers" were also prominent, each occurring 66 times in the coded transcripts (see Appendix H). This distribution highlights the relative emphasis placed on these key concepts within the participants' interviews. Additionally, 17 the analysis revealed that the themes "Models" and "Academic-Practice Partnership" were most frequently coded together, with 45 instances of concurrent coding (see Table 1). Based on this analysis, a set of evidence-based recommendations were developed for implementing the APP, addressing identified challenges, resource needs, and strategies for aligning educational objectives with NFP program requirements. A poster presentation was developed to present the results of this needs assessment to faculty at the target academic nursing institution (see Appendix I). Discussion Summary The findings from this project align well with the problem statement and theoretical framework, providing insights into integrating graduate nursing students into the NFP through an APP. Key themes from stakeholder interviews included potential student interference in nurseclient relationships, the need for systemic support, and integrating NFP concepts into nursing curricula. These concerns highlight critical areas for effective implementation. The results generally aligned with expectations, though the emphasis on potential student interference was more frequent than anticipated. This underscores the need for careful integration of students to maintain trust between nurses and clients. The project's strengths include diverse stakeholder input, alignment with existing literature, and practical considerations for implementation. By addressing Utah's unique challenges, such as high birth rates, the findings are highly relevant to the local context. Overall, this assessment provides a solid foundation for evidence-based recommendations to implement an APP. Interpretation 18 The results highlight three critical areas that will significantly influence the success of the APP implementation including potential student interference with nurse-client relationships, the need for systemic support, and integration of NFP concepts into nursing curricula. These findings generally align with existing literature on academic-practice partnerships in nursing education. The emphasis on systemic support and curriculum integration is consistent with previous studies that highlight the importance of organizational commitment and tailored educational programs in successful APPs. However, the frequent concern about student interference in nurse-client relationships appears to be a unique finding in this context, possibly due to the sensitive nature of the NFP program and the relationships created therein. The high emphasis on potential student interference in nurse-client relationships was more frequent than anticipated as this was not reflected in the literature (see Appendix J). This could be attributed to several things including the nature of the NFP program, which involves long-term, intimate relationships with vulnerable populations and the stakeholders' deep understanding of the critical role of trust in the NFP model. The project's findings have significant implications for various stakeholders including students, academic institutions, and the NFP organization. For students, the implementation of an APP would provide valuable hands-on experience in community health nursing, potentially enhancing their skills and career prospects. For the involved academic institutions, the findings suggest that curriculum modifications and increased support systems will be necessary, potentially leading to more comprehensive and practice-oriented education. Finally, for the NFP organization the partnership could lead to a more robust pipeline of qualified nurses, addressing workforce needs and potentially improving service quality and reach. 19 The findings are particularly relevant to Utah's context, given its high birth rates and the potential impact of the NFP program on maternal and child health outcomes. The emphasis on systemic support and curriculum integration aligns well with the need for a comprehensive approach to address these unique challenges. Overall, this needs assessment provides a robust foundation for developing evidencebased recommendations to implement an APP between graduate nursing programs and the NFP. The findings highlight critical areas of focus, including the need for careful student integration, strong systemic support, and curriculum alignment. By addressing these key themes, the proposed APP has the potential to enhance nursing education, improve NFP service delivery, and ultimately contribute to better maternal and child health outcomes in Utah. Limitations The primary limitation of this project was the small data set. This is significant to the results of this project for several reasons. A small data set may not adequately represent the broader population which limits the assessment’s applicability. Additionally, there was reduced statistical power because with fewer data points it can be difficult to determine significant trends or differences. During the data collection phase, an unforeseen challenge emerged, contributing to a smaller dataset and potentially limiting the breadth of insights. Some intended participants were unable to engage in an interview due to time constraints or scheduling conflicts. This resulted in data gaps that may have otherwise provided valuable perspectives on the implementation process. These limitations should be considered when interpreting the findings, as additional participant insights could have offered a more comprehensive understanding of the necessary steps for successful implementation. 20 Conclusion This needs assessment was a successful evaluation of the considerations and interventions required for an APP to be successful in this setting. The included stakeholders generally found the proposed intervention worthwhile, recognizing its potential to enhance nursing education and expand NFP’s reach. However, concerns about student interference in nurse-client relationships emphasized the need for careful implementation. This intervention is sustainable with systemic support. A sustainability plan would require NFP leadership and academic partners to drive ongoing collaboration along with monitoring to track performance metrics such as client outcomes, student competency, and ensuring adherence to the NFP model. While this needs assessment was catered to Utah’s context (high birth rates, health disparities), the APP framework could be adapted to other regions with similar challenges, provided local needs assessments and stakeholder buy-in are prioritized. The results of this assessment have significant implications for practice including the potential to strengthen nursing curricula with NFP’s evidence-based practices and highlighting the need to balance educational goals while preserving nurse-client trust. Areas for further study to further inform next steps could be cost effectiveness of integrating graduate students into NFP and strategies to mitigate risks to the nurse-client relationship. Next steps for this project could include the development of a pilot program to test different models of integration, the formalization of a partnership between the academic institution and NFP, the creation of training modules for students and preceptors, and the securement of funding for program expansion. This approach would ideally ensure that the potential of the program is maximized while addressing critical challenges identified by stakeholders. 21 Acknowledgements This project was supported by a generous grant from the Burton family. 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W., Henderson, C. R., Jr, Hanks, C., Bondy, J., & Holmberg, J. (2004). Effects of nurse home-visiting on maternal life course and child development: age 6 follow-up results of a randomized trial. Pediatrics, 114(6), 1550–1559. https://doi.org/10.1542/peds.2004-0962 Olds, D. L., Robinson, J., O'Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., Jr, Ng, R. K., Sheff, K. L., Korfmacher, J., Hiatt, S., & Talmi, A. (2002). Home visiting by paraprofessionals and by nurses: A randomized, controlled trial. Pediatrics, 110(3), 486– 496. https://doi.org/10.1542/peds.110.3.486 Proven Results. (2024). Nurse-Family Partnership. Retrieved December 2, 2024, from https://www.nursefamilypartnership.org/about/proven-results/ SocioCultural Research Consultants, LLC. (2023). Dedoose (Version 9.0.17). cloud application for managing, analyzing, and presenting qualitative and mixed method research data. Los Angeles, CA www.dedoose.com The Guiding Principles for Academic-Practice Partnerships. (2012). Retrieved December 2, 2024, from https://www.aacnnursing.org/our-initiatives/education-practice/academicpractice-partnerships/the-guiding-principles-for-academic-practice-partnerships 25 U.S. Department of Health and Human Services, Administration for Children and Families. (2024). Family Partnership (NFP)® | Home Visiting Evidence of Effectiveness. https://homvee.acf.hhs.gov/models/nurse-family-partnership-nfpr Utah Department of Health: Office of Health Disparities. (2021, January). A Utah health disparities profile: Maternal mortality and morbidity among Utah minority women. Retrieved January 23, 2025. http://healthequity.utah.gov/wpcontent/uploads/2022/02/UtahHealthDisparitiesProfileMaternalMortalityMorbidity2021. pdf Wang, G., Xia, Y., Halili, X., Tang, S., & Chen, Q. (2023). Academic-practice partnerships in evidence-based nursing education: Protocol of a theory-guided scoping review. Nurse Education in Practice, 69, 103644. https://doi.org/10.1016/j.nepr.2023.103644 26 Table 1 Code Co-occurrence Chart 27 Table 2 Code Occurrence in Transcripts Chart 28 Table 3 Code Presence Chart 29 Appendix A NFP Interview Script Introduction “Hello, and thank you for taking the time to join this interview today. My name is Grace Jordan and I am conducting this interview as part of a qualitative study aimed at understanding the challenges of implementing NFP into the curriculum of a college of nursing. As you have a program that has successfully done so, I look forward to gaining your insight. “ “Today’s interview will last approximately 45 minutes, and your insights will be invaluable for improving how nursing students are prepared for roles in community health programs like the NFP. The information gathered from this interview will remain confidential and will be used solely for research purposes.” Permission to Record “Before we start, I would like to ask for your permission to record this interview. Recording will allow me to capture your responses accurately, so I can focus entirely on our conversation. The recording will only be accessible to the research team and will be securely stored. Do I have your permission to record our conversation today?” If permission is granted: “Thank you. I will start the recording now.” If permission is not granted: “Thank you for letting me know. I will take notes instead as we proceed with the interview.” Interview Questions What is your role and how long have you been in it: 1. What were the key steps and challenges in launching the NFP program in your organization, and what strategies were most effective in overcoming these challenges? 2. Which resources (financial, staffing, training) were essential for successful implementation, and what unexpected resource needs arose after the program was established? 3. What are the most important lessons learned from your experience with the NFP program, and what advice would you give to organizations considering implementing a similar program? 4. What strategies have you used to maintain program quality and fidelity to the NFP model over time, and how have you kept staff and community partners engaged? 5. What metrics or indicators have you found most useful for evaluating the NFP program's success, and how do you use feedback from participants to improve the program? 30 6. Can you share any notable outcomes or impacts the program has had on the community you serve? 7. What advice would you offer to an academic institution aiming to develop a partnership with healthcare organizations to deliver the NFP program? 8. What should be the primary focus for an academic-practice partnership to ensure it meets the needs of both nursing students and the communities they serve? 9. Are there particular challenges or opportunities that you believe are unique to academicpractice partnerships in the context of the program? Closing “Thank you very much for sharing your thoughts and experiences with me today. Your input is invaluable for understanding how the College of Nursing at the University of Utah can successfully incorporate the NFP into our curriculum. If you have any additional thoughts after this interview, please feel free to reach out.” “Once again, thank you for your time and insights. I will stop the recording now. Have a great day!” 31 Appendix B Student Interview Script Introduction “Hello, and thank you for taking the time to join this interview today. My name is Grace Jordan, and I am conducting this interview as part of a qualitative study aimed at understanding students’ perspectives and preparation for participating in the Nurse-Family Partnership program. The NFP program is dedicated to supporting low-income first-time mothers by pairing them with nurses who provide guidance and care throughout pregnancy and early childhood.” “Today’s interview will last approximately 45 minutes, and your insights will be invaluable for improving how nursing students are prepared for roles in community health programs like the NFP. The information gathered from this interview will remain confidential and will be used solely for research purposes.” Permission to Record “Before we start, I would like to ask for your permission to record this interview. Recording will allow me to capture your responses accurately, so I can focus entirely on our conversation. The recording will only be accessible to the research team and will be securely stored. Do I have your permission to record our conversation today?” If permission is granted: “Thank you. I will start the recording now.” If permission is not granted: “Thank you for letting me know. I will take notes instead as we proceed with the interview.” Interview Questions 1. What do you currently know about the Nurse-Family Partnership (NFP) program and its goals? 2. What interests you most about potentially participating in the NFP program? 3. What specific skills or experiences do you hope to gain from working with the NFP program? 4. How prepared do you feel to engage in home visits and provide care to low-income firsttime mothers? 5. What types of training or support do you think would be most helpful before starting a role in the NFP program? 6. How comfortable are you with engaging clients from diverse cultural and socioeconomic backgrounds? 7. What concerns or challenges do you anticipate in working as part of the NFP program? 8. How confident do you feel in your ability to address social determinants of health with clients? 32 9. Do you have any suggestions for improving the integration of the NFP program into the nursing curriculum? 10. How do you think the College of Nursing could better prepare students for roles in community health programs like NFP? Closing “Thank you very much for sharing your thoughts and experiences with me today. Your input is invaluable for understanding how the College of Nursing can better support students in preparing for roles within the Nurse-Family Partnership program and similar community health initiatives. If you have any additional thoughts after this interview, please feel free to reach out.” “Once again, thank you for your time and insights. I will stop the recording now. Have a great day!” 33 Appendix C Academic Leadership and Faculty Interview Script Introduction “Hello, and thank you for taking the time to join this interview today. My name is Grace Jordan and I am conducting this interview as part of a qualitative study aimed at understanding the challenges of implementing NFP into the curriculum of the college of nursing. I look forward to hearing your perspective on the feasibility of incorporating NFP into the College of Nursing curriculum via and Academic-Practice Partnership (APP). “Today’s interview will last approximately 45 minutes, and your insights will be invaluable for improving how nursing students are prepared for roles in community health programs like the NFP. The information gathered from this interview will remain confidential and will be used solely for research purposes.” Permission to Record “Before we start, I would like to ask for your permission to record this interview. Recording will allow me to capture your responses accurately, so I can focus entirely on our conversation. The recording will only be accessible to the research team and will be securely stored. Do I have your permission to record our conversation today?” If permission is granted: “Thank you. I will start the recording now.” If permission is not granted: “Thank you for letting me know. I will take notes instead as we proceed with the interview.” Interview Questions 1. What are your initial thoughts on the concept of an Academic-Practice Partnership between the College of Nursing and Intermountain Healthcare for the NFP program, and how do you think this partnership could benefit the training of graduate nursing students? 2. From your perspective, what are the critical skills and competencies that nursing students need to effectively support the NFP program? 3. What challenges do you foresee in implementing this partnership, especially regarding training and integration of nursing students into the NFP program? 4. How prepared do you think the College of Nursing is to support graduate students in delivering the NFP program, and what factors would most influence the readiness of Intermountain Healthcare or other community partners to engage in this partnership? 5. What strengths do you believe the College of Nursing brings to a partnership with the NFP program, and how can Intermountain Healthcare support the educational goals of the College of Nursing in this collaboration? 6. What strategies do you think would be effective in ensuring that the partnership is implemented smoothly and remains aligned with the core goals of the NFP, such as improving maternal and child health outcomes? 34 7. In your opinion, what would be key factors to consider for the long-term sustainability of this partnership? 8. How do you envision the partnership evolving over the next few years to continue meeting the needs of both students and the communities served by the NFP? 9. Are there specific areas where you believe the College of Nursing or Intermountain Healthcare may need additional resources or support to implement this program successfully? 10. Is there anything else you would like to add regarding the potential Academic-Practice Partnership or the NFP program, and would you be open to participating in follow-up discussions or providing feedback as the project progresses? Closing “Thank you very much for sharing your thoughts and experiences with me today. Your input is invaluable for understanding how the College of Nursing at the University of Utah can successfully incorporate the NFP into our curriculum. If you have any additional thoughts after this interview, please feel free to reach out.” “Once again, thank you for your time and insights. I will stop the recording now. Have a great day!” 35 Appendix D Existing Programs Email Template Hello, I hope this message finds you well! My name is Grace Jordan, and I am a Doctor of Nursing Practice (DNP) student at the University of Utah. I am currently working on my DNP project, which involves conducting a needs assessment to explore the establishment of an academicpractice partnership with a local healthcare system. My aim is to integrate the Nurse Family Partnership (NFP) into our graduate and undergraduate nursing curricula. I understand that your university has successfully implemented the NFP program, and I would be grateful for the opportunity to learn from your experiences. Would it be possible to meet with someone from your team for a brief 30–45-minute conversation? I would love to gain insights into the program and discuss any challenges you faced while incorporating it into your nursing curriculum. Thank you very much for considering my request. I look forward to the possibility of connecting! Warm regards, Grace Jordan 36 Appendix E Dean Email Template Hello, I hope this email finds you well. My name is Grace Jordan, and I am a Doctor of Nursing Practice student at the College of Nursing. I am writing to request a brief meeting with the dean regarding an exciting project that aligns with our college's commitment to innovative nursing education and community health. As part of my DNP project, I am conducting a needs assessment to establish an academicpractice partnership with a local healthcare system. The goal is to integrate the Nurse-Family Partnership (NFP) program into our graduate and undergraduate nursing curricula. This initiative has the potential to enhance our students' learning experiences while also benefiting our community's health outcomes. I would be grateful for the opportunity to meet with the dean for a 30–45-minute conversation to discuss: 1. The potential impact of integrating NFP into our nursing programs 2. Insights on overcoming challenges in curriculum integration 3. Possibilities for collaboration between the College of Nursing and local healthcare systems I believe this project aligns well with our college's mission to advance nursing science and prepare the next generation of nurse leaders. Could you please check her availability for a brief meeting in the coming weeks? I am happy to accommodate her schedule. Thank you for your time and consideration. Best regards, 37 Appendix F NFP Service Office Email Template Hello, I hope this message finds you well! My name is Grace Jordan, and I am currently a Doctor of Nursing Practice (DNP) student at the University of Utah. I am excited to share that I am working on my DNP project, which focuses on conducting a needs assessment to establish an academic-practice partnership with a local healthcare system. The goal is to integrate Nurse Family Partnership (NFP) into our graduate and undergraduate nursing curricula. I would greatly appreciate the opportunity to meet with someone from the national service office for a brief 30–45-minute interview. This conversation would help me gain valuable insights into the program and understand the challenges associated with incorporating it into nursing education. Please let me know if this is something we could arrange. Thank you very much for considering my request! Warm regards, Grace Jordan 38 Appendix G Themes Chart Description: These are the key themes from the data. They were organized into five descriptive categories: Background, Obstacles and Compliance, Supporting Progress, Program Development, and Performance Metrics. Theme Background Academic Practice Partnership Description The concept of an academic-practice partnership, highlighting its role in integrating nursing education with real-world healthcare settings. Supporting Quote “We partnered with our County Health Department. So the funding piece was from the Health Department philanthropic Donors. The School of Nursing piece was the Administration, and obviously finding the nurses” “Implementing NFP like through a school of nursing …really checks all the boxes. As far as your tripart type mission. …service, scholarship and teaching. And so, it hits all of those boxes. And so it's really great for a school of nursing. I mean, it really impacts the community around you.” Obstacles and Compliance “We have an academic side, and we have a medical center side, and they don't really form a systems perspective like there's kind of a divide and services. And so, it's hard to get data from one side to the other.” Barriers Barriers to effective academic-practice partnerships, focusing on challenges with communication, logistics, and relationships “One of the requirements of NFP is that those nurses are BSN prepared, and in our more rural communities. There aren't very many BSN prepared nurses. So that is something that has been a challenge” “Always be aware of as supervisor, …that having students, that often can sometimes take a toll on our clients. So obviously, it's a very therapeutic type of relationship that the nurses have with these clients.” “We try to get as much notice ahead of time of what the students schedule is going to look like as far as 39 Theme Description Supporting Quote like when lectures and when their other clinicals are, because we, we only have 8 weeks to get 40 students through, and so it's a short time, and then they still have their hospital rotation as well in there, and so sometimes it can get a little tricky” Unintended Outcomes Unintended outcomes for the client and student that can arise from academicpractice partnerships in nursing education. “If the same kind client typically has a lot of students. They might end up canceling, or, you know, like not being as engaged in the program. And it might just because they're feeling overwhelmed with all the students.” “We've had a couple of times where students have felt really kind of triggered after a certain visit, especially if it's something that, like they personally have been through or like the client, is showing a lot of really traumatic history” “We don't do ride alongs. This was, you know. We Legal Considerations Legal considerations involved in academicpractice partnerships for nursing education. don't put students in the car with us and have them go on the whole day with a visit.” “Even just little logistics of like the health record. And what do we? What are we doing with that? And making sure the students all are signing the HIPPA things, and you know all those kind of things” “You learn something from sitting in a client's home that you will never learn sitting at the bedside or in an office. There's such great value in experiencing that and seeing the in the world from your patients” “They tell their nurses things that they don't tell their you know, their physician, their midwife, their Relationships Unique and profound you know anybody else, because they have built connections formed between this, you know essentially, by the end of it, a 2-anda-half-year relationship. You really become almost nurses and clients in the Nurse-Family Partnership like part of the family. And so, there's a lot of trust.” (NFP) program. “[It] is all about the relationship and trust, you know, and all of those things, and so having to have people [students] coming cycle through, you know. Kind of for me, felt like an intrusion.” “Something that I have to always kind of be aware of as supervisor is that having students very often 40 Theme Description Supporting Quote can sometimes take a toll on our clients so obviously, it's a very therapeutic type of relationship that the nurses have with these clients.” Supporting Progress “You know malpractice insurance, or things like that for our nurses. So, there's a lot of protection in being part of a large university system and the School of Nursing, and having those things taken care of.” Resources Various assets and support systems available to academic-practice partnerships implementing Nurse-Family Partnership (NFP) programs. “And so, some of those Sims [simulation experiences] have been used by the whole State of Colorado to implement training for new nurse Family Partnership home visitors coming in, and so that use of the SIM lab is huge.” “I was reaching out to them, you know, like, hey, you know I'm creating these run charts. These are the things that I'm seeing. Can you tell me what you're seeing on your end, on the State level. So, leverage as much as you can with the resources that you have around you” *“They provided funding with several other philanthropic donors for the 1st three years of our project, and just to cover Jefferson County.” “So, we got some grant funding from the State and Federal partners to cover a couple more counties and then have continued to add counties.” Facilitators Factors that have “[They allowed] us to bill for Nurse Family contributed to the successful Partnership services through Medicaid. And when implementation of Nursethat happened, that kind of opened some doors for Family Partnership (NFP) us from a billing perspective. And the hospital was like, ‘Oh, there's money.” programs at other institutions. “I mean, the funding actually came really easily, because people are really invested in helping mothers and babies.” “I did have buy-in from, my executive leadership, at the organization, from my administrator, who also happened to be the COO of my organization. And then I also had a mentor who happened to be the 41 Theme Description Supporting Quote educator for the organization. And so there was buy-in on different levels.” “What's been crucial is just really good support and buy in from the college… a lot of support from leadership has been huge. My administrator is also our department chair for the nursing school, so she's very in touch with what's happening with the program.” Program Development “Which is why I said I was encouraging them to try to do a project to work with families, you know, to present to families, because that would be something useful for them, right? learning the information, creating a presentation, and then actually doing the presentation, but then also good for the family, because the family gets something from that right?” Curriculum The integration of NurseFamily Partnership (NFP) concepts into nursing education curricula. “I think you'd need to make sure you build into your curriculum some basic understanding. There is a lot of schools[that] do talk about nurse family partnership in their curriculum.” “We would need to enhance our curriculum to include specific NFP protocols and practices.” “You know, community health portion. Some people do also integrate it into peds and labor and delivery. There's a lot of different places it can fit, depending on what phase” “I believe there are several critical skills and Skills competencies our nursing students need to develop. Firstly, they need strong assessment skills, The essential competencies particularly in conducting sensitive nursing required for nurses and assessments during home visits, this includes the students involved in Nurse- ability to identify and address issues like intimate Family Partnership (NFP) partner violence. additionally, they need excellent communication and relationship-building skills to programs create connections with clients, often in challenging environments.” 42 Theme Description Supporting Quote “Learning about how to have productive discussions about sensitive topics and learning more about home visit dynamics would be helpful.” “I would hope to gain skills in providing comprehensive women's health education and supporting healthy family dynamics.” “So NFP prioritizes using motivational interviewing”. “Students could gain real-world experience in community health, working directly with vulnerable populations. They'd develop skills in providing culturally sensitive care and addressing social determinants of health. Plus, it would give them a unique perspective on public health nursing that's hard to replicate in a classroom setting.” “Flip their lens from being a, you know, an inpatient bedside nurse to working in the community in someone's home, with the understanding that the client is the expert of their life and not us.” Training The educational aspects of integrating Nurse-Family Partnership (NFP) into academic-practice partnerships. “Students would have the chance to work and learn simultaneously, applying theoretical knowledge to practical situations.” “And so, the nurses are all trained in the debrief training that the college uses, so that we're all doing it the same way with students. But I think that part [the debriefing] has been the most impactful for students.” “Participating in a case conference where they're reflecting on the nurse’s experience with the client. So, I think there's things that are outside of the visit itself, where we actually can learn a lot, too.” Strategies “We found really quickly that outcomes improved Various approaches used to with participation with [the] Nurse Family enhance the effectiveness of Partnership.” Nurse-Family Partnership (NFP) programs within “I encourage them to try to do a project to work with families, you know, to present to families, academic-practice because that would be something useful for them. partnerships Learning the information, creating a presentation, 43 Theme Description Supporting Quote and then actually doing the presentation, but then also good for the family, because the family gets something from that right?” I think having somebody dedicated to CQI (Continuous Quality Improvement). A CQI project takes time…. PDSA’s are small things…. but we also know that those small things are leading towards bigger things and it's [an] iterative process. “The nurses are really good at it. Kind of knowing like, hey, this is a heavier client. I might not take a student to that one. Or definitely, if it's like, it's a new enrollment or you know, things like that. We'll just make sure we don't take the students out on that one. They've done it where they'll go out in the morning with the student, and then they'll give the student a break for lunch, and they'll go see that client, and then they'll meet back up with the student and do another visit,” “Because our outcomes in pockets of Jefferson County were particularly [high] for infant mortality [and] were really, really shocking, and so we partnered with them [the County Health Department].” “But we also have the student’s kind of be on call. So, if the 1st client cancels, and you were supposed to go with that one. You might go to a different visit that day. We don't do ride alongs.” Models Various models and approaches used in implementing Nurse-Family “I have a team of 4 nurses, and then one data administrator and they, the nurse, all serve as Partnership (NFP) programs clinical instructors as well for the college. So, the within academic-practice way it's set up currently is 80% of their salary partnerships. comes from the grant from NFP and then 20% of their salary comes from the college as their clinical instructor role.” “We have team meetings and case conferences that are built into the structure of the model. And so, there is a meeting every week, and you have 2 meetings a month are case conferences and 2 meetings a month of team meetings” 44 Theme Description Supporting Quote “We use live actors as clients [in simulation], and we do the whole pre-brief and debrief everything with that. So that's been another neat thing that I think other programs don't necessarily have access to that has been beneficial for our partnership with the school.” Performance Metrics “Outcomes were great, and so caught the attention of the State, and so we got some grant funding from the State and Federal partners to cover a couple more counties and then have continued to add counties.” “I could see this partnership expanding in several ways. We might develop joint continuing education programs for practicing nurses [and] create interprofessional education opportunities with The long-term viability and other healthcare disciplines” Sustainability growth of Nurse-Family Partnership (NFP) programs “The trickier part that we've had and implementing this program, we're going on about 8 or 9 years within academic-practice now, but is because of the teaching piece. The partnerships. college does require that the nurses have a master's degree, and so that makes their salary a little bit harder, for like the grant, necessarily. So that's how we split it up so that the college covers the 20%. And then the grant can cover the 80% because it's not a requirement for NFP to have an advanced degree.” “When I take graduate students, I actually really love it because it's kind of like I always joke that it's a little bit of free labor. Every year we have to write to reapply for our grant.” “Yeah, we keep a really close eye on pregnancy and birth outcomes. We do preterm birth, low birth weight, and breastfeeding.” Indicators of Success The key metrics used to evaluate the effectiveness of “Yeah, our preterm birth rate in the State of Nurse-Family Partnership Alabama is generally around 12 to 13%. Our NFP client preterm birth rate has been as low as 8.8%. (NFP) programs. Right now, it's about 10%. But that has been the biggest thing.” 45 Theme Description Supporting Quote “A lot of our clients are young. If you're in high school, then, you know, being in school is your job. We look at mental health. We look at depression and anxiety in school, and how they improve after engagement with the program. “What do we both want here? What are the aims? And then you guys decide what your indicators of success are.” 46 Appendix H Word Cloud Description: A visual representation of the most frequently occurring codes from the qualitative coding analysis 47 Appendix I Poster Description: Poster for presentation of needs assessment to faculty at target institution. 48 Appendix J Literature/Interview Comparison Table Description: Comparison of information from the literature review to insights from the stakeholder interviews. Theme Literature Review Insights Knowledge of NFP Program NFP is a home visitation CNM student: Familiar with basic goals; program for first-time mothers WHNP student: Unaware of NFP before in poverty, focusing on discussion. Both students expressed interest maternal and child health in its goals after learning about them. outcomes. Skills to Be Gained Emphasis on trauma-informed Students hope to gain skills in women’s care, healthy attachment health education, family dynamics, and promotion, and addressing SDOH. Faculty highlighted assessment skills, social determinants of health communication, and relationship-building as (SDOH). critical competencies for home visits. Preparedness Students feel confident in for Home Visits clinical care but less prepared for addressing social/economic factors or pediatric issues. Interview Insights WHNP student: Concerned about home visit logistics; CNM student: Intimidated by intimate settings of home visits. Faculty emphasized the need for better training in community health and sensitive assessment. Training Needs Training on local resources, Students requested training on community child development milestones, resources and strategies for sensitive and home visit dynamics is discussions. Faculty suggested curriculum essential. enhancements to include NFP protocols and interdisciplinary coursework. Comfort with Diverse Populations Students are moderately comfortable working with diverse populations but lack extensive experience. Both students expressed comfort but acknowledged limited hands-on practice with diverse socioeconomic groups. Faculty emphasized cultural sensitivity as a key skill to develop through partnerships. Challenges Addressing complex social issues and navigating intimate home settings are major concerns. Students anticipate difficulties in resource navigation and communication during home visits. Faculty noted logistical challenges like aligning schedules and ensuring adequate support for students and staff. Established programs emphasized concerns about student interference in nurse client relationships. 49 Benefits of Academic Partnerships Partnerships provide realworld experience, enhance public health focus, and improve community impact. Faculty highlighted experiential learning opportunities and alignment with healthcare trends. Academic leadership emphasized bridging academic learning with clinical practice as essential for preparing future nurses. Suggestions for Greater focus on public health Students suggested electives or shadowing Curriculum nursing, interdisciplinary opportunities in community health programs. Change collaboration, and community Faculty recommended interdisciplinary health integration is needed. coursework with public health/social work students to enhance preparation. Vision for Partnership Evolution Partnerships should focus on continuous improvement in maternal-child health outcomes through innovative practices. Faculty envision expanding partnerships to include more NFP sites, developing joint continuing education programs, and fostering interprofessional education opportunities over time. 50 Appendix K Executive Summary Introduction: This project aims to evaluate the feasibility of integrating graduate nursing students into the Nurse-Family Partnership (NFP) program through an Academic-Practice Partnership (APP). The initiative addresses the clinical challenge of improving maternal and child health outcomes for low-income, first-time mothers while enhancing nursing education and expanding NFP’s capacity to serve vulnerable populations. Background: Low-income, first-time mothers face significant barriers, including limited healthcare access, inadequate social support, and high stress levels, contributing to health disparities. Utah’s high birth rate and persistent socioeconomic and racial disparities further exacerbate these challenges. The NFP program has a proven track record of improving maternalchild health outcomes, and integrating graduate nursing students into this evidence-based program offers a dual benefit: enhancing nurse training and increasing NFP’s reach. Results: The needs assessment revealed three major findings: 1. Concerns about potential interference in nurse-client relationships by students 2. Emphasis on systemic support to sustain the partnership 3. Importance of integrating NFP concepts into nursing curricula for effective implementation. Practical benefits for stakeholders include improved patient outcomes, enhanced nurse training, reduced health disparities, and increased program sustainability. A cost-benefit analysis showed that the APP could be implemented with minimal additional resources while yielding significant long-term societal benefits. Category Costs Benefits Training Resources Moderate upfront costs Enhanced nurse preparation Program Expansion Increased workload Improved maternal-child health outcomes Sustainability Efforts Systemic support required Reduced health disparities Conclusions and Recommendations: 1. Develop a phased training programs for graduate nursing students within NFP to maintain care quality. 2. Enhance nursing curricula to include cultural competence and client-centered care frameworks. 3. Secure systemic support from academic institutions and healthcare systems to sustain the APP initiative. 51 4. Enhance performance metrics to monitor outcomes and ensure program effectiveness over time. The findings from this project can inform policy revisions, guide the implementation of similar programs, and improve care delivery models for vulnerable populations across Utah and beyond.