Applying a health equity tool to assess a public health nursing guideline for practice in sexually transmitted infection assessment in British Columbia.

SETTING: There is a multitude of health equity tools but little guidance on how to effectively use these tools in public health nursing practice. In BC, public health nurses who are certified in sexually transmitted infection care utilize guidelines authorized by the nursing regulatory body. INTERVENTION: As part of the Equity Lens in Public Health (ELPH) research project, an assessment of the nursing guideline, Sexually Transmitted Infection (STI) Assessment Decision Support Tool, was undertaken using the Assessing Equity in Clinical Practice Guidelines health equity assessment tool. The chosen tool is intended for use by health care providers, is broadly applicable to clinical practice guidelines, can be used retrospectively, and falls within the category of equity checklists and audits. OUTCOMES: Overall, the tool was useful in assessing the inclusion and omission of an equity focus in the guideline. However, there were several challenges: the identification of an appropriate health equity tool; the absence of an evaluation of the chosen tool; the tool's focus on chronic disease versus communicable disease; and the difficulty of obtaining client perspectives. IMPLICATIONS: For an improved equity lens in the STI Assessment Decision Support Tool, future revisions should be equity focused and include perspectives from affected populations, an emphasis on the determinants of health that perpetuate inequities for populations who experience a disproportionate burden of STI, information on provincially available resources, and service delivery models that improve timely and equitable access to treatment and care.

Primary care of women who have sex with women. Recommendations from the research.

Research on women who have sex with women has increased in the last decade. Attention has been brought to this group of women through the IOM report, which noted a lack of research related to their care. Most of the research has not been published in nursing literature. This article reviews this literature with recommendations for primary care practice.

Sexual health risks and health-seeking behaviours among substance-misusing women.

AIMS: To report on a survey of sexual health service needs among substance-misusing women attending a substance misuse service. BACKGROUND: Substance-misusing women carry a disproportionate burden of sexual ill health, yet the range and frequency of their sexual health risks, morbidities and service engagement are poorly understood. DESIGN: A cross-sectional survey of a convenience sample of substance-misusing women attending a substance misuse service. METHODS: From 4 April 2010-17 September 2010, substance-misusing women in Hastings & Ore, UK, were invited to complete a paper questionnaire addressing: drug use; cervical cytology, sexually transmitted infection and HIV screening history; pregnancy history, perceived pregnancy risk and contraceptive advice and supply; sexual activity and assault. Of 91 respondents, 77 attended local drug treatment services - results comprise analysis of this sub-sample. RESULTS: The study sample was characterized by long-term opioid and crack cocaine use. Of 53% sexually active in the previous 4 weeks, 66% perceived they had experienced sexual intercourse that could lead to pregnancy during that time. Fifty-five per cent had been forced to have sex against their will during their lifetime. High rates of sexually transmitted infections, pregnancy termination, miscarriage and abnormal cervical cytology were reported. CONCLUSIONS: Findings indicate the need to recognize the breadth of elevated sexual health risks and morbidities experienced by substance-misusing women with long-term opioid/crack use, including those not identifying as intravenous drug users. Poor recall of drop-in and appointment times, reluctance to disclose substance misuse and likelihood of previous sexual assault present significant challenges to nurses, who must take a sensitive, opportunistic approach to referral and provision of sexual health interventions to substance-misusing women.

Healthcare reform: implications for knowledge translation in primary care.

BACKGROUND: The primary care sector represents the linchpin of many health systems. However, the translation of evidence-based practices into patient care can be difficult, particularly during healthcare reform. This can have significant implications for patients, their communities, and the public purse. This is aptly demonstrated in the area of sexual health. The aim of this paper is to determine what works to facilitate evidence-based sexual healthcare within the primary care sector. METHODS: 431 clinicians (214 general practitioners and 217 practice nurses) in New South Wales, Australia, were surveyed about their awareness, their use, the perceived impact, and the factors that hindered the use of six resources to promote sexual healthcare. Descriptive statistics were calculated from the responses to the closed survey items, while responses to open-ended item were thematically analyzed. RESULTS: All six resources were reported to improve the delivery of evidence-based sexual healthcare. Two resources - both double-sided A4-placards - had the greatest reach and use. Barriers that hindered resource-use included limited time, limited perceived need, and limited access to, or familiarity with the resources. Furthermore, the reorganization of the primary care sector and the removal of particular medical benefits scheme items may have hampered clinician capacity to translate evidence-based practices into patient care. CONCLUSIONS: Findings reveal: (1) the translation of evidence-based practices into patient care is viable despite reform; (2) the potential value of a multi-modal approach; (3) the dissemination of relatively inexpensive resources might influence clinical practices; and (4) reforms to governance and/or funding arrangements may widen the void between evidence-based practices and patient care.

Nurse leaders' experiences of implementing regulatory changes in sexual health nursing practice in British Columbia, Canada.

Most research about regulatory policy change concerning expanded nursing activities has emphasized advanced practice roles and acute care settings. This study is a contribution to the small pool of research concerned with regulatory policy implementation for nurses undertaking expanded nursing practice activities in a public health context. Using the regulatory changes in certified nursing practice in one Canadian province as our starting point, we investigated the experiences of nurse leaders in implementing this change. Using a qualitative interpretive descriptive approach informed by tenets of complexity theory, we examined the experiences of 16 nurse leaders as situated within the larger public health care system in which nurses practice. Two interrelated themes, (a) preparing for certification and (b) the certification process, were identified to illustrate how competing and contrasting demands between health care and regulatory organizations created substantial barriers to policy change. Implications for health service delivery and future research are discussed.

Teenage pregnancy and sexual health.

The under-18 conception rate in England is at a 40-year low but a further reduction is needed to reach levels in comparable western European countries. Sexually transmitted infections are common among young people, with chlamydia the most prevalent STI in the UK. To challenge this, a multi-agency approach is needed, with high-quality sex and relationships education, easy access to contraception and sexual health services and an open culture around relationships and sexual health. Nurses play a crucial role in supporting young people within both contraception and sexual health services and as trusted practitioners in a range of settings.

Atuação do enfermeiro na estratégia saúde da família: um estudo aplicado à prática profissional no município de Macaé / The role of the nurse in the light of public policies in the Women's Health

Estudo de caso, na abordagem de Yin Robert K. (2010), do tipo exploratório, teve como objeto de estudo a atuação do enfermeiro em saúde da mulher na ESF na perspectiva da ABS no município de Macaé – RJ. Objetivos: descrever as atividades do Enfermeiro inserido na ESF na assistência direta à Saúde da Mulher, discutir a atuação do Enfermeiro à luz das políticas públicas em Saúde da Mulher da ABS e da PNAISM, relacionar as possibilidades e dificuldades encontradas pelos Enfermeiros em sua atuação na ESF no município de Macaé. Utilizou como fontes de evidências ficha de caracterização dos enfermeiros, as entrevistas, o auxilio de documentos e o registro de observações diretas de interesse ao escopo do estudo. As entrevistas, na modalidade aberta, levantaram comportamentos, atitudes e percepções individuais o que caracterizou o perfil profissional de vinte (20) enfermeiros e sua atuação como membro da Equipe de Saúde da Família, mais precisamente na área de Saúde da Mulher. Os enfermeiros que participaram do estudo contribuíram por meio dos seus depoimentos na construção de quatro dimensões que se relacionam com a realidade em que se encontram no momento em que foi realizada a investigação, e são elas: A atuação dos enfermeiros antes de sua inserção na Estratégia de Saúde da Família; A atuação dos enfermeiros na Estratégia de Saúde da Família; Possibilidades e as dificuldades que vivenciaram na sua atuação na Estratégia de Saúde da Família...

[Access to somatic care for patients undergoing psychiatric treatment]. / L'accès aux soins somatiques pour les patients suivis en psychiatrie.

In France, there is no across-the-board formal connection between psychiatric and somatic treatment and the somatic care of patients undergoing psychiatric treatment remains very heterogeneous and inadequate. Despite some attempts at providing structure, it is the place of the physician which must be examined and optimised.

Sexual health: meeting adolescents' needs.

BACKGROUND: The UK has the highest rate of sexually transmitted infections (STIs), especially among young people, in western Europe. Knowledge of what influences young people's sexual behaviour is limited which highlights a need to understand adolescent development and recognise that they are at increased risk of acquiring an STI compared with other groups. This article examines the risks of acquiring STIs in adolescence and discusses how nurses feel about treating young people with sexual health needs. CONCLUSION: Postgraduate training needs to incorporate specific modules relating to young people within sexual health. Sexual health providers go some way to providing an adolescent-friendly service, but more creative approaches to service delivery such as flexible opening hours and contraception outreach services would make them more accessible to young people.

The nurse role in implementing the national sexual health strategy.

The rising incidence of sexually transmitted infections (STIs) in England and a recognition that looking after our sexual health is essential for long-term well-being, prompted the government to unveil its first sexual health and HIV strategy (Department of Health, 2001). The government's aim is to modernize sexual health and HIV services and help primary care trusts (PCTs) to address the rise in STIs and HIV, and to reduce unintended pregnancies.

Risk assessment, screening and the subsequent management of STIs.

Sexually transmitted infections can present with symptoms similar to a range of conditions, so patients with possible signs of an STI should undergo a risk assessment to facilitate a definitive diagnosis. The second article in this series looks at why patients may be reluctant to seek help from specialist services and describes how nurses should approach treatment and follow-up.

The historical role and education of nurses for the care and management of sexually transmitted infections in the United Kingdom: 1 role.

Nurses have been involved in the management of sexually transmitted infections (STIs) well before the era of Florence Nightingale. Their role has varied from that of the technician, almoner, counsellor, and doctor's assistant, to one in which they are able to provide first line management of STIs in nurse led clinics. However, changes to the role of the nurse have not been entirely through choice. It appears that nurses have often been called upon in times of crisis and need-their role often evolving only through demand for services and personnel. Barriers to developing the role of the nurse continue to exist as we move into the 21st century. From Lock hospitals to specialised genitourinary medicine clinics, this historical review looks at how the role of the nurse has evolved over the past 150 years and suggests how past lessons can help enhance the contribution nurses will make to the future of STI management and control.

Sexually transmitted diseases and reproductive health in women.

The effect of sexually transmitted diseases (STDs) on the reproductive health of women, the reasons why women bear a disproportionate percent of STD morbidity and mortality, and the factors contributing to an increased risk for STDs and their complications in women are enumerated. Conclusions and recommendations from the 1997 Institute of Medicine report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, are categorized and addressed. The categories are education, population groups, and clinical practice. The contributions of midwives to implementing pertinent Institute of Medicine recommendations in basic and continuing education programs, individual practice, and in influencing policy are detailed. Factual information about STDs, risk assessment history, essential STD-related services, and treatment guidelines are provided in tables.