Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Lois C. Howland, DrPH, MSN, RN, Chairperson; Mary-Rose Mueller, PhD, RN; Mary Jo Clark, PhD, RN, PHN


at-risk Postpartum, home visitation services, maternal-child health, nursing, public health nurses, women


During the late 19th century, public health nursing emerged in the United States as an autonomous nursing specialty providing maternal-child health (MCH) home visitation services. Present day MCH public health nurses (PHNs), guided by their predecessors, focus on health promotion and disease prevention in at-risk maternal-child populations. Health policies, funding streams, and local public health nursing protocols are examples of extrinsic factors that may affect length of home visitation services for at-risk women and their children. The purpose of this study was to better understand the factors related to variations in PHN decisions to terminate home visitation services for at-risk postpartum clients. The participants in this qualitative descriptive study were MCH PHNs working in a Southwestern United States public health nursing department. Snowball sampling was incorporated in order to reach a purposive sample saturation of 18 PHNs. The data consisted of verbatim transcripts of semi-structured, open-ended interviews with individual participants; field notes; and analytic memos. Data analysis was an ongoing process of conventional content analysis which included the incorporation of new data and researcher reflections. Consensual validation of the results was achieved through the participation of the research committee members' peer review of the analysis process and study results. This work has resulted in three manuscripts. The first manuscript, "The Patient Protection and Affordable Care Act of 2010(PL 111-148): An Analysis of Maternal-Child Health Home Visitation," was published in the journal of Policy, Politics, and Nursing Practice. The second and third manuscripts, "At-Risk Postpartum Clients Receiving Public Health Nurse Home Visitation Services, Part I: Opening a Case; and Part II: Closing a Case," describe the study methodology and research findings. Study results indicated that PHN case closure decisions occur along a continuum of cognitive analysis and intuition. Services are rendered on a short-term or long-term basis and length of services are affected by PHN, workplace, and client factors. The findings suggest the need to advance the research specific to PHN home visitation services for at-risk postpartum women and their children.

Document Type

Dissertation: Open Access



Included in

Nursing Commons