In a hard spot: Providing group prenatal care in two urban clinics

AbstractObjectivesCenteringPregnancy (Centering) group prenatal care has been demonstrated to improve perinatal outcomes and provide a positive experience of care for women, but it can be difficult to implement and sustain in some clinical settings. The purpose of this study was to examine the challenges encountered when Centering group prenatal care was provided, and the responses of Centering group leaders to these challenges.Designthis was a longitudinal, qualitative study using interpretive description. Data collection included participant-observation and interviews with group leaders and women receiving group prenatal care.Settingtwo urban clinics providing care to low income women in the northeastern United States.Participantsinterview participants were 23 pregnant women (primarily African-American and Hispanic) receiving group prenatal care; other participants were 24 significant others and support staff participating in groups, and two nurse-midwife group leaders.Findingsthe clinics did not always provide full resources for implementing Centering as designed, creating numerous challenges for the group leaders, who were committed to providing group prenatal care. In an attempt to sustain the model in the face of these limitations, the group leaders made a number of compromises and modifications to the Centering model.Key conclusionsthe limited clinic resources and resulting modifications of the model had a number of downstream effects, some of which affected relationships within groups, participation, and group cohesion.Implicationsmodifications of the Centering model should be undertaken with caution. Strategies are needed to enhance the success and sustainability of Centering in varied clinical settings so that the benefits of the model, which have been demonstrated under more controlled circumstances, can be conferred to women receiving routine care during pregnancy

Women’s Experience of Group Prenatal Care

Group prenatal care (GPNC) is an innovative alternative to individual prenatal care. In this longitudinal study we used ethnographic methods to explore African American and Hispanic women’s experiences of receiving GPNC in two urban clinics. Methods included individual, in-depth, semistructured interviews of women and group leaders in GPNC, participant observation of GPNC sessions, and medical record review. GPNC offered positive experiences and met many of the women’s expressed preferences regarding prenatal care. Six themes were identified, which represented separate aspects of women’s experiences: investment, collaborative venture, a social gathering, relationships with boundaries, learning in the group, and changing self. Taken together, the themes conveyed the overall experience of GPNC. Women were especially enthusiastic about learning in groups, about their relationships with group leaders, and about having their pregnancy-related changes and fears normalized. There were also important boundaries on relationships between participants, and some women wished for greater privacy during physical examinations

Analysing the governance system for the promotion of industrial symbiosis in the Humber region, UK

Government and industry increasingly recognise the need to develop a more circular, resource efficient and bioeconomy that is less dependent on fossil resources. Industrial symbiosis, in this study interpreted as biowaste-to-resource innovation, is a proven strategy to limit carbon emissions whilst increasing resource-efficiency and business growth. However, the effects of governance on the implementation of industrial symbiosis have remained under-explored. Hence this study analysed the governance system for biowaste-to-resource innovation in the Humber region, UK. Key individuals within governmental and associated organisations were interviewed in 2014. The results revealed that, since 2012, public sector cuts and sub-national governance changes resulted in the removal of several organisations from the regional governance network, while capacity within the remaining organisations decreased in terms of connectivity within and between governing organisations, delivered governance activities, and crucial resources including people, money, and knowledge and skills to promote resource innovation. Formal governance to specifically monitor, plan and promote (bio)waste-to-resource innovation is now virtually absent in the Humber region. This study recommends strengthening the governance for biowaste-to-resource innovation by a) increasing integration and flexibility of the regulatory ‘landscape’ across governmental departments at all governance levels; b) building better connections between national and regional level governmental organisations as well as within the Humber region; and c) investing in knowledge and skills as well as operational capacity of regional governance actors. These recommendations should contribute to restoring the balance between regional capacity and the national ambitions to promote biowaste-to-resource innovation as part of the circular bioeconomy

Online_Supplementary_Table_1_READY – Supplemental material for Toxic Stress and Vulnerable Mothers: A Multilevel Framework of Stressors and Strengths

<p>Supplemental material, Online_Supplementary_Table_1_READY for Toxic Stress and Vulnerable Mothers: A Multilevel Framework of Stressors and Strengths by Eileen M. Condon and Lois S. Sadler in Western Journal of Nursing Research</p

The Intersection of Everyday Life and Group Prenatal Care for Women in Two Urban Clinics

Women from vulnerable populations encounter challenging circumstances that generate stress and may adversely affect their health. Group prenatal care (GPNC) incorporates features which address social stressors, and has been demonstrated to improve pregnancy outcomes and prenatal care experiences. In this qualitative study, we describe the complex circumstances in the lives of women receiving care in two urban clinics and how GPNC attenuated them. Stressors included problems with transportation and child care, demanding jobs, poverty, homelessness, difficult relationships with partners, limited family support, and frustrating health care experiences. Receiving prenatal care in groups allowed women to strengthen relationships with significant others, gain social support, and develop meaningful relationships with group leaders. By eliminating waits and providing the opportunity to participate in care, GPNC also offered sanctuary from frustrations encountered in receiving individual care. Reducing such stressors may help improve pregnancy outcomes; however, more evidence is needed on mechanisms underlying these effects

\u3cem\u3eAn Unbelievable Ordeal\u3c/em\u3e: The Experiences of Adult Survivors Treated with Extracorporeal Membrane Oxygenation

Background: Extracorporeal membrane oxygenation (ECMO) is a rescue treatment option for adult patients with severe cardiac dysfunction or respiratory failure. While short-term patient outcomes, such as in-hospital mortality and complications, have been widely described, little is known about the illness or recovery experience from the perspectives of survivors. Subjective reports of health are important indicators of the full, long-term impact of critical illness and treatment with ECMO on survivors’ lives. Objective: The objective of this study was to describe the experiences and needs of adults treated with ECMO, from onset of illness symptoms through the process of survivorship. Methods: This study was guided by the qualitative method of interpretive description. We conducted in-depth, semistructured interviews with 16 adult survivors of ECMO who were treated at two participating regional ECMO centres in the northeast United States. Additional data were collected from demographic questionnaires, field notes, memos, and medical record review. Development of interview guides and data analysis were informed by the Family Management Style Framework. Qualitative data were analysed using thematic analysis techniques. Results: The sample (n = 16) included 75% male participants; ages ranged from 23 to 65 years. Duration from hospital discharge to interviews ranged from 11 to 90 (M = 54; standard deviation = 28) months. Survivors progressed through three stages: Trauma and Vulnerability, Resiliency and Recovery, and Survivorship. Participants described short- and long-term impacts of the ECMO experience: all experienced physical challenges, two-thirds had at least one psychological or cognitive difficulty, and 25% were unable to return to work. All were deeply influenced by their own specific contexts, family support, and interactions with healthcare providers. Conclusions: The ECMO experience is traumatic and complex. Recovery requires considerable time, perseverance, and support. Long-term sequelae include impairments in cognitive, mental, emotional, physical, and social health. Survivors could likely benefit from specialised posthospital health services that include integrated, comprehensive follow-up care