Nurse visits bring hospital care to mothers’ homes

In the dim light of her mother’s apartment, 16-year-old Shena Tabert cradled her baby, Da-Shawn, and patiently answered Marty Kulp’s questions about the 1-month-old’s development.

“How is he nursing?” asked Kulp, a public health nurse with the Bremerton-Kitsap County Health District.

Tabert said at first nursing caused soreness in her breasts, and she was ready to quit. But she persisted.

Kulp, a lactation consultant, smiled reassuringly. She took no notes, but watched the interaction between mother and child carefully.

“How about his sleep schedule, is he getting you up a lot during the night?” Kulp probed.

Tabert explained that Da-Shawn usually goes to bed around 11 p.m., wakes up at 3 a.m. and sleeps until between 6 and 8 a.m.

Kulp inquired about Tabert’s relationship with the infant’s father, car seat use and the baby’s shots while Tabert stripped the child to be weighed and measured.

Despite the intimate nature of the questions, the exchange was relaxed and cordial.

Kulp cooed and tried to comfort the child’s cries as she laid him on the scale and recorded his weight.

Kulp is part of a long tradition of public health nurses who have made home visits for more than 100 years. She is one of nine field nurses who make home visits for the Bremerton-Kitsap County Health District.

Although nurses have made house calls for years, the long-term benefits of these pre- and post-natal visits are just beginning to be understood.

Jessie Johnson has been enrolled in the home visits program for more than two years, and she said she valued the nurses’ listening skills.

“I don’t mean to sound selfish, but it’s nice to have someone want to hear all about what’s going on with you,” Johnson said.

Johnson had a hip ailment that was causing back pain, and Kulp helped get her an appointment with a specialist. She even called the doctor ahead of time to explain the problem.

Kulp also has connected Johnson with community resources.

“She talks to me a lot about counseling because I have a lot of issues right now. She makes me aware of my resources,” Johnson said.

As nurses develop a rapport with parents, they often are able to read subtle cues not visible during clinic visits.

“It’s a benefit to see parents in their home because you get a full picture of the home. You can see if they have stairs and if they need safety cages. It’s also on their turf and they’re more relaxed,” said Kulp, who worked in a hospital before becoming a field nurse.

Home visits typically begin with a referral and can continue as needed, Kulp said.

Nurses usually make pre-natal home visits about once a month. After birth, nurses might visit as often as twice a week if mother or child have health problems. In other cases, the frequency of the visits is tailored to meet clients’ needs.

The relationship a nurse cultivates with a family also might uncover other problems, like domestic violence or health difficulties the mother is having.

“(Field nurses) are so unique because they are professionals who take a holistic approach to the family,” said Ruth Westergaard, community liaison for the Bremerton-Kitsap County Health District.

Most women in the nurse home visits program are enrolled through First Steps, a program that enables women to access prenatal care though DSHS, Kulp said.

But she also gets referrals from the Navy, hospitals, the health district’s family planning division and by parent request.

Kulp said she thinks her main jobs are education, support, and helping mothers “really learn to fall in love with their babies.”

She added that home visits have become increasingly important as parents often are more isolated from their extended families.

“With families moving and parents not a close we can help reassure moms they are doing a good job,” Kulp said.

For more information about nurse home visits, call 337-5262.

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