Sexual and Reproductive Health Content in the 3 Ps in Nurse Practitioner Education.

BACKGROUND: Nurse practitioners (NPs) in primary care provide sexual and reproductive health care, an integral component of health and well-being. This study explored the degree of inclusion of sexual and reproductive health content in the foundational courses in NP preparation including advanced health assessment, advanced physiology and pathophysiology, and advanced pharmacology, known as the 3 Ps. METHOD: Qualitative interviews were conducted with 30 NPs in their first 2 years of practice. RESULTS: Sexual and reproductive health content was well integrated into advanced assessment courses, although participants wanted more comfort and skill with discussing sensitive sexual health issues. Advanced pharmacology and advanced pathophysiology courses were not likely to include the content. CONCLUSION: Interactive learning opportunities, such as simulation with feedback, promote communication skills with sensitive health issues. Foundational courses would benefit from a deeper understanding of the menstrual cycle, sexual functioning, and medications specific to sexual and reproductive health. [J Nurs Educ. 2022;61(3):131-136.].

The key to successful NP transition to practice.

ABSTRACT: This article explores the experiences of the new NP's onboarding process based on data from two qualitative studies. Interviews with 27 new graduates were used to inform the design, implementation, and experience of an onboarding program in a small healthcare setting without robust internal resources or a human resource department.

Did I learn enough to practice? Reflections of new nurse practitioner graduates in providing sexual and reproductive health care.

BACKGROUND: The Centers for Disease Control and Prevention and the US Office of Population Health have published guidelines for providing family planning services. PURPOSE: The study explores how nurse practitioners (NPs) perceived their preparation and competency in providing a range of sexual and reproductive health care in their first two years of community-based practice. METHODOLOGICAL ORIENTATION: Qualitative. Thematic analysis used to analyze data from structured and open-ended interview questions. SAMPLE: Through snowballing recruitment, 35 NPs participated in interviews. CONCLUSIONS: Participants were most confident and likely to provide contraceptive and sexually transmitted infection services. Participants felt less prepared to provide male sexual health and care to the lesbian, gay, bisexual, transgender, queer, and intersex+ population. Nurse practitioners expressed interest in building skills with discussing healthy sexuality across the life span, specifically postmenopausal sexual concerns, teen sexuality, trauma-informed care related to sexual violence, and early pregnancy decision making. Some participants had little preparation in early pregnancy decision making/options counseling. Faculty need to examine barriers to teaching these skills because the curriculum should address all legal pregnancy options, including discussing the NP's professional obligations. More preparation was needed in the clinical management of erectile dysfunction, polycystic ovary syndrome, herpes, syphilis, abnormal uterine bleeding, dyspareunia, pelvic pain, miscarriage management, and how to discuss prostate cancer screening. IMPLICATIONS FOR PRACTICE: The recommendations of the quality family planning, with additions, form a sound basis for sexual and reproductive health care standards, education, and clinical practice, should be part of NP education.

Sexual and reproductive health content in nurse practitioner transition to practice training programs.

OBJECTIVE: To describe the sexual and reproductive health (SRH) offerings of transition to practice training programs for certified primary care nurse practitioners in the United States. STUDY DESIGN: Program Directors from all identified primary care training programs (n = 51) were invited to participate in an online survey to assess the SRH didactic and clinical offerings based on competencies developed by the World Health Organization and adapted for the US across 15 domains and 15 related procedures. RESULTS: Twenty-two (43%) surveys were completed. There was considerable variation in offerings, with no single domain required by all programs, nor any program requiring trainees to complete didactic and clinical offerings in all domains. On average, programs required didactic and clinical training for approximately a third of the competencies in the Reproductive Tract Cancers domain (the most required domain) and for approximately a quarter of the competencies in the Contraceptive domain. Infertility/Fertility and Environmental Risks to Reproductive Health were the least commonly required domains. Clinical training tended to be more frequently required or offered than didactic instruction in almost all domains.Regarding procedures, both didactic and clinical training on insertion and removal of intrauterine devices were required by one third of programs. No-scalpel vasectomy was the procedure in which programs were least likely to offer trainees either didactic or clinical training, followed by uterine aspiration for missed or elective abortion or heavy menstrual bleeding. CONCLUSION: Although SRH is recognized as an essential component of primary care, its inclusion in transition to practice primary care training programs for NPs is low and inconsistent. IMPLICATIONS STATEMENT: Preparing primary care NPs to deliver competent SRH care is important for workforce development and patient care. Our study highlights a need for additional research to determine the baseline competency in SRH care among primary care NPs in order to further enhance education, training and policies with this aim.

Longitudinal study of advanced practice nurses' implementation of screening intervals for cervical cancer screening.

BACKGROUND AND PURPOSE: The past two decades brought changes in cervical cancer screening guidelines. Frequent modifications and earlier lack of agreement about recommendations created confusion. The purpose of this study was to explore to what extent advanced practice nurses (APNs) adopted cervical cancer screening guidelines. METHODS: A longitudinal survey of 358 APNs conducted in three New England states regarding cervical cancer screening practices in 2008, 2012, and 2015. CONCLUSIONS: Advanced practice nurses are incorporating guidelines at a high rate. Advanced practice nurses found it easier to incorporate guidelines to delay screening until the age of 21 years, to discontinue screening after total hysterectomy for benign reasons, and to discontinue screening at the age of 65 years. In 2012, 15% of APNs were screening women aged 21-29 years every 3 years; by 2015, this rate rose to 72%. By 2015, half of APNs were screening low-risk women aged 30-64 every 5 years. Because screening practices changed, APNs questioned the need to perform screening pelvic and breast examinations. Advanced practice nurses no longer perform screening pelvic examinations (93%) or breast examinations (75%) in adolescents. IMPLICATIONS FOR PRACTICE: Some APNs indicated that office-based practice standards are barriers to adherence to guidelines. Advanced practice nurses need to be involved in practice committees to ensure that evidence guides practice decisions.

Systematic Review of Sexual and Reproductive Health Care Content in Nursing Curricula.

OBJECTIVE: To examine whether and to what extent pre-licensure nursing programs include sexual and reproductive health (SRH) content in their curricula. DATA SOURCES: Electronic databases, including CINAHL, MEDLINE, PubMed, Web of Science, Science Direct, Google Scholar, ProQuest, and CAB Direct were searched for relevant literature. We also reviewed the reference lists of all studies, nursing organization Web sites, and the personal files of the authors. STUDY SELECTION: Inclusion criteria were studies focused on SRH content in pre-licensure nursing education, written in English, and published between January 1990 and November 2016. We identified 632 articles, and of these, 22 met the inclusion criteria. Duplicates were discarded, and 13 articles were reviewed (9 quantitative descriptive, 2 modified Delphi, 2 mixed methods). DATA EXTRACTION: Data extraction and subsequent analysis were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted and organized under the following headings: author and year to establish a historical timeline, study purpose and design, sample size, data collection methods, main study findings, and limitations. DATA SYNTHESIS: We found the following: (a) most studies focused on baccalaureate education; if associated degree programs were reviewed, findings were not reported separately; (b) definitions were not consistent, which affected the scope of study results; (c) the SRH topics taught were similar; (d) there is a recent interest in sexual orientation and gender identity curriculum; (e) barriers to including content were time constraints, competing demands with other curriculum priorities, and a need for creative curriculum tools. CONCLUSION: Documentation of SRH content in pre-licensure nursing education is limited. Faculty should conduct ongoing evaluation of their curricular strategies and clinical experiences and publish results in the literature.

The Annual Gynecologic Examination Updated for the 21st Century.

The concept of an annual gynecologic screening visit to identify disease at an early stage has long been an established component of women's health care. Women and their health care providers have historically accepted the schedule of an annual gynecologic examination with cervical cancer screening and a pelvic examination. Recently, researchers questioned the value of the annual breast and pelvic examinations in asymptomatic women and re-established the intervals for Pap test screening with the addition of human papillomavirus co-testing to establish cervical cancer risk. The updated well woman examination is now an opportunity to engage women in health education, screening for chronic disease risks, and health care concerns such as depression and violence.

Core competencies in sexual and reproductive health for the interprofessional primary care team.

OBJECTIVE: A primary care workforce that is well prepared to provide high-quality sexual and reproductive health (SRH) care has the potential to enhance access to care and reduce health disparities. This project aimed to identify core competencies to guide SRH training across the primary care professions. STUDY DESIGN: A six-member interprofessional expert working group drafted SRH competencies for primary care team members. Primary care providers including family physicians, nurses, nurse practitioners and certified nurse midwives, physician assistants and pharmacists were invited to participate in a three-round electronic Delphi survey. In each round, participants voted by email to retain, eliminate or revise each competency, with their suggested edits to the competencies incorporated by the researchers after each round. RESULTS: Fifty providers from six professions participated. In Round 1, 17 of 33 draft competencies reached the 75% predetermined agreement level to be accepted as written. Five were combined, reducing the total number to 28. Based on Round 2 feedback, 21 competencies were reworded, and 2 were combined. In Round 3, all 26 competencies reached at least 83.7% agreement, with 9 achieving 100% agreement. CONCLUSION: The 33 core competencies encompass professional ethics and reproductive justice, collaboration, SRH services and conditions affecting SRH. These core competencies will be disseminated and adapted to each profession's scope of practice to inform required curricula. IMPLICATIONS: SRH competencies for primary care can inform the required curricula across professions, filling the gap between an established standard of care necessary to meet patient needs and the outcomes of that care.

The SEARCH Project: Acquainting Students in the Health Professions with Interprofessional Care.

The SEARCH NH project (Student Experiences and Rotations in Community Health in New Hampshire) was a 3-year collaboration of the New Hampshire Area Health Education Center, four educational institutions, and four community health centers. The purpose was to introduce students in the health professions to interprofessional care in underserved areas. It was funded by the National Health Services Corps. The background of the project, its development, and findings are described. Seventy-four students from undergraduate and graduate nursing programs, a physician assistant program, and a medical school participated. Prior to a focused immersion experience in a community health center, they were exposed didactically to concepts of interprofessional care. Findings from the collaborative project are reported using a clinical microsystems framework to analyze student reflections on their experiences and resultant learning. In quotes offered as exemplars, students report increased appreciation of the clinical microsystem's 5 Ps: purpose, professionals, patients, patterns, and processes in interprofessional work.

Essential competencies in nursing education for prevention and care related to unintended pregnancy.

OBJECTIVES: To identify the essential competencies for prevention and care related to unintended pregnancy to develop program outcomes for nursing curricula. DESIGN: Modified Delphi study. SETTING: National. PARTICIPANTS: Eighty-five nurse experts, including academic faculty and advanced practice nurses providing sexual and reproductive health care in primary or specialty care settings. METHODS: Expert panelists completed a three-round Delphi study using an electronic survey. RESULTS: Eighty-five panelists completed the first round survey, and 72 panelists completed all three rounds. Twenty-seven items achieved consensus of at least 75% of the experts by the third round to comprise the educational competencies. CONCLUSION: Through an iterative process, experts in prevention and care related to unintended pregnancy reached consensus on 27 core educational competencies for nursing education. The competencies provide a framework for curricular development in an important area of nursing education.

Women's experience of decision-making with medication abortion.

BACKGROUND: Medication abortion received regulatory approval in 2001 in the United States with healthcare providers increasingly offering this method. However, most studies in the United States have only explored acceptability and decision-making with women who participated in clinical trials. Overall, the literature on women's experience with a method that it is now widely available is under research in the United States. OBJECTIVE: To describe and analyze the women's experience as they choose the option of and experienced the process of medication abortion. DESIGN: A constructivist grounded theory study. SETTING: Outpatient clinical offices in a three-state area in the northeast region of the United States. PARTICIPANTS: A purposive sample of 22 women aged 16 to 45 who experienced a medication abortion. METHODS: Data were collected by in-depth, open-ended, face-to-face interviews. The constant comparative method was used for analysis. RESULTS: Five interwoven categories emerged regarding women's initial decision to have a medication abortion: choosing a natural process, avoiding "surgery," respecting the "baby," scheduling to meet needs, and appreciating the home setting. The enhanced sense of personal control associated with the medication abortion option was the overriding reason given for choosing this method. CONCLUSION: This study contributes to the paucity of literature on the reasons why women choose medication abortion. It is important for nurses to understand the complexity of medication abortion decision-making so that they can effectively support women through this process.

A qualitative study of women's decision to view or not view an ultrasound image before early medication abortion.

BACKGROUND: Transvaginal ultrasounds are commonly performed for gestational dating of pregnancy before a medication abortion. This paper presents findings regarding women's perspectives on viewing the gestational dating ultrasound image, which arose from a study exploring women's medication abortion experience. By providing women the opportunity to talk about their medication abortion experience through open-ended interviews, women reported their experience of viewing or not viewing the ultrasound in detail, which to date has been underexplored. METHODS: A constructivist, grounded theory approach was used. The purposive sample consisted of 18 women in the United States who experienced a medication abortion in the preceding 4 months. FINDINGS: Not all women wanted to view the ultrasound; however, they all wanted a choice. Women wanted to view the image to confirm health and fertility, satisfy curiosity, and process their decision regarding the pregnancy. None of the women stated that they wanted to view the image as a prerequisite to making their decision to terminate the pregnancy; rather, viewing was a way to process their decision. CONCLUSIONS: Women wanted a choice of whether to view the ultrasound image because they felt it was their right to decide whether to access this aspect of their personal health information. They wanted providers to engage in a dialogue about viewing the image or not and to respect their decision. Providers need to be appropriately prepared to offer women the choice to view and to support women in their decision.

IUDs: beyond the basics.

This article reviews the changes in patient selection for intrauterine devices (IUDs) and evidence-based practices regarding counseling and management of common IUD issues. Where evidence-based research is lacking, expert opinion and common standards of practice are reviewed, and current clinical resources are identified.

Clinical issues in post-abortion care.

This article provides an overview of the clinical issues in post-abortion care, including types of abortion procedures, expected post-abortion course, possible complications, and the components of the post-abortion visit. By providing follow-up care to their patients, NPs can increase continuity of care and promote successful contraceptive use.

Applying ethical practice competencies to the prevention and management of unintended pregnancy.

Using a case study that incorporates patient, nurse practitioner, and student perspectives, we address ethical principles of respect for autonomy, beneficence, and fairness; professionals' right of conscience; and a social justice model for the discussion of prevention and management of unintended pregnancy. Through an ongoing process of self-reflection and values clarification, nurses can prepare for the challenge of applying ethical principles to the reproductive health care of women.

Bring the popcorn: using film to teach sexual and reproductive health.

The use of film as a teaching modality offers an opportunity for nursing students to explore the intersections of science, theory, and personal values prior to caring for clients with sexual and reproductive health (SRH) needs. Although the use of a broad range of arts and humanities modalities in the classroom is described in the literature, the use of film in relationship to teaching SRH has not been explored. Furthermore, there is a paucity of literature regarding the didactic or clinical teaching of SRH in nursing education. This article provides a framework for incorporating film as a teaching strategy into both case-based and problem-based teaching pedagogies. Reviews and discussion questions of films are provided.

Professional right of conscience.

In recent years there have been numerous media reports of professionals attempting to expand the right of conscience and deny health care services requested by consumers. While the media has focused the most attention on pharmacists' right to refuse access to contraception, this trend is an expansion of the right originally established to protect professionals from being required to perform abortions or to provide direct assistance with abortions. State legislatures have addressed this issue, in some cases by overtly protecting consumers' rights and in other cases by broadening professional right of conscience. In this article, the literature on provider right of conscience is reviewed, and approaches advised by professional organizations are discussed.

Evaluation of undergraduate students using Objective Structured Clinical Evaluation.

This study proposed to develop an Objective Structured Clinical Evaluation (OSCE) for senior undergraduate nursing students. This evaluation process uses a simulated and standardized format to measure synthesis of knowledge and clinical skills. The benefit of OSCE is that it provides a formative evaluation for both students and the educational institute. The study included developing case studies, identifying or developing assessment tools, hiring and training standardized patients, obtaining a testing site, and analyzing data. A total of 49 students were assessed on three of six patient simulation stations and one of two nonpatient stationary stations. Both formative and summative evalu-