Evaluaciones de salud sexual en atención primaria: un estudio cualitativo de las experiencias vividas por enfermeras practicantes / Sexual health assessments in primary care: a qualitative study of nurse practitioners' lived experiences

La salud sexual y reproductiva es una prioridad mundial de salud, desarrollo y derechos humanos. Además, el acceso universal a la salud sexual y reproductiva es esencial. Desafortunadamente, muchas enfermeras se sienten incómodas hablando con sus pacientes sobre la salud sexual. El propósito de este estudio cualitativo es iluminar las experiencias vividas de las enfermeras practicantes familiares en atención primaria de salud cuando realizan evaluaciones de salud sexual en sus clientes adultos. Utilizando el enfoque fenomenológico interpretativo de van Manen, se transcribieron y analizaron diez entrevistas. La comprensión de la experiencia vivida de estas FNP femeninas, iluminó algunas de las experiencias comunes al realizar una evaluación de salud sexual en sus clientes adultos. Se identificaron tres temas: autoconcepto, presencia y prudencia. Existen implicaciones globales de enfermería al comprender estas experiencias sobre educación, práctica e investigación en enfermería.

Sexual and reproductive health is a global health, development, and human rights priority. In addition, universal access to sexual and reproductive health is essential. Unfortunately, many nurses feel uncomfortable talking to their patients about sexual health. The purpose of this qualitative study is to illuminate the lived experiences of family nurse practitioners in primary health care when performing sexual health assessments on their adult clients. Using van Manen's interpretive phenomenological approach, ten interviews were transcribed and analyzed. Understanding the lived experience of these female FNPs, illuminated some of the common experiences when performing a sexual health assessment on their adult clients. Three themes were identified: self-concept, presence, and prudence. There are global nursing implications from understanding these experiences on nursing education, practice, and research.

A Mixed Method Review of Tobacco Cessation for the Cardiopulmonary Rehabilitation Clinician.

PURPOSE: To systematically survey the literature, describe the current tobacco science, and perform a mixed method review of randomized control trials of tobacco research in the cardiopulmonary population. METHODS: Mixed method review was conducted on major resource databases. Inclusion criteria were English language with a minimum follow-up of 6 months, published between January 1, 2007, and June 30, 2016; adult smokers ≥18 years of age with cardiovascular and/or pulmonary disease; initiation of subject recruitment from hospital or community; tobacco cessation (TC) as the main aim of the study; biometric validation of smoking status; first-line TC medications; and nonpharmacological treatments. RESULTS: The pooling of the 10 studies through forest plot analysis revealed the effect of tobacco continuous abstinence rates significant at 3, 6, and 12 months (total OR = 3.73; 95% CI, 2.58-5.38). Also, tobacco point prevalence rates of TC treatments demonstrated overall effects that were significant at the different end points (total OR = 2.63; 95% CI, 1.90-3.64). In both cases, the higher ORs were found in the 3 months end point. Most successful interventions consisted of a combination of pharmacological and nonpharmacological therapy (predominantly counseling). CONCLUSIONS: The evidence continues to support the recommended first-line TC pharmacotherapy and nonpharmacological practices published in the 2008 national guidelines. Implications for cardiopulmonary rehabilitation clinicians are discussed.

Putting the mouth back in the head: HEENT to HEENOT.

Improving oral health is a leading population health goal; however, curricula preparing health professionals have a dearth of oral health content and clinical experiences. We detail an educational and clinical innovation transitioning the traditional head, ears, eyes, nose, and throat (HEENT) examination to the addition of the teeth, gums, mucosa, tongue, and palate examination (HEENOT) for assessment, diagnosis, and treatment of oral-systemic health. Many New York University nursing, dental, and medical faculty and students have been exposed to interprofessional oral health HEENOT classroom, simulation, and clinical experiences. This was associated with increased dental-primary care referrals. This innovation has potential to build interprofessional oral health workforce capacity that addresses a significant public health issue, increases oral health care access, and improves oral-systemic health across the lifespan.

Patient and provider acceptance of oral HIV screening in a dental school setting.

In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine HIV screening in health care settings regardless of the patient's level of risk. This pilot study was developed in response to the suggestion by some health care professionals that dental settings would be appropriate for expansion of HIV testing. This project consisted of two parts: oral fluid HIV testing of patients in the clinic of a dental school and a survey of the clinical dental faculty members' attitudes about acceptability of routine HIV testing in the dental clinic. When patients' agreement to participate in oral fluid HIV testing was examined, 8.2 percent of the patients contacted by the clinic administration staff completed testing. When approached by a faculty member or student during the dental visit admission and tested during the dental visit, however, 88.2 percent completed testing. Of the faculty members who took the survey, 27.4 percent were neutral, 26.4 percent were somewhat in agreement, and 32.1 percent were willing to incorporate HIV testing into routine dental care. In this pilot study, HIV testing of dental patients was most successful when a dental care provider approached patients about testing. If consent was given, the testing was performed during the visit. For the faculty members, the major barrier to testing was a lack of protocol familiarity.

Implementing tobacco use treatment guidelines in public health dental clinics in New York City.

In this study we evaluated the effect of a multicomponent intervention to implement the Public Health Service (PHS) guideline Treating Tobacco Use and Dependence in six randomly selected dental clinics in New York University's College of Dentistry. The main outcome measure-provider adherence to tobacco use treatment guidelines-was assessed by auditing a random selection of patient charts pre (698) and post (641) intervention. The intervention components included a chart reminder and referral system, free nicotine replacement therapy (NRT), and provider training and feedback. The results showed that rates of screening for tobacco use did not change between pre and post test chart audits. However, providers were significantly more likely to offer advice (28.4 percent pre, 49 percent post), assess readiness to quit (17.8 percent pre, 29.9 percent post), and offer assistance (6.5 percent pre and 15.6 percent post) in the post test period. Increases in NRT distribution were associated with booster training sessions but declined in the time periods between those trainings. Research is needed to further define sustainable strategies for implementing tobacco use treatment in dental clinics. The results of this study suggest the feasibility and effectiveness of using a tailored multicomponent approach to implement tobacco use treatment guidelines in dental clinics.