Alison Moriarty Daley

A model of teen-friendly care for young women with negative pregnancy test results☆

Sexually active adolescents, and especially those who receive negative pregnancy test results, are a self-identified group at particularly high risk for STIs and unintended pregnancies. Although reproductive health care alone will not totally prevent the occurrence of teen pregnancy and STIs, providing care that is accessible and designed to be teen-friendly will help diminish this area of health risk for hundreds of thousands of U.S. adolescents. Clinical interventions that are theoretically sound and based on research allow for the development of innovative, individualized, and evolving models of adolescent health care to address the needs of a challenging group of patients within a changing and competitive health care environment.

Tailoring Clinical Services to Address the Unique Needs of Adolescents from the Pregnancy Test to Parenthood

Clinicians across disciplines and practice settings are likely to encounter adolescents who are at risk for a pregnancy. In 2010, 34.2/1000 15-19-year-old teens had a live birth in the United States, many more will seek care for a pregnancy scare or options counseling. Teen mothers are also at risk for a second or higher-order pregnancy during adolescence. This paper provides clinicians with adolescent-friendly clinical and counseling strategies for pregnancy prevention, pre- and post-pregnancy test counseling, pregnancy-related care, and a review of the developmental challenges encountered by teens in the transition to parenthood. Clinicians are in a better position to approach the developmental, health and mental health needs of adolescents related to pregnancy if they understand and appreciate the obstacles adolescents may face negotiating the healthcare system. In addition, when clinical services are specially tailored to the needs of the adolescent, fewer opportunities will be lost to prevent unintended pregnancies, assist teens into timely prenatal services, and improve outcomes for their pregnancies and the transition to parenthood.

How to perform a pelvic exam for the sexually active adolescent.

The pelvic examination is a necessary health screening for sexually active female adolescents. This article describes how to perform a pelvic examination, including collecting specimens for sexually transmitted infections, wet mount evaluation, and the Papanicolaou test. Additional sections cover abnormal findings and special considerations.

Providing adolescent-friendly HPV education.

Human papillomavirus (HPV) is the most common sexually transmitted infection, affecting more than 6.2 million individuals every year. Most new infections occur in adolescents and young adults shortly after the onset of sexual activity. Nurse practitioners play a key role in preventing HPV infection in teens through adolescent-friendly HPV education, prevention, and vaccination.

Rationale for Reducing the Spread of Human Papillomavirus in Adolescents: Strategies to Improve Outcomes (CME Multimedia Activity)

As detailed in this online CME activity (http://cmeaccess.com/cme/JAH_HPV_program/index.asp?link_id=2), human papillomavirus (HPV) infection is the cause of cervical cancer and neoplasias in women, and genital warts in men and women. In addition, 35%-85% of vaginal, vulvar, anal, penile, and oropharyngeal cancers are attributable to HPV. An estimated 80% of females and 50% of males in the United States will become infected at some point in their lives; however, the incidence of this highly prevalent infection peaks in adolescents and young adults. Owing to the importance of vaccination before this elevated risk of exposure, the Centers for Disease Control and Prevention recommends HPV vaccination for girls aged 11-12 years with either the bivalent or quadrivalent vaccine. Recently, the quadrivalent vaccine, which also protects against genital warts and anal neoplasias and cancer, was approved for use in boys as well. Although the coverage rate has increased steadily in the 5 years since the vaccines introduction, it remains below 50%. To overcome barriers to vaccination, including lack of awareness about adolescents HPV risk and challenges associated with preventive care in this age group in general, healthcare providers must be able to educate parents/patients about HPV and the vaccine, as well as maximize opportunities to vaccinate adolescents at every office visit.

Use of home pregnancy tests among adolescent women.

Many adolescents use home pregnancy tests when they suspect pregnancy. However, because of developmental issues and greater variation in menstrual cycles, teens are at risk for obtaining false-negative test results. Moreover, with teens, the need for a pregnancy test often accompanies the need for comprehensive reproductive care including evaluation for sexually transmitted infections and contraception. This article reviews the mechanisms of home pregnancy testing including sensitivity, accuracy, and home testing procedures. Clinical strategies for improving the accuracy of home pregnancy tests for teen users are discussed. Lastly, policy implications to improve teens’ access to more accurate pregnancy testing and to reproductive health services are suggested.

Effective contraceptive counseling with adolescents in a nurse-based setting

Nurses serve a critical role in working with adolescents on reproductive health issues. Nurses must be knowledgeable and comfortable with providing counseling on contraceptive choices and decision making in order to meet the important goal of helping teens prevent unintended pregnancies.

“Treat Me Like a Normal Person!” A Meta-Ethnography of Adolescents' Expectations of Their Health Care Providers

Purpose Preventive health care services provide an important opportunity to assist adolescents to establish and maintain a healthy lifestyle and assume an increasing independent role in their health care. National guidelines emphasize the importance of an annual wellness visit to identify and address risk‐behaviors that contribute significantly to the morbidity and mortality in this population. Despite these recommendations, adolescents utilize preventive health care at declining rates throughout adolescence. The purpose of this study was to capture a more holistic view of what adolescents, as consumers of health care services, expect from their primary health care providers (HCPs). Method A metasynthesis of 12 qualitative research studies was conducted using Noblit and Hares (1988) meta‐ethnographic approach. Results Five overarching metaphors, Talk with Me‐ Not at Me, Accept Me, Respect My Privacy and Confidentiality, Show Me You Are a Professional, and A Trusted Relationship described adolescents’ expectations of their HCPs. Conclusions This study provides a more holistic view of adolescents’ expectations of their HCPs. Clinical strategies are suggested to assist HCPs to meet adolescents’ expectations. HighlightsThe majority of the morbidity and mortality in the adolescent population results from preventable causes.Less than half of adolescents in the United States receive an annual preventive visit and fewer receive developmentally appropriate screening and anticipatory guidance.This metasynthesis identified five overarching metaphors describing adolescents’ expectations of their health care providers: Talk With Me ‐ Not At Me, Respect My Privacy and Confidentiality, Accept Me, Show Me You Are a Professional, and A Trusted Relationship.A Trusted Relationship was found to play a central role in adolescents’ health care expectations.This qualitative study provides a more holistic view of what teens, as consumers of primary health care services, expect from their health care providers.

“Contraceptive Care for Adolescents in School-Based Health Centers Is Essential!”: The Lived Experience of Nurse Practitioners

Adolescents often face hurdles that may interfere with accessing contraceptive services. School-based health centers (SBHCs) are available to many teens in the United States; however, only half of SBHCs that serve adolescents are permitted to provide contraception. The aim of this descriptive phenomenological study was to describe the lived experience of nurse practitioners (NPs) providing contraceptive care to teens in SBHCs. Twelve NPs were interviewed and Colaizzi’s method of descriptive phenomenological analysis was used to describe the lived experience of NPs providing contraceptive care to adolescents in SBHCs. Three themes emerged: Contraception is an Essential Part of Care for Teens Using SBHCs; Frustration! There are so Many Hurdles to Negotiate; and Walking a Fine Line. Despite the restrictions on SBHC services and the hurdles the NPs encountered, they remained committed to providing contraceptive services and seized available opportunities to provide health education and support for the adolescents accessing the SBHCs.

Pediatric Nurse Practitioners' Perspectives on Health Care Transition From Pediatric to Adult Care

INTRODUCTIONnThis study examined the perspectives of pediatric nurse practitioners (PNPs) regarding the needs of adolescents, parents/caregivers, clinicians, and institutions in the health care transition (HCT) process for adolescents/young adults.nnnMETHODSnPNPs (N = 170) participated in a luncheon for those interested in transition at an annual conference. Small groups discussed and recorded their perspectives related to health care transition from adolescent to adult services. Content analysis was used to analyze responses (Krippendorff, 2013).nnnRESULTSnFour themes, Education, Health care system, Support, and Communication, emerged from the data analysis. PNPs identified health care informatics and adolescents use of technology as additional critical aspects to be considered in health care transition.nnnDISCUSSIONnOpportunities and challenges identified by the PNPs are discussed to improve the quality and process of transitioning adolescents to adult services. This report will help National Association of Pediatric Nurse Practitioners formulate a new Health Care Transition Policy Statement for the organization.