ABSTRACT
The purpose of the Gestational Diabetes Group Program (GDGP) was to provide patients with diabetes self-management education that occurs in a supportive, prenatal group care setting. The Centering Pregnancy Interdisciplinary Model of Empowerment and the Chronic Care Model guided the program. The pilot project took place at an urban clinic that cares for a diverse, underserved population. The GDGP, a series of four prenatal group sessions after the diagnosis of gestational diabetes and one postpartum group, used an interprofessional/interdisciplinary approach to care with the groups cofacilitated by certified nurse-midwives, certified diabetes nurse-educators, and other community partners. The program was able to show statistically significant changes in knowledge and empowerment, optimal pregnancy outcomes, and high patient satisfaction.
ABSTRACT
Research in the post-genomic era has provided substantial contributions toward identification of medical, genetic and environmental heritability factors associated with autism spectrum disorder (ASD). A specific etiology related to the diagnosis remains unclear, although prevalence statistics continue to rise with profound impact on families and their primary care providers (PCPs). Support professionals encounter significant challenges delivering comprehensive management for this complex neurobehavioral and developmental disorder. Children with ASD experience significantly higher risk for unmet healthcare needs, and parents report less satisfaction with their care although current literature does not fully explain why this issue persists. This study sought parent insight for the missing answers needed to inform practice. Eleven parents of children with an ASD participated in the study. Parent perceptions of care were examined utilizing Interpretive Phenomenological Analysis (IPA) and the Measure of Process of Care (MPOC-20) to illuminate and describe their lived experiences raising children with ASD, and interactions with their PCPs. Most parents utilized their child's PCP for general health maintenance, and many felt their PCP was unable to manage issues specifically related to their child's ASD. Most did not have an expectation for support with behavioral management in the home and school setting or identification of community and mental health resources, although many struggled with unaddressed needs in both of these realms. Utilizing parent perceptions to highlight practice deficiencies can build a foundation for care models that are more comprehensive and family centered.
Subject(s)
Autism Spectrum Disorder/therapy , Developmental Disabilities/therapy , Parents/psychology , Patient-Centered Care/organization & administration , Quality of Life , Adult , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/psychology , Child , Child, Preschool , Developmental Disabilities/diagnosis , Developmental Disabilities/psychology , Female , Humans , Male , Middle Aged , Needs Assessment , Parent-Child Relations , Perception , Primary Health Care/organization & administration , Risk Assessment , Surveys and Questionnaires , Treatment Outcome , United StatesABSTRACT
In this article I revisit the results of research completed in the mid-1990s and recently reviewed with women's updated input. The basic social process named "changing focus" that women use as they negotiate the perimenopausal transition is discussed. This process consists of five parts: monitoring the voice of the woman within, listening to the voices of others, integrating the wisdom, nourishing the woman within, and becoming a wise woman. In view of continuing discoveries pertaining to the effects of symptom management treatments on perimenopausal women's health, this process continues to provide guidance for women and providers.
