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Celebrate Solutions: What Does Patient-Centered Family Planning Care Look Like?

By: Claire Watt Rothschild and Catherine Owinga, Jacaranda Health

In June’s ‘Celebrate Solutions’ columns, Women Deliver is highlighting Jacaranda Health’s efforts to change the way family planning decision-making happens in the postpartum period among low-income women in Kenya.  As a maternity health care organization, Jacaranda Health works to make pregnancy and childbirth safer for women and newborns by building a new model of maternity care in East Africa; one that is respectful, high-quality and patient-centered.

“I’ve heard it’s a huge metal thing,” Njeri, a new mother, told Jacaranda Health midwife and nurse-in-charge Catherine Owinga at a recent family planning consultation. Njeri was describing what she knew about the copper-bearing intrauterine contraceptive device (IUCD), or the “coil,” as it is called locally. Njeri’s fears about an IUCD – that it is so large that it has to be inserted under general anesthesia or can travel through your veins and get stuck in your heart – were familiar to Catherine.

“So,” Catherine recalls, “I pulled out our sample IUCD that we keep for counseling sessions and gave it to Njeri. I asked her to feel it, to bend it around, to see how small and flexible it is. At first, she thought I was joking. She thought this tiny thing couldn’t possibly be the coil. In fact, what Njeri thought was an IUCD was actually a speculum.”

Catherine and Jacaranda’s other nurse-midwives can attest that Njeri’s story is not an anomaly. “I think one reason why women keep coming to Jacaranda for family planning is because we listen,” Catherine explains, “We listen. Often when a mother goes for family planning, at most facilities, she isn’t given a choice. The providers just ask a woman if she wants an implant and, when she nods, say, ‘Okay, fine,’ and move on to administering the method. They don’t tell her what to expect or what to do if side effects occur. At Jacaranda, we listen to our clients, ask them about their fears, and explain to them how each method works and what she should do if she has any issues.”

Jacaranda’s in-house family planning training program provides one-on-one mentorship to every nurse and patient care assistant, with an emphasis on on-job, competency-based learning. By first observing and then conducting supervised consultations, our clinical staff learns best practices by having areas for improvement identified and addressed as they occur. Jacaranda aims to continuously support our staff to improve their family planning counseling and technical skills through the following opportunities:

  • Monthly case reviews

At each of maternity facility, case reviews are an opportunity for nurses and patient care assistants to discuss interesting cases; share learning opportunities, quality of care issues, and clinical updates; and provide suggestions for updating protocols to provide the evidence-based best practice. They also reinforce a culture of openness and sharing, where providers are encouraged to ask questions and request support from their colleagues.

  • Public sector partnerships

Jacaranda Health has cultivated partnerships with public health providers working in the area. Through these partnerships, Jacaranda sends nurses – accompanied and supervised by Jacaranda mentors – to learn in the setting of a large, high-volume public facility. This allows our nurse mentees more opportunity for practicing their technical skills in IUCD and hormonal implant insertion and removal, while still benefitting from individualized mentorship provided by a Jacaranda nurse mentor.

  • Opportunities to teach

Many Kenyan nurses receive some family planning theory in nursing school, but lack opportunities to practice family planning skills regularly, if at all. Often, family planning is handled by only a select number of experienced nurses. As a result, many nurses are never given the chance to provide family planning or develop their skills when they begin working at a facility. By contrast, Jacaranda creates an individualized training and skills development plan for each nurse and patient care assistant to ensure every provider is proficient in family planning. Jacaranda’s program relies heavily on in-house mentorship, with mentors recruited from the “graduates” of our family planning training program.

Practical tips from colleagues – such as letting a client like Njeri hold an IUCD – are as critical to Jacaranda’s family planning training as theory. By supporting each nurse and patient care assistant to gain proficiency and mentorship skills and giving them the opportunity to teach others, Jacaranda’s team of health providers improves quality of care by learning from the experiences of each patient. This is how they define patient-centered care in family planning.

*The client’s name has been changed to protect her identity.

To read the rest of the Celebrate Solutions series on Jarcaranda Health please click.

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