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.
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.
The focus of this article is the development of a family adaptation tool t o be utilized by nurses in a two-stage referral mechanism. This tool can assist in the development of the clinical practice of maternal-child and community health nurses to further facilitate a positive childbearing experience.
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