Susan C. Vonderheid

Introduction of CenteringPregnancy in a Public Health Clinic

CenteringPregnancy is a promising group visit prenatal care innovation that provides substantial health promotion content. Elements unique to group care include peer support and self-management training and activities. CenteringPregnancy was introduced at a large public health clinic serving predominantly low-income African American pregnant women. All prenatal care at this clinic was provided by certified nurse-midwives, and all providers were trained in the CenteringPregnancy model. One hundred and ten women received prenatal care in CenteringPregnancy groups. Focus groups of pregnant women, providers, and health center staff reported that the program benefited women despite implementation challenges such as scheduling changes. Compared to women in individual care, women in CenteringPregnancy had significantly more prenatal visits, increased weight gain, increased breast feeding rates, and higher overall satisfaction. This pilot project demonstrated that CenteringPregnancy can be implemented in a busy public health clinic serving predominantly low-income pregnant women and is associated with positive health outcomes.

“They’ve Walked in My Shoes”: Mothers of Very Low Birth Weight Infants and Their Experiences With Breastfeeding Peer Counselors in the Neonatal Intensive Care Unit

The effectiveness of the breastfeeding peer counselor role is thought to be embedded in the relationship between new and experienced mothers. In this study, new mothers of very low birth weight infants emphasized that one of the most important aspects of their relationship with the breastfeeding peer counselors is the peer or shared experience of how difficult it can be to provide milk and breastfeed while coping with the emotional stress of having an infant in the neonatal intensive care unit. This study provides evidence for the promotion and facilitation of lactation for mothers of neonatal intensive care unit infants through the use of breastfeeding peer counselors who are peers by virtue of the shared experience of providing milk for an infant hospitalized in the neonatal intensive care unit.

Prenatal health promotion content and health behaviors.

To improve the effectiveness of prenatal care, there is a need to understand the association between health promotion content and health behaviors during pregnancy. The purpose of this study was to determine the association between prenatal health promotion content and health behaviors during pregnancy among low-income African American and Mexican American women. Twenty-two recommended health promotion topics and their related health behaviors were measured. Structured interviews on health promotion topics and health behaviors were conducted with 159 pregnant women receiving prenatal care at a low-risk urban clinic. Wide variation was found in the number of health promotion topics discussed. Bivariate and regression analyses examined the association between content topics and behaviors. Healthier behaviors were associated with womens reports of discussing more health promotion topics, using fewer substances prepregnancy, and having a more positive attitude toward pregnancy. Data suggest that increasing prenatal health promotion content during routine visits might improve the effectiveness of prenatal care.

Maternal obesity: do patients understand the risks?

Objective:To evaluate patient knowledge of the risks of maternal obesity and compare knowledge between non-obese and obese women.Study Design:A face-to-face survey was administered to 105 women at their first prenatal visit. The survey assessed their knowledge of obesity-related risks during pregnancy, weight history and goals and health behaviors. Descriptive statistics described the entire sample. Students t-test and χ2 tests compared knowledge between non-obese (body mass index (BMI) of <30 kg m–2) and obese (BMI of ⩾30 kg m–2) gravidas.Result:There were 56 (54%) non-obese and 47 (46%) obese participants. There were no significant differences between the weight groups with respect to age, race, insurance, education, tobacco use and primigravity. Overall, 49% participants knew that obesity increases risks in pregnancy. The knowledge of specific risks was similar in the non-obese (60% correct) and obese (64% correct) groups (P=0.76). Obese patients were more aware of the risk for diabetes (68 vs 96%, P<0.001). Obese gravidas expressed more interest in weight loss before another pregnancy (61 vs 81%, P=0.03), although the desired BMIs (22.1±2.3 vs 26.2±3.0 kg m–2, P<0.001) were different for non-obese and obese women, respectively. Of all participants, 9% discussed the risks of maternal obesity with a provider before study participation and 75% wanted to participate in a study on weight loss before pregnancy to determine whether it leads to healthier pregnancies.Conclusion:Regardless of BMI category, patients required more knowledge about the risks of obesity in pregnancy, requested additional information and were motivated to lose weight before future pregnancies. Because obese women underestimated their optimal weight loss goals, it is necessary to target this group for further education.

The Safety Net: Academic Nurse-Managed Centers’ Role

This article reports on a study conducted in 2001 that examined the role of four schools of nursing (SONs) in Michigan and their challenges in serving the safety net population through primary care nurse-managed centers (NMCs). The NMCs are described and compared to community health centers (CHCs) in terms of patient mix, funding sources, and contributions SONs make as a substitute resource for federal funding to the NMCs. NMCs are frequently invisible providers in the health system, yet they serve high-need populations. Similarities and differences between NMCs and CHCs are discussed as well as the unique challenges faced by NMCs and their SONs as the result of policies that sometimes limit NMCs ability to serve safety net populations.

CenteringPregnancy-Africa: a pilot of group antenatal care to address Millennium Development Goals.

BACKGROUND severe health worker shortages and resource limitations negatively affect quality of antenatal care (ANC) throughout sub-Saharan Africa. Group ANC, specifically CenteringPregnancy (CP), may offer an innovative approach to enable midwives to offer higher quality ANC. OBJECTIVE our overarching goal was to prepare to conduct a clinical trial of CenteringPregnancy-Africa (CP-Africa) in Malawi and Tanzania. In Phase 1, our goal was to determine the acceptability of CP as a model for ANC in both countries. In Phase 2, our objective was to develop CP-Africa session content consistent with the Essential Elements of CP model and with national standards in both Malawi and Tanzania. In Phase 3, our objective was to pilot CP-Africa in Malawi to determine whether sessions could be conducted with fidelity to the Centering process. SETTING Phases 1 and 2 took place in Malawi and Tanzania. Phase 3, the piloting of two sessions of CP-Africa, occurred at two sites in Malawi: a district hospital and a small clinic. DESIGN we used an Action Research approach to promote partnerships among university researchers, the Centering Healthcare Institute, health care administrators, health professionals and women attending ANC to develop CP-Africa session content and pilot this model of group ANC. PARTICIPANTS for Phases 1 and 2, members of the Ministries of Health, health professionals and pregnant women in Malawi and Tanzania were introduced to and interviewed about CP. In Phase 2, we finalised CP-Africa content and trained 13 health professionals in the Centering Healthcare model. In Phase 3, we conducted a small pilot with 24 pregnant women (12 at each site). MEASUREMENTS AND FINDINGS participants enthusiastically embraced CP-Africa as an acceptable model of ANC health care delivery. The CP-Africa content met both CP and national standards. The pilot established that the CP model could be implemented with process fidelity to the 13 Essential Elements. Several implementation challenges and strategies to address these challenges were identified. KEY CONCLUSIONS preliminary data suggest that CP-Africa is feasible in resource-constrained, low-literacy, high-HIV settings in sub-Saharan Africa. By improving the quality of ANC delivery, midwives have an opportunity to make a contribution towards Millennium Development Goals (MDG) targeting improvements in child, maternal and HIV-related health outcomes (MDGs 4, 5 and 6). A clinical trial is needed to establish efficacy. IMPLICATIONS FOR PRACTICE CP-Africa also has the potential to reduce job-related stress and enhance job satisfaction for midwives in low income countries. If CP can be transferred with fidelity to process in sub-Saharan Africa and retain similar results to those reported in clinical trials, it has the potential to benefit pregnant women and their infants and could make a positive contribution to MGDs 4, 5 and 6.

Ethnicity and prenatal health promotion content

Prenatal care health promotion education is an important strategy for reducing perinatal health disparities. The purposes of this study were to (a) identify differences between the health promotion content women wanted to discuss and the content women reported discussing and (b) determine whether ethnicity was related to health promotion content. A cross-sectional study used face-to-face interviews to obtain data about 159 Mexican American and African American pregnant womens prenatal experience. Women wanted more health promotion content than they discussed. Despite wanting information about more health promotion topics than African American women. Mexican American women discussed fewer topics. Ethnicity, number of topics women wanted to discuss, whether a woman had a primary provider, and type of prenatal provider model were also related to content.

Financially viable nurse-managed centers.

Nurse managed centers play an important role in the health service delivery system; often serving those in greatest need, while struggling to remain financially viable. This article discusses the role of a Financial Advisory Committee (FAC) and the process of financial peer review in academic nurse-managed centers to improve financial outcomes. Advanced practice nurses may find the identified strategies for financial sustainability useful in their own practices.

Using Focus Groups and Social Marketing to Strengthen Promotion of Group Prenatal Care

Centering Pregnancy, an innovative group model of prenatal care, shows promise to reduce persistent adverse maternal-infant outcomes and contain costs. Because this innovation requires systemwide change, clinics reported needing support enrolling women into groups and obtaining organizational buy-in. This study used the 3-step social marketing communication strategy to help clinic staff identify key customers and customer-specific barriers to adopting or supporting Centering Pregnancy. They developed targeted information to reduce barriers and built skills in communicating with different customers through role-playing. Findings provide practical information for others to use this communication strategy to improve implementation of Centering Pregnancy.

Cost and health outcomes associated with mandatory MRSA screening in a special care nursery.

PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) rates continue to rise and pose a threat to patient health and limited hospital resources. In 2007, Illinois passed a legislative mandate requiring active surveillance cultures to screen for MRSA in all patients in hospital intensive care units. However, professional guidelines do not support mandated universal surveillance cultures, and funding to cover screening costs was not included. The purpose of the study was to examine the costs (personnel, screening test, and supply) associated with the mandated universal MRSA screening and to examine the infant health-related outcomes and costs associated with implementing MRSA screening in a special care nursery. SUBJECTS: Personnel—54 observations of staff members in a community-based hospital in a large midwestern city. Infants—445 infants admitted from January 2008 through January 2009. METHODS: Time and motion (related to screening activities by registered nurses) based on observations of staff during MRSA screenings, and abstraction of health and cost data from the infant log, infant medical records, and financial reports. MAIN OUTCOME MEASURES: Costs (laboratory tests, personnel, and supplies) and infant health outcomes. DESIGN: A prospective descriptive study. RESULTS: Mandatory screening leads to increased costs, problems related to false-positives, and unintended consequences (eg, decision whether to treat non-MRSA organisms identified on screening cultures, possibility of legal implications, adverse family psychosocial affects, and questionable validity of the polymerase chain reaction test). The average total costs of laboratory, supply, and personnel were