Kent County Teenage Pregnancy Plan of Care

Chelsey Giovanni, Shannon Gregson, Leigh Anne Koonmen, Lashonda Martin

Ferris State University

Teen Pregnancy in Kent County

Kent Countys 2011 Community Health Needs Assessment (CHNA) and Health Profile is
a process involving community members that is used to examine health indicators and analyze
priorities in order to better meet the health needs of Kent Countys occupants. The goal of the
Kent County CHNA is to allow its residents the opportunity to obtain the necessary tools to
attain permanent physical, mental, and social well being. The CHNA identifies many strengths
and weaknesses of the area, but focuses primarily on five specific priorities to address in its
upcoming project. One of these priorities is to reduce disparities in adequacy of prenatal care to
promote a coordinated system of care that is local, preventive, holistic, and patient centered
(CHNA, 2011).
The rate of teen pregnancy (ages 15-19) is higher in Kent County with 61.5 per 1,000
than in Michigan which has 53.6 per 1,000. When compared to the national benchmark of 22,
Kent Countys teen birth rate is almost double (CHNA, 2011). Groups that are particularly
affected by this issue are Blacks (19.8% inadequate prenatal care), Hispanics (17.9% inadequate
prenatal care), and Arabs (17.5% inadequate prenatal care) when compared to Whites (9.6%
inadequate prenatal care. In addition, the Fetal Infant Mortality Review revealed that African
American infants are more likely to die before the age of one compared to any other race
(CHNA, 2011).
As we know, regular prenatal visits are essential for the health of both mother and baby.
Regular visits allow healthcare providers to educate mothers on what to expect during pregnancy,
the importance of diet and nutrition, benefits of breastfeeding, weight gain, immunizations,
exercise, and abstinence from drugs and alcohol. They are also given the opportunity to identify
any complications and address any health concerns (Child Trends Databank, 2014). Studies have

shown that teen mothers are less likely than adults to receive early or adequate prenatal care, and
therefore are three times more likely to have an unhealthy or complicated pregnancy and deliver
a preterm baby with health issues. Teen mothers are also more likely to engage in risky behaviors
that are associated with infant mortality, birth defects, and low birth weight. In addition, these
young women are more susceptible to mental health issues such as anxiety and depression (Child
Trends Databank, 2014).
Some of the resources and services provided by Kent Countys health department include
but are not limited to nutritional assessments and programs such as WIC, care coordination,
parenting and health education, transportation arrangement, comprehensive psychological
assessment, and referrals to other community services. These services are strengths that increase
the likelihood of successfully addressing the rate of teen pregnancy in Kent County, this issue
has also been made a priority by CHNA. They also offer routine vaccination clinics for adult
and children, a free maternal infant health program, and free Medicaid enrollment for pregnant
women who are uninsured (Access Kent, 2014). Although the multitude of resources offered by
the local health department are more than adequate, the problem of teen pregnancy and teen
mothers not seeking prenatal care still persists. This may be due to a lack of education. Young
women are not properly educated on the importance of early prenatal care. Teen mothers are also
often scared, embarrassed, and are fearful of or mistrustful in the healthcare system. For these
reasons they are not likely to seek health care. Factors that contribute to such a high teen
pregnancy rate in Kent County may be but are not limited to poverty or low socioeconomic
status, a knowledge deficit/lack of education, peer pressure and media, alcohol and drug use,
child abuse, low self-esteem, lack of health insurance, and misuse or no use of contraception.
Partners in the Community

Kent County not only has access to many medical services for expecting mothers there
are also many support groups and agencies in the area that can assist these clients. There are
multiple church groups that collect food and donations to give to these mothers; they also hold
soup kitchens and food distributions weekly in the community. There are also many womens
clinics, such as Alpha Womens Center and Baxter Community Center which provides
pregnancy and STD testing, alternatives to abortions, maternity and infant clothing, and day care.
These facilities use the collaboration of dieticians, mental health counselors, as well as
physicians and nurses to provide resources that can help ensure the health of both the mother and
infant.
Transtheoretical Model
The transtheoretical model is an approach to behavior that analyzes the readiness of the
learner. (Harkness & DeMarco, 2012) This model includes five stages in promoting change the
stages include pre-contemplation, contemplation, preparation, action, and maintenance. This
model is important in determining the clients ability to make change towards a healthier lifestyle
and pregnancy.

A patient in the precontemplation phase has no plans to schedule an

appointment, a patient in contemplation has the intent to schedule an appointment soon, but has
yet to do so, a patient in preparation doesnt have a definite plan but is beginning to develop a
program. An expectant mother in any of these phases would be at risk for inadequate health
care. Even though there are many resources available to expectant mothers with low income in
the area, if they are unwilling to participate in their care those resources will do little good for
them. Patient participation is a large barrier in lowering the rate of teen pregnancy and in
promoting a healthy pregnancy.
Nursing Diagnosis

According to Marjorie Muecke (1984), a community health nursing diagnosis is

grounded in medical epidemiology by its emphasis on morbidity and mortality of whole
populations...and on environmental factors implicated in the etiology of the health problem (p.
24). For this particular community, the diagnosis is as follows: Teens are at risk for pregnancy
related to the lack of education regarding sexual health as evidence by high rates of teenage
pregnancy throughout Kent County. This is measured by data made available through county
health records collected by the Kent County Health Department. State and national records are
available to compare rates of teenage pregnancy to local levels and indicate that the rate of
teenage pregnancy in Kent County is significantly higher than rates found at the state and
national levels. Comparison of these rates across all levels aids the community health nurse to
determine which programs are effective in preventing teenage pregnancy.
SMART Goal
A SMART goal is one that is specific, measurable, achievable, relevant, and time bound
(Harkness & DeMarco, 2012). The issue of teen pregnancy is one that is easily preventable if
proper teaching and support is given. Through the use of sexual education classes, the SMART
goal that will be utilized by the Kent County public schools is as follows: teenage pregnancy
rates to girls ages 15 to 19 will decrease by at least 25% from 61.8 births per 1,000 population in
2011 to 46.2 births per 1,000 population in 2016. The following is a proposal for sexual
education class implementation within the public schools in Kent County.
Proposal
As previously mentioned, lack of education/knowledge deficit are factors that increase
the rates of teen pregnancy. It is important to implement mandatory sexual education classes
within the public school system as a way of preventing and reducing the number of teen

pregnancies in Kent County. Through collaboration with school nurses, classes will address
abstinence education, contraceptive methods, and reproductive health.
The program will focus on abstinence as the main means of preventing both pregnancy
and the spread of sexually transmitted infections (STIs), but will also include other forms of
prevention such as the use of birth control and condoms. Students will be aware of the risks
associated with sexual intercourse, such as pregnancy and STIs, and will have the opportunity to
speak privately with the school nurse if they have concerns.
Conclusion
Through identification of the population at risk utilizing a community nursing diagnosis,
possible causative factors for the risk, and interventions, the community health nurse can identify
groups within the community with existing or potential health risks. In examining Kent County
health records, teenage pregnancy is identified as a significant health risk for girls aged 15-19, in
addition to inadequate prenatal care. The proposed plan of action for this population is to start at
the source and educate teenage students in the Kent County public school district about sexual
health that includes abstinence education, contraceptive methods, and reproductive health. The
goal with the sexual health education intervention is to decrease rates of teenage pregnancy by a
minimum of 25% in Kent County over a five year period.

References

Harkness, G. & De Marco, R. (2012). Community and public health nursing : Evidence
for practice. Philadelphia: Lippincott Williams & Wilkins
Kent county 2011 community health needs assessment and health profile (2011). Michigan
Public Health Institute. Retrieved from http://www.kentcountychna.org/pdfs/CHNA.pdf
Kent county pregnancy resource guide (2010). Child and Family Resource Council. Retrieved
from http://www.familyfutures.net/wp-content/uploads/2011/09/pregnancy_resource_guide.pdf
Late or no prenatal care (2014). Child Trends DataBank. Retrieved from
http://www.childtrends.org/?indicators=late-or-no-prenatal-care
Maternal and infant health. (2014). Access Kent: Kent County, Michigan. Retrieved from
https://www.accesskent.com/Health/PregnancyParenting/health.htm
Muecke, M. A. (1984). Community health diagnosis in nursing. Public Health Nursing, 1(1),
22-35.