This paper analyzes the group prenatal care model as an appropriate service delivery approach for maternal health programs, specifically for Partners for a Healthy Baby. Drawing on critical reviews of research comparing individual and group prenatal care, the paper establishes the theoretical foundation for human service delivery and demonstrates how group prenatal care aligns with current patient-centered care standards. The paper evaluates operational requirements, implementation best practices, recruitment strategies, and the nurse's multifaceted role in facilitating, evaluating, and researching this model. It concludes that group prenatal care, supported by evidence-based practice and nursing innovation, can improve perinatal outcomes while meeting national health goals for maternal and child health.
The theory of human service delivery is based on an understanding of how people and systems function in producing committed service (Reader, 2015). Unlike other service inputs, human effort or service cannot be quantified except in a subjective way. This means that the estimation of human service is a sensitive task. Experts in this field have always sought the best systems to produce the best services.
It is important to recognize that services are intangible, variable, limited, and ideological in nature (Reader, 2015). Services cannot be touched, handled, or resold. They involve interactions with individuals who receive the service. The quality of services differs from one encounter to another and can be improved, which makes evaluation necessary. Services are limited to the size of an organization's workforce, and they are ideological in that an internal philosophy underlies the organization and motivates its people to undertake the service.
The group prenatal care model has been deemed appropriate for the Partners for a Healthy Baby job design for the Wilson County Department of Social Services (Thielen, 2012). Its value was established through a critical review of research published between 1998 and 2009. These studies compared individual and group prenatal care, using middle-range theories including Pender's health promotion model and Swanson's theory of caring. These theories were merged to enhance the relationship between pregnant women and the group prenatal care model.
Five of the seventeen qualified research studies reviewed examined women's gestational age and birth weight. The researchers found that infants of mothers in group prenatal care had longer gestation and greater birth weight, particularly in the preterm birth population. The review concluded that group prenatal care could be a potential method for improving perinatal conditions among pregnant women. Nurse educators and leaders should promote and encourage its implementation (Thielen, 2012).
Current healthcare practices are directed at patient-centered care, such as in medical homes or health care centers (Thielen, 2012). The chosen delivery model, group prenatal care, also focuses on the patient. Its curriculum is driven by patient need, and the delivery model promises to reduce paternalism by enhancing the patient-provider relationship through partnership and trust. This partnership in care is itself a newer concept in healthcare delivery.
In recent years, content-driven education has been gaining strength and displacing previous process-oriented models (Thielen, 2012). These older models utilized concrete standards based on gestation. The new delivery model may be guided by a similar curriculum, but its content is subject to modification by the facilitator according to feedback. Feedback is encouraged at the beginning of each class or group activity. This model is also aligned with organizations that promote healthy pregnancies, such as Lamaze International, through evidence-based education provided to childbirth instructors, providers, and parents working toward the same maternal and child health goals (Thielen, 2012).
Technology has altered the reception of childbirth education and health education itself (Thielen, 2012). The proliferation of internet information, books, and mass media—especially digital media—have certainly affected attitudes toward pregnancy and childbirth. Interactive computer-based prenatal information continues to increase in many health facilities and settings. These newer and more sophisticated systems attract the attention of younger populations who might otherwise receive prenatal education from home or friends.
A 2006 survey found that only 25 percent of mothers attended childbirth classes. The majority received childbirth education through television exposure rather than from formal prenatal classes. These trends suggest the need to access health information through modern technology. Additionally, society's compelling need to acquire information quickly must be a major consideration in evaluating the delivery of prenatal care and education (Thielen, 2012).
Studies from past decades reveal longer gestations and heavier birth weights among mothers participating in group prenatal care (Thielen, 2012; Lornas, 1985). This signals their involvement in the changes prenatal care models are undergoing. Participants can be assured that group prenatal care can be reimbursed through public and private insurance. It can also be delivered through a multidisciplinary approach involving guest speakers, such as medical social workers, dietitians, or dental hygienists. Nurses may orchestrate and facilitate groups and practice in an advanced role (Thielen, 2012).
Two maternal, infant, and child health goals relating to prenatal care are listed in the Healthy People 2020 national program (Thielen, 2012). One aims at increasing the number of pregnant women receiving early and sufficient prenatal care. The other aims at increasing the number of women attending prepared childbirth classes. These national goals are met by the selected delivery model.
The delivery model gives nurses more time to spend with patients (Thielen, 2012). Facilitators can provide instructions on special concerns, such as domestic abuse or HIV, and create opportunities for participants to share concerns with one another. In this setting, the nurse can create interest and support for pregnant teenagers. The variability of the prenatal program allows nurses room for creativity in reaching and retaining patients. Nurses can also act as patient advocates by offering transportation assistance, recruiting culturally competent facilitators, forming groups at accessible locations, and providing family-friendly options such as childcare. A nurse plays a teacher role when delivering content to patients.
"Nurse leadership in advancing prenatal care models through research"
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