Wiseman O, Emmett L, Hickford G, Knight M, Lazar J, Yuill C, McCourt C
City, University of London, School of Health Sciences, 1 Myddelton Street, London EC1R 1UW, UK.
Epsom St. Helier University Hospital NHS Trust, Epsom Hospital, Dorking Road, Epsom, Surrey, KT18 7EG, UK.
Midwifery. 2022 Jun;109:103333. doi: 10.1016/j.midw.2022.103333. Epub 2022 Mar 31.
To identify the challenges and opportunities for rolling out a bespoke model of group antenatal care called Pregnancy Circles (PC) within the National Health Service: what kind of support and training is needed and what adaptations are appropriate, including during a pandemic when face-to-face interaction is limited.
Exploratory qualitative study (online focus group). Study co-designed with midwives. Data analysed thematically using an ecological model to synthesise.
Five maternity services within the National Health Service.
Seven midwives who facilitated PCs. Three senior midwives with implementation experience participated in the co-design process.
Three themes operating across the ecological model were identified: 'Implementing innovation', 'Philosophy of care' and 'Resource management'. Tensions were identified between group care's focus on relationships and professional autonomy, and concepts of efficiency within the NHS's market model of care. Midwives found protected time, training and ongoing support essential for developing the skills and confidence needed to deliver this innovative model of care. Integrating Pregnancy Circles with continuity of carer models was seen as the most promising opportunity for long-term implementation. Midwives perceived continuity and peer support as the most effective elements of the model and there was some evidence that the model may be robust enough to withstand adaptation to online delivery.
Midwives facilitating group care enjoyed the relationships, autonomy and professional development the model offered. Harnessing this personal (micro-level) satisfaction is key to wider implementation. Group care is well aligned with current maternity policy but the challenges midwives face (temporal, practical and cultural) must be anticipated and addressed at macro and meso level for wider implementation to be sustainable. The PC model may be flexible enough to adapt to online delivery and extend continuity of care but further research is needed in these areas.
Implementation of group care in the NHS requires senior leadership and expertise in change management, protected time for training and delivery of the model, and funding for equipment. Training and ongoing support, are vital for sustainability and quality control. There is potential for online delivery and integrating group care with continuity models.
确定在国民医疗服务体系（NHS）中推行一种名为“孕期圈子”（PC）的定制化团体产前护理模式所面临的挑战和机遇：需要何种支持与培训，以及何种调整是合适的，包括在面对面互动受限的疫情期间。
探索性定性研究（在线焦点小组）。研究与助产士共同设计。使用生态模型进行主题分析以综合数据。
国民医疗服务体系内的五个产科服务机构。
七位负责组织PC活动的助产士。三位有实施经验的资深助产士参与了共同设计过程。
确定了贯穿生态模型的三个主题：“实施创新”、“护理理念”和“资源管理”。团体护理对人际关系和专业自主性的关注与NHS护理市场模式中的效率概念之间存在紧张关系。助产士发现，有受保护的时间、培训和持续支持对于培养提供这种创新护理模式所需的技能和信心至关重要。将孕期圈子与连续性护理模式相结合被视为长期实施的最有前景的机会。助产士认为连续性和同伴支持是该模式最有效的要素，并且有一些证据表明该模式可能足够强大，能够适应向在线模式的转变。
组织团体护理的助产士享受该模式所提供的人际关系、自主性和专业发展。利用这种个人层面（微观层面）的满意度是更广泛实施的关键。团体护理与当前的产科政策高度契合，但助产士面临的挑战（时间、实际操作和文化方面）必须在宏观和中观层面得到预见和解决，以便更广泛的实施具有可持续性。PC模式可能足够灵活，能够适应在线模式并扩展护理的连续性，但在这些领域还需要进一步研究。
在NHS中实施团体护理需要高层领导和变革管理方面的专业知识、用于培训和实施该模式的受保护时间，以及设备资金。培训和持续支持对于可持续性和质量控制至关重要。在线模式实施以及将团体护理与连续性模式相结合具有潜力。
