Learning Objective #1: Describe the use of process measures in identifying vulnerabilities in nurses' implementation of an evidence-based program for parents and infants

Learning Objective #2: Articulate quality improvment strategies that may be used to improve the use of evidence-based interventions

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Concern over escalating federal and state costs associated with prevention and treatment programs for vulnerable populations has promoted an emphasis on program outcomes and the translation of effective programs into evidence-based practice. The Nurse-Family Partnership (NFP), a home visiting program for low-income parents expecting their first child, has been identified as a preventive intervention program that meets high evidentiary standards as a result of its being tested and shown to work in three randomized clinical trials. Widespread implementation of efficacious research interventions, however, is unlikely to attain the outcomes demonstrated in research trials unless there is careful attention given to monitoring the quality of implementation through the use of carefully selected process indicators. Analyses of data from 47,000 families served by the program since 1996 indicate that nurses in community practice tend to spend less time on the promotion of competent parenting with families than their counterparts in the trials. In an effort to understand why this may be occurring, a mixed-model regression approach was used to examine site, nurse, and family characteristics associated with the percent of time nurses devoted to helping parents care competently for their children during the first two years following birth. Results of this analysis will be presented. A plan for implementing and evaluating quality improvement strategies to enhance nurses' competence in the promotion of parenting will be described.