Prenatal group care with Community Health Workers; Teaching and Practice benefits
1) To address group based care in marginalized populations for reduction of health disparities and improved student and patient satisfaction.
2) To improve the status of maternal child health (MCH) in Sandoval County, while demonstrating an innovative model of graduate and undergraduate nursing education in a faculty practice where students learn together.
Background
Only 60% of pregnant women in Sandoval County receive adequate prenatal care according to the Kotelchuck Index. Many of these women are affected by social determinants such as: low social-economics status, lower educational levels, poor living conditions and increased behavioral health needs. Nurses must develop collaborative, team-building skills that proactively adapt to the ever-changing healthcare system in the United States.
Brief Description
Group faculty-practice model:
- Demonstrates family-centered care during both the child-bearing and postpartum year.
- Utilizes Community Health Workers (CHWs) and nurse-midwives co-facilitation of prenatal groups.
- Responds in a culturally-sensitive manner to individual needs.
- Interfaces graduate advance practice and undergraduate nursing students in clinical learning.
Outcomes Achieved
A CHW and a nurse-midwifery team developed comprehensive educational group sessions, which supportive family members or friends were encouraged to attend.
Group prenatal care with CHWs:
- Exceeded the educational standards of conventional prenatal care by including topics such as, family-infant bonding, budgeting, oral care, breast-feeding, infant care, and pain management during labor, as well as, any issues raised by group participants.
- Received positive feedback from patients and achieved a higher than average postpartum return rate (98%).
- Achieved a high rate (93%) of the women starting prenatal care in the first trimester.
- Surpassed the county’s rate of women that received adequate levels of prenatal care (85%).
- Attained low levels of preterm births (6%).
- Provided care for a high percent of underserved patients (66% Medicaid; 23% self-pay; and 1% privately insured).
A year-long Community-Maternal Child Health (MCH) baccalaureate nursing elective was created to offer students the opportunity to follow families through their pregnancy and first postnatal year.
MCH undergraduate elective:
- Each student had an opportunity to share their clinical experience at a monthly seminar.
- Course evaluations were significantly higher than other courses in this discipline.
- Twenty-one students participated; a common theme among students was that continuity developed better relationships with patients. They observed how a family’s needs change throughout pregnancy and in the child’s first year.
- Fourteen percent have applied for admission to an advanced practice nursing program.
- Four students presented at a national public health nursing conference on this course experience.
The project provided a home-visit shortly after hospital discharge for mom and baby. The visit consisted of a nurse-provider and CHW, and often included a nursing student. The timing of the visit was optimal for supporting successful breast-feeding.
We strived to increase access to care by reducing transportation needs and making care affordable. Our partnership with various community agencies (WIC, Santa Fe Young Fathers, GRADS, etc.) enriched the success of our project.
Conclusion
This comprehensive nurse provider model increased patients’ access to care and offered students a unique experience to learn community connection, advocacy, and innovative, inter-professional skills.