I recently had the opportunity to attend, participate in a Centering Group facilitated by the CNM’s and WHNPs at March Army Community Hospital (MACH). Enrollment in these groups is limited to 8-10 participants of similar gestational progress. This model for group prenatal care is intended to provide assessment, support and education throughout the course of pregnancy. Women are encouraged to participate more in their own care while the group as a whole shares past and present experiences of pregnancy. The class is organized into 10 planned sessions each of which has its own educational focus appropriate to the specific phase of pregnancy.
Centering is copyrighted program and the individual institution is required to pay for the privilege of incorporating Centering as a program offered by their clinic. Facilitators must participate in a 2 day work shop prior to leading a centering group.
In addition to the group interaction, and education each woman is assessed by the OB provider, and appropriate checks in cluding fundal height, fetal heart tones are performed at each class, with additional assessments cervical checks, and ultra sounds perfomed indiiually as required and or necessary.
The program incorporates self evaluations from participants who provide feedback. MACH is not currently conducting additional surveys or research to evaluate the programs effectiveness as compared to traditional prenatal care or to other prenatal classes.
The class of seven women which I observed seemed to be very effective in that all of the participants appeared to share information and advice openly but not so much as to be overbearing. The facilitator, a CNM, presented appropriate educational materials encouraged comments from the participants about what was being discussed, while allowing and encouraging participants to be fully involved in the class. Private time for assessment was provided in a way which was discrete and which did not detract from the overall flow and development of the day’s class.
Overall I found that I was impressed by the process and the individual participants seemed to be well satisfied. The advantage of this program for military personnel is that it excellent forum for discussion and sharing of pregnancy related issues along with personal support for women who are often remote to their natural family support systems
Subscribe to:
Post Comments (Atom)
I could not agree with you more. Excellent summary. Going there and sitting in on a similar process I agree that the flow of information and support for class members by fellow class members was invaluable. The group was much more empowered to make health care decisions and ultimately that is what it is all about. I will defineately consider implementing this program or being a strong advocate as part of my practice.
ReplyDeleteFort Bragg has just started their first real centering program with a relatively small group of women. I believe the concept is outstanding and I remember when I was at Fort Bliss back in 2005 we were talking about this approach. It is a great way for women to meet eachother and discuss common concerns that come along with pregnancy. I think that when women are exposed to "common" complaints of pregnancy via "real women" and not the proverbial "purple book" they begin to have confidence in their pregnancy and reassured that they and their babies are just like every one else. There is a gap, of course, between uncomplicated and complicated pregancies but again,, as you mentioned, the opportunity for support is outstanding for both populations.
ReplyDeleteFort Hood, CRDarnall Army Medical Center is actually in phase 2 research looking at the outcome difference(s) between pregnant women/significant others involved in the Centering Program and those women/significant others in "traditional" pregnancy care. In the first phase (without a control group), there was a noted trend in decreasing the number of pre-term deliveries and now with the control group added, they are going to measure level of significance between the 2 groups. This is a fantastic program started in Civilian Hospitals through the March of Dimes. It seems like a very positive influence on the newest (and youngest) mom's and FOB's-many patients transferring in their care due to PCS were asking to be part of the Centering which they had good experience with previously at other MHS facilities!
ReplyDeleteGreat summary! I hope all of you see more of this type of patient centered care in your career...I can think of several settings (outside of the Psych setting) in which group care could be very useful (Osteoporosis, HTN etc.)
ReplyDeleteWhen I was Head Nurse of the Cardiology Clinic in Germany I began Coumadin Clinic and Cardiac Rehab pt care groups-the pt interaction and support with/for each other was very positive/beneficial and I thought more efficient as I was able to answer questions and teach all 10-15 patients at once, and the patients started trying to "do better" than each other (in behavior/physical improvement changes). Plus, they all got to put up with my TLC changes "demands" in a united front, so if one of them started messing up/backsliding the others would provide additional support (they had been there/done that), and they would "kick each others ---, butts" to do better and comply with needed treatment plans, even if it meant giving up eating 1/2 lb of "yummy" bacon every morning.
ReplyDelete