1, a. Assessment of the problem. In communities with increasing teenage pregnancy rate, does the use of peer led safe sex discussion groups, compared to the traditional sexual education lectures, have a greater impact on reducing the rate of teenage pregnancies and sexually transmitted diseases?
In this particular community, one of the growing (P) problems is the rise in pregnancies in the middle and high school populations. An (I) intervention that would benefit this group would be teen led safe sex practice groups. A medical professional, such as a community health nurse, could educate teens from the community who are interested in leading the group. These teens can then hold discussions after school addressing safe sex practices amongst their peers. The community health nurse could then (C) compare the effect this intervention has in creating a safe space to speak honestly about safe sex practices on the teen population as opposed to the traditional safe sex lectures presented in the classroom setting led by a teacher. The (O) outcome the nurse would expect to discover is that teens are more likely to address safe sex concerns within a peer group rather than in a classroom setting and have a future impact on reducing the rate of teenage pregnancy within this community.
1,b. Literature Review. In order to collect evidence to conduct a literature review, I would begin by researching various topics related to my posed question such as teenage pregnancy in low socioeconomic areas, safe sex education among the teenage population, peer led health education groups among the teenage population and any other topics that might stem from this search that are related to the topic. During my research I would like to utilize information from quantitative studies that are designed as experimental, quasi-experimental and non-experimental. These particular types of designs present the strongest evidence to support my question. Through the use of quantitative studies, we can use statistical analysis to measure my proposed outcome of reducing teen pregnancies in teen led safe sex peer groups rather than by traditional health class lectures alone. After gathering sufficient research to support my claim, I would then use the scientific research process to critically examine and appraise all evidence. If the material is found to be valid and reliable, I will then organize my information to present to the community.
1,c. Organization and Presentation of Findings. After careful examination of my research, I would present all evidenced based findings that support teen led safe sex peer groups in reducing the rates of pregnancies and sexually transmitted diseases using the most cost effective approaches available. In order to implement this practice, my team of community health nurses would post flyers throughout the school regarding the safe sex education workshops for teens that want to teach other teens. We would also have a separate meeting for parents to obtain information on the groups as well to aide in educating their family. Once our team of nurses recruited a number of students that are interested in leading discussion groups, we would then spend time educating the students on various safe sex practices and encourage their input and any questions. We would also educate on how to begin such discussions and conduct group meetings. The students who are interested in volunteering can utilize this activity as community service for college applications and scholarships in the future. It would also give teens a first hand experience on the application of leadership skills.
1.d, Reevaluation and Revision. After implementation of the peer led groups in this sample population, the community health nurse would then reevaluate the outcome the peer groups had on decreasing teenage pregnancies. If the peer led groups were successful in preventing teenage pregnancies, then the community health nurse could begin to work with larger organizations to initiate similar groups nationwide as an after school program for instance. The community health nurse can then begin to contact such agencies as the as The Advocates for Youth as well as his or her home state nursing association to lobby for such programs to be offered nationwide as all teens would benefit from truthful information on safe sex practices. If any negative impacts were presented during the peer led groups, the nurse could then revise the initial plan and formulate a new intervention for experimentation.
1.e, Three core functions of public health are addressed in my example by beginning with assessment of the community. As the community health nurse, I noticed a rise in the teen pregnancy rate of this neighborhood. Using the PICO process, I was able to identify the problem, explore a possible intervention, and a comparison to discover possible outcomes. Part of the role of the community health nurse is to establish interventions that can be valid in other communities that may lead to policy development. Upon learning that there is significant evidence to support my claim that peer led groups would benefit teens as well as sexual education in the classroom setting; I reached out to other organizations in hopes of establishing similar programs nationally. By developing a larger scale intervention using evidenced based research, there could be a decrease in teenage pregnancies, sexually transmitted diseases and provide the public with an assurance that we have their best interests in mind when developing interventions.
2.a, Evidence from research is central in working with clients from community A because the community can serve as a living laboratory for the nurse to prove her finds. The nurse was able to find literature that shows that diesel engines emit 30 to 100 times more particles than gasoline and draw connections between the high levels of diesel exhaust and respiratory illnesses among the population. Using this evidence from the community and the evidence from current literature, the community nurse now has a significant argument to lobby for new policies to decrease pollution in this community and others like it.
2.b, Evidence from nursing clinical practice provides approaches to care for community A by utilizing the skills obtained through best practices in the clinical setting. The community health nurse must utilize what he or she has learned in bedside nursing in providing care for patients with respiratory illnesses but often without the luxury of having the necessary tools that are readily available at the bedside. In this case, the community health nurse is in a unique position where new innovative techniques in rendering care can be implemented. These new techniques can then become topics of research and possibly utilized at the bedside and improve patient outcomes in the future.
2.c, Evidence from the client’s experience impacts the client’s plan of care for community A through the complexity of the various issues present within this population. The residents of this population have long been voicing their concerns over this issue and it seems as though it has been brushed under the rug so to speak. In addition to the pollution from the bus depot, the community is finding that clinics are few, their hospital is on the verge of closing and the little remaining healthcare professionals left are being recruited to other areas. This community may have a lack of trust for the community health nurse and feel as though they are without a voice. It is imperative that the community health nurse seeks various ways in which to understand the needs of this community and locate all the resources possible to make this change effective.
2.d, The parts of the Alliance for Health Model that relate to community A are:
- Community-Based Needs. Higher instance of respiratory illnesses in children and the elderly that is greater than the national average leading to increased morbidity and mortality. The city’s eight diesel bus depots and 650 buses are housed in this small 7.4-square-mile area.
- Vision of the client. Residents feel the diesel bus pollution plays a significant role in contributing to the rising respiratory illnesses.
- Resource allocation. Community A is a low-income area with very few local clinics and the local private hospital is on the brink of closure due to the high cost of excessive emergency care related to the respiratory illnesses. In the passage provided there seems to be very little funding available or that the community needs education on accessing funds that they may be unaware are available to make the necessary changes.
- Systems of Care Management. As stated above, there are currently very few clinics available to the population causing residents to seek excessive emergency care that is placing a heavy financial burden on the local private hospital. In addition to the limited healthcare centers, the available healthcare personnel are being recruited to work in other areas.
- Expertise of the provider. The community health nurse found research that supports the community’s claim that the diesel fuels are the likely cause of the increasing respiratory illnesses. The community health nurse is in a unique position to assist Community A in making changes occur to increase quality of living. By obtaining research to support the claims, the nurse is responding like a professional and using his or her education to benefit the community.
2.e, A local outcome that I would like to see for community A is that the bus depot will be relocated to another area that is less densely populated. I would also like to see a mobile respiratory clinic available to all residents who require treatment for these illnesses that are clearly caused by poor city planning. A national policy change outcome that I would like to see is a clean air act initiation. I would lobby for a restriction on the amount of buses that are stationed in a particular zone at one time and I would like see an implementation of cleaner fuels or fuel alternatives such as hybrid buses to decrease the overall pollution in Community A and other communities facing similar issues.
