Jacki Witt

Health Concerns of Mature Women Living With HIV in the Midwestern United States

This study was performed to better understand the health concerns of mature Midwestern women living with HIV and to offer health care providers information about the spectrum of medical and psychosocial needs of this population. Individual interviews were conducted with 18 low-income women who were 41 to 68 years of age. Interviews showed multiple needs that encompassed both physical and emotional health: more frequent health screenings, the ability to differentiate symptoms of advancing HIV from those of aging, desire for knowledge about reasonable expectations for aging women with HIV, and attention to emotional health needs and social support. Interventions aimed at helping mature HIV-infected women cope as they age, education about the normal aging process, consumer information about appropriate timing of health care screenings, and mechanisms to facilitate the creation of social support networks to decrease isolation seem to be needed in this population.

Development and Feasibility of an HIV and IPV Prevention Intervention Among Low-Income Mothers Receiving Services in a Missouri Day Care Center

This article outlines the development and feasibility of an HIV and IPV prevention intervention. Researchers formed a partnership with a group of women representative of the population that the intervention was intended to reach using methods derived from participatory action research. The use of health protective behaviors changed from pre- to postintervention in the clinically desirable direction. Results indicated that intervention delivery was feasible in the novel setting of a large urban day care center. This intervention has promise as a strategy to reduce HIV among low-income women; however, a controlled study is indicated to further examine intervention efficacy.

Development of a Mobile App for Family Planning Providers

Purpose: To provide an overview of lessons learned during the development process of an app for iOS and Android based on national recommendations for providing quality family planning services. Study and Design: After a review of existing apps was conducted to determine whether an app of clinical recommendations for family planning existed, a team of clinicians, training specialists, and app developers created a resource app by first drafting a comprehensive content map. A prototype of the app was then pilot tested using smart tablets by a volunteer convenience sample of womens healthcare professionals. Outcomes measured included usability, acceptability, download analytics, and satisfaction by clinicians as reported through an investigator-developed tool. Results: Sixty-nine professionals tested a prototype of the app, and completed a user satisfaction tool. Overall, user feedback was positive, and a zoom function was added to the final version as a result of the pilot test. Within 3 months of being publicly available, the app was downloaded 677 times, with 97% of downloads occurring on smart phones, 76% downloads occurring on iOS devices, and 24% on Android devices. This trend persisted throughout the following 3 months. Clinical Implications: Clinicians with an interest in developing an app should consider a team approach to development, pilot test the app prior to wider distribution, and develop a web-based version of the app to be used by clinicians who are unable to access smart devices in their practice setting.

Advanced Practice Registered Nurses and Long-Acting Reversible Contraception.

Introduction: Advanced practice registered nurses (APRNs) are in an excellent position to address the high rates of unintended pregnancy in the United States by providing long‐acting reversible contraceptives (LARCs). These methods are significant in their effectiveness in preventing pregnancy in individual women and in having population‐level effects on unintended pregnancy. The aim of this study was to learn more about APRN practices around long‐acting reversible contraception and influences on those practices. Methods: A cross‐sectional survey of APRNs who provide womens health services was conducted during the summer of 2015 using an existing adapted instrument with items on personal and patient characteristics, opinions, practices, and training around LARC methods. Zero‐inflated Poisson regression models were conducted to study the factors that influenced the number of LARC insertions in the past year. Results: While 84% of the 390 respondents were inserting intrauterine devices (IUDs) and 77% single‐rod implants, only 16% of these were inserting more devices than 5 years earlier. The most significant predictor of placement of these contraceptives was the clinical practice of requiring only one visit for completion. Discussion: National guidelines and recommendations have been in place for several years stating that women should be able to receive the contraceptive method of their choice in just one clinic visit. Womens access to LARCs from APRNs may be less than optimal. Additional research is needed to understand if the limitations in accessibility of this important reproductive health service are a function of clinician practices or clinic policies.

SANE-A-PALOOZA: a clinical immersion experience to close the gap for new sexual assault nurse examiners

ABSTRACT Background: Traditional educational methods for new sexual assault nurse examiners (SANEs) have had a gap in time between didactic instruction and the application to forensic nursing practice. In this interval, which can take several months, SANE trainees must locate a preceptor and perform at least 10 pelvic examinations. Only then can they apply their didactic knowledge and pelvic examination skills to actual patients presenting for forensic examinations. In 2011, Kansas City educators developed SANE-A-PALOOZA, a program that eliminated this gap, facilitated a unified educational experience, and ensured rapid integration of knowledge and skills. Objectives: The aims of this study were to briefly describe an educational method for SANEs based on adult learning principles and constructivist learning theory and to provide preliminary quantitative evaluation data, which are limited in contemporary literature. Methods: Immediately after the formal 40-hour didactic educational experience, trainees took part in an 8-hour SANE-A-PALOOZA, a clinically focused continuing education course that included standardized pelvic examination patients, skills immersion experience with advanced practice nurses and experienced sexual assault nurses, and a hands-on practicum with a crime scene photographer. Each of the 44 trainees performed 8–10 female pelvic and two male genital examinations on standardized patients and took forensic genital photographs in three of those examinations. Participants completed a variety of preevaluation and postevaluation instruments, including knowledge, clinical skills checklists, and confidence measures. Results: SANE-A-PALOOZA participants’ self-evaluations indicate high satisfaction with the educational program. Pretest/posttest scores indicate increased comfort, competence, and confidence after this immersion practicum. Conclusion: Skills education via a hands-on immersion experience can address the gap between didactic and hands-on clinical experience for SANEs.

The intention of advanced practice registered nurses to remain in positions at family planning clinics serving low-income women.

Federally funded Title X Family Planning Clinics are critical safety nets for reproductive health services in which advanced practice nurses (APRNs) provide the majority of care. The goal of this study was to identify factors affecting APRNs intention to remain in positions at these clinics. An Internet-administered survey was completed by 406 APRNs working in Title X clinics. The survey, based on a causal model of retention adapted for APRN practice, included 10 factors. Factor significance and model selection criteria were used to determine model fit. Intention to remain in current positions was associated with greater family responsibilities and lower levels of involvement in professional associations. Less routinization, more integration, and a greater sense of distributive justice were significant causal paths to job satisfaction (a significant mediator for intention to remain). Results provide Title X administrators information that can guide them in policy development to maximize APRN retention.

Family planning providers' role in offering PrEP to women.

Pre-exposure prophylaxis (PrEP) provides a radically different HIV prevention option for women. Not only is PrEP the first discrete, woman-controlled method that is taken in advance of exposure, but it is both safe and highly effective, offering over 90% protection if taken daily. While multiple modalities of PrEP are in development ranging from vaginal rings to injectables and implants, only PrEP with oral tenofovir/emtricitabine is currently FDA-approved. Family planning clinics provide key access points for many women to learn about and obtain PrEP. By incorporating PrEP services into family planning care, family planning providers have the opportunity to meet womens expectations, ensure women are aware of and offered comprehensive HIV prevention options, and reverse emerging disparities in PrEP access. Despite real and perceived barriers to integrating PrEP into family planning care, providing PrEP services, ranging from education to onsite provision, is not only possible but an important component of providing high-quality sexual and reproductive healthcare to women. Lessons learned from early adopters will help guide those in family planning settings initiating or enhancing PrEP services.

Facilitating State-Wide Collaboration around Family Planning Care in the Context of Zika

INTRODUCTION Family planning providers have an important role to play in the response to the public health challenge posed by Zika. In the United States, there are high rates of unintended pregnancy, especially in states most at risk for mosquito-borne transmission of the Zika virus. This paper describes efforts by eight of these states (Arizona, California, Florida, Georgia, Louisiana, Mississippi, South Carolina, and Texas) to build capacity for quality family planning care in the context of Zika. METHODS Drawing on resources developed by the Office of Population Affairs, including a toolkit for family planning care in the context of Zika, agencies and stakeholders involved in the family planning delivery system in Southern states at risk for mosquito-borne transmission met over several months in the summer of 2016 to coordinate efforts to respond to the risk of Zika in their jurisdictions. RESULTS Through proactive communication and collaboration, states took steps to integrate Zika-related family planning care, including screening for Zika risk and providing appropriate, client-centered counseling. Challenges faced by the states included not having family planning included as a component of their states Zika response effort, limited funding for family planning activities, and the need for robust communication networks between multiple state and federal agencies. CONCLUSIONS The efforts described in this paper can help other states to integrate family planning into their Zika response. This is relevant to all states; even when mosquito-borne transmission is not occurring or expected, all states experience travel-related and sexually transmitted Zika infections.

SANE-A-PALOOZA: Logistical Development and Implementation of a Clinical Immersion Course for Sexual Assault Nurse Examiners.

ABSTRACT SANE-A-PALOOZA, a continuing education program that utilizes hands-on practice with standardized patients and human simulators, was developed to fulfill a portion of the required supervised clinical experience for certification as a sexual assault nurse examiner. The program is designed to provide concentrated clinical skill practice application, eliminate the time gap between gaining and applying clinical knowledge, and decrease discontinuity among multiple preceptors. This article provides an overview of SANE-A-PALOOZA logistics, with the goal of aiding other organizations in developing skill-building experiences for new or less-experienced sexual assault nurse examiners.