Table 2.

Data Extraction from Inclusive Literature Findings

Database	Authors	Purpose	Method	Relative findings	Location
CINAHL	Bircher21	Describe the challenges migrant farm workers face surrounding prenatal health and access to equitable care	Editorial	Pregnant migrant workers face significant barriers to receiving prenatal care—including cost, limited clinic hours, inadequate knowledge regarding prenatal care recommendations, and migratory work with long hours and geographical isolation NPs provide safe, competent, and cost-efficient care focused on a family-centered model of care Mobile health clinic consisting of NPs bridges the gap between isolated pregnant women seeking prenatal care and primary care providers Mobile health clinics help to reduce health care costs, improve access, and promote communication between provider and patient	U.S.
CINAHL	Murfet et al.11	Analyze maternal and neonatal health outcomes pre- and postintervention of an NP-led model of care for managing diabetes in pregnancy	Uncontrolled interventional study Sample size: preintervention n = 112 and postintervention n = 149	Collaborative model comprising an NP, diabetes educator, obstetrician, midwife, and dietician There were no significant differences on maternal outcomes, yet substantial neonatal health benefits were observed There was a 24% reduction in adverse neonatal outcomes, including fetal macrosomia, hypoglycemia, respiratory distress syndrome, and congenital abnormalities	Australia
MEDLINE	Pinto et al.15	Detect challenges that obstetric providers (currently and/or previously) face in providing prenatal care and identify core components necessary for alternative methods of obstetrical care	Qualitative study with in-depth semistructured interviews and 46 health care professionals working in an obstetrical system in rural Georgia	Tiered model of risk-appropriate care based on specific needs of the prenatal population Enhances provider efficiency and streamlines patient care by having patients see an appropriate level of provider based on individual needs NPs providing prenatal care to low-risk women allows for increased availability of obstetricians to care for high-risk pregnant women Some specialists prefer to care for all levels of prenatal patients regardless of risk A clear, sustainable alternative model of care lacks consensus, thus different approaches are community specific	U.S.
CINAHL	Snyder and Thatcher12	Review the effects of implementing an NP model providing prenatal care in a mobile health clinic reaching out to rural populations	Article	Geographical barriers to people in Appalachia receiving medical care—specifically women Before NPs' arrival, the local county had the highest infant mortality rate, with delay of prenatal care being one of the major contributing factors “Health Wagon”—implementation of a mobile NP-led clinic providing a wide variety of health care services to rural families As a result, the county had a decrease in infant mortality rates from an average of 6.69 deaths per year to 1.86 per year	U.S.
MEDLINE	Hansen et al.19	Identify a potential correlation between providers' knowledge and support of transvaginal ultrasound to screen for preterm birth risk and the actual incidence of preterm birth for rural women	Mixed methods study Semistructured interviews and survey scale Sample size: 14 health care providers	Preterm birth prevention through cervical length screening via transvaginal ultrasound during pregnancy Rural women are at a disadvantage of receiving adequate prenatal care due to limited providers, lack of resources, multiple comorbidities, and insufficient public transportation Factors contributing to lack of cervical length surveillance include lack of access to sonography, patient noncompliance, and socioeconomic factors, including financial constraints and inability to afford transportation Low health literacy and lack of prenatal care are factors contributing to women not recognizing long-term consequences of preterm birth	U.S.
MEDLINE	Mills et al.20	Pilot program to advance registered nurses' roles to provide antenatal services under supervision of a general practitioner	Mixed methods research design Sample size: 11 advanced practice RNs and 4 GPs	Rural nurses with advanced antenatal training provided care for low-risk pregnant women in response to the maternity service provider shortage The study has multiple limitations, but the overall conclusion is that nurses with advanced practice were able to sufficiently provide antenatal services to low-risk women living in remote areas of Australia	Australia
CINAHL	Veith et al.17	Pilot program to evaluate effect of collaborative prenatal care for high-risk obstetrics in rural populations with the use of advanced practice nurses and telemedicine.	Quantitative research design Sample size: 374 Comparison group: 181	NPs on site providing hands-on care, while a perinatologist attends virtually via telemedicine Success of the pilot program was measured in improved rates of appointment attendance and decreased adverse effects of pregnancy such as average time for neonatal intensive care unit admission Cumulative travel distance saved for patients in this 3-year study was an impressive 162,126 miles!	U.S.
CINAHL	Bruyere22	Editorial that argues the importance of utilizing allied health professionals such as NPs for prenatal counseling and education in response to widespread physician shortage	Editorial	A collaborative care model between physicians and NPs sharing prenatal patients improves access to consistent prenatal care and thus pregnancy outcomes NPs have longer appointment times, allowing for patients to ask questions and providing ongoing prenatal counseling and support Patients are more likely to receive earlier initial pregnancy screening, prenatal care, and education regarding lifestyle risk factors (abstinence from alcohol, smoking cessation, and healthy weight gain), resulting in a decrease in risk of preterm delivery NPs provide consistent prenatal care essential to the success of therapeutic relationships between the care provider and patient With their nursing background and values, NPs have an enhanced ability to create strong patient–provider relationships and ease patient anxiety about labor and delivery by providing support and education Continuity of care is maintained by frequent prenatal appointments that NPs can provide in collaboration with the physician at the first and last prenatal appointments Having a team of providers focusing on individualized patient-centered care provides an opportunity for the best possible pregnancy outcomes	U.S.
CINAHL	Pflugeisen et al.16	Compare traditional prenatal care where patients receive routine face-to-face appointments with a physician and “Virtual Visit” prenatal care where patients receive a combination of in-person and virtual visits through videoconferencing between a physician and NP	Quality improvement study Quantitative research design Sample size: 1058 women	“Virtual Visit” prenatal program developed and implemented to provide women with an alternative method of accessible care Women who had more than one child at home were interested in prenatal care that was convenient, efficient, flexible, and individualized—all highlights of the “Virtual Visit” program Offered to women in the U.S. for low-risk pregnancies Results showed that there were no increased risks to mother or baby with virtual prenatal care compared with traditional care. There was a higher incidence of women in the “Virtual Visit” program who were partnered, higher income, and had given birth before	U.S.
CINAHL	Edgerley et al.18	Evaluate the birth outcomes for rural underserved women receiving early prenatal care through the use of a mobile health van compared with women receiving traditional prenatal care in community clinics	Retrospective cohort study Sample size: 108 women	Mobile health van staffed with an obstetrician–gynecologist and family NP Variety of services are offered, including, but not limited to, pregnancy testing, pelvic ultrasound, pregnancy counseling, and education Initial care is conducted in the van, and the mobile clinic acts as a bridge connecting pregnant patients to local primary care clinics for further prenatal appointments On average, women who utilized the mobile van initiated prenatal care 3 weeks earlier than those who initiated prenatal care at their local clinic Women (79.6%) who received care through the mobile van did so in the first trimester of pregnancy, in comparison with 59.8% of nonvan patients	U.S.

NP, nurse practitioner; U.S., United States.