Running head: NURSE LED SEXUAL HEALTH CLINIC FOR TEENS

Nurse Led Sexual Health Clinic for Teens Deborah Rafferty American Sentinel University Capstone Project BSN499 Professor Victoria Brahe August 18, 2012

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS Nurse Led Sexual Health Clinic for Teens Adolescent sexuality has been a major discussion for generations. The teens of today have started exploring at an earlier age. Girls are reaching puberty earlier, oral sex is on the rise, uncertainty about sexual orientation is increased and about half of high school students have

reported having sex. Although condom use has increased it has not stopped the rise of STDs. It is reported that 1 in 4 teens have been infected with human papillomavirus, Chlamydia, herpes, or trichomoniasis. It is difficult to provide teenagers with sexual healthcare when the teens are struggling to understand their own sexuality while trying to fit in with other teens. Health care providers need to teach the teens the consequences the teens face when exploring their sexual behaviors (Garofalo & Forcier, 2011). The purpose of this paper is to describe the process of creating a Nurse Led Sexual Health Clinic for Teens in my community. Problem Teen pregnancy is one of these negative risks and a problem in the United States. There were over 409 thousand babies born in 2009 from teenage girls ages 15 to 19, the majority of these births were not intended. Although living in poverty, being from a single parent household, and having difficulty in school increase the chance of becoming a teen parent, it can happen in any socioeconomic neighborhood. Being an offspring to teen parents increases the chance by 33% that they will become teen parents as well ("About teen pregnancy," 2011). There are many problems associated with teen pregnancy. Each year teen pregnancies cost over nine billion dollars for the U.S. taxpayers. The money assists in the costs for foster care, the cost of increase healthcare, the increase rates of incarceration of the offspring of teen parents, and the loss in tax revenue due to the increase rate of high school drop outs ("About teen pregnancy," 2011). The health risks for these pregnant

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teens include high blood pressure, preterm labor, poor nutrition and anemia. Since the teen mom is less likely to seek prenatal care, the risks are even greater. These young mothers are also more likely to smoke, drink and have untreated STDs, all of which can have a negative effect on the unborn child ("Teen Pregnancy," 2011). The teen birthrate in Delaware County as per the County Health Rankings is 23 out of 1000 females aged 15 to 19 (County Health Rankings, 2011, p. 1), which is about 3,438 a year. There are approximately 16,770 children in this county between the age of 5 and 18. In 2007, this county had 851 reported teen pregnancies (Delaware County Teen Pregnancy Prevention Coalition, n.d.) and in 2008 there were 529; 105 of those births were not the teens first pregnancy (Delaware County Teen Pregnancy Prevention Coalition, n.d.). At least 20% of the families live in poverty (County Health Rankings, 2011). Poverty can contribute to teen pregnancies, which they are usually a product of single parent homes using welfare (OHalloran, 1998). Goal and Outcomes The goal of this project is to start a nurse led sexual clinic for teens. The anticipated outcomes of this project include: Increase the number of teens using condoms by 30 days after starting Increase the number of teens using oral, implanted or injected contraceptives by 30 days after starting Increase the number of males that participate by 30 days after starting Increase the number of pregnant teens that will seek prenatal care by 30 days after starting Decrease the number of teens with STDs 60 days after starting

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS Decrease the number of pregnancies by 90 days after starting

Giving the teens a place to seek help without judgment or prejudice will increase the knowledge and use of contraceptives therefore decreasing teen pregnancy as well as sexually transmitted diseases. Although one of the main focuses of this clinic is to prevent teen pregnancy, accidents do happen. For these teens that become pregnant making sure they receive proper prenatal care is essential for the wellbeing of their baby and themselves. Without prenatal care the teens that have any pre-existing conditions such as HIV/AIDS, high blood pressure, STDs, diabetes, or any health issues involving heart, lungs, or kidneys, are putting themselves at an even higher risk for health problems. Equally as detrimental can be conditions that can occur during a pregnancy, including preeclampsia, gestational diabetes, preterm labor, multiple births, placenta previa and fetal problems ("Managing High-Risk Pregnancy," n.d.). If any of these conditions are present, being under the watchful eye of a doctor will decrease the chance of a poor outcome. To increase male participation, the advertising has to be geared towards their interests and needs. Some studies have suggested that young males do not want to be seen going into a girls clinic (Lindberg et al., 2006). So if males are not attending the clinic, advertise a time that just male teens could come in, this may increase the number of males that use this service. Maternal morbidity and mortality can be directly correlated to hemorrhage, embolism, infection, high blood pressure, cardiomyopathy unsafe abortion, and obstructed labor, yet 90% are presentable with prenatal care ("Maternal Health," 2011) (Allender et al., 2010). The underlying cause of these fatalities can be related to any number of risk factors listed above as well as teen pregnancy and living in poverty. With proper intervention most of these teens would

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS have a healthier pregnancy and newborn, this is why it is important to refer a pregnant teen to a perinatal provider as soon as possible. Increasing the teens knowledge of STDs, prevention, symptoms and treatment, should decrease the number of teens that contract them. According to the World Health Organization (WHO) there are over 300 million cases of STDs that occur in the world each year. Teen girls

may suffer pelvic inflammatory disease, infertility or and ectopic pregnancy while teen boys may suffer urethral strictures if their STDs go untreated. Having the resources easily accessible for the teens to be able to diagnosis and treat the STDs will be an enormous benefit for these teens (Dehne & Riedner, 2005). The last outcome this program would like to achieve is to decrease teen pregnancy; it is by far, the most important. Teen pregnancy has a negative affect on the teen, the offspring and the community. The school nurse may have a list of the pregnant teens that are already in the school, when the clinic is made available, the number should stay the same. If the teen already has a child, the hope is they will not have another while still in their teens. Teaching both male and females about the pressure of having a sexual relationship and the consequences will be an ongoing project for this clinic ("Meeting the needs," 2009). Consistency of Project with the Role of Nursing in Society Nationwide there are over 250 nurse-run clinics (Dennehy, 2012). Theses clinics are the result of the increasing uninsured people living in the United States. It is estimated that roughly 30 million people will be seeking new health care providers in the next two years because of the new federal healthcare reform. Nurse practitioners are able to provide the same care to their patients as physicians, at a lower cost. The patients have a higher satisfaction because of the teaching and education the nurse is able to provide regarding disease prevention and health

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS promotion (Dennehy, 2012). It is a win-win situation for the community, the patients get excellent healthcare while the tax payers pay less for a nurses salary as compared to that of a physician. The Institute of Medicine released a report called The Future of Nursing that urges

nurses to practice to their fullest extent, be partners with physicians, and pursue higher levels of education. This report encourages insurance companies and hospitals to recognize advanced practice nurses as clinical personnel that are able to bill insurance companies for their services. Expanding opportunities for nurses to manage successful practices and conducting research is a recommendation that stands out (Institute of Medicine [IOM], 2010). Nurses have many roles in a community; clinician, teacher, manager, advocate, leader, researcher and collaborator which allows them to be on the front line of patient care (Allender, Rector, & Warner, 2010). These roles assist the nurse in addressing both the physical, psychological, and even the spiritual needs of the patient. Not all medical problems need a physicians input (Jaret, 2010). Research Review Research has shown that nurses are more than capable of carrying out tasks as well as doctors, with higher patient satisfaction (Miles, Penny, Power, & Mercey, 2003). There was a study conducted on the satisfaction of patients in a nurse-led clinic as opposed to seeing a physician in the same clinic. The nurses were able to perform such tasks as speculum exams, sexual history, collecting specimens, and providing a diagnosis and treatments. When a problem occurred that was out of their scope of practice, they referred them to a physician. This study concluded that their reliable questionnaire informed them that their patients were more satisfied with the care they had received from the nurse clinic, then the doctor clinic (Miles et al., 2003).

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS In 2005, Norway had enough adolescent nurse led health clinics that 90 % of their teen population had access to, yet 90% of the teens using them were females. These clinics were created to prevent unwanted pregnancies, decrease sexually transmitted diseases, limit the number of abortions, and promote responsibility and self-care. An associate professor in Norway, Ragnhild Sollesnes, conducted research on what would influence a teenager to seek

assistance from an adolescent health clinic (AHC). The aim of this study was to discuss the need for the clinics to be based on the needs and wishes of the teens, at their comfort and learning levels and it should be encouraged for both genders. Using focus groups he compiled enough information to determine why the youths preferred to go to the AHCs as apposed to their family doctor. His qualitative study concluded the number one reason the teens preferred a clinic is the anonymity. If they went to their family doctor they could be exposed by using their insurance card or running into to someone in the waiting room. Some of the other findings for the clinics were that the nurse had more time to discuss issues, the cost was free, and the wait time for their appointment was nothing compared to that of the doctors office. The teens also expressed the importance for the clinic to be adolescent friendly and the practitioners can communicate on their level (Sollesnes, 2010). A study conducted in New Jersey concentrated on the reasons why young urban males did not seek out reproductive health care. Lindberg, Lewis-Spruill, and Crownovers (2006) conducted a study that would increase the awareness of the need to have a clinic that would welcome the male youth of today. Young men are at risk for STDs, HIV, and becoming a father. These issues can have a long lasting negative affect on our young male teens both physically and mentally. STDs that go untreated can cause sterility and an increased chance of contracting HIV. Becoming a teen father can cause anger, depression, drug use, low grades in school, and a lower

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paying job. Focus groups were used in this qualitative study to find out why adolescent teens did not pursue sexual and reproductive health care and what changes are needed to improve their ability to receive the care. The teens were able to go into a clinic and receive free condoms without an appointment. They did not however, go for any other issues or concerns. There were a number of concerns about preexisting clinics in their area; prolonged waiting times, unfriendly staff, seeing someone they know. In describing what kind of clinic they would go to their overwhelming response was to provide a relaxing atmosphere with competent care from clinicians that respected them (Lindberg, Lewis-Spruill, & Crownover, 2006). A group of nurses in Connecticut conducted research pertaining to the services that were available for teens that have a negative pregnancy test (NPT). This study was conducted using the information obtained from focus groups of teen caregivers from various venues. There were four different types of care services discussed in this study; a walk-in pregnancy service, adolescent clinic, school-based clinic and pediatric office. Although the adolescent clinic provided the pregnancy test, pelvic exam, contraceptive counseling, STD screening and contraceptive dispensing, it was noted the school-based clinic gave the students easier access because of its location. This qualitative study also concluded the best care for these teens would be counseling on contraceptives, a pelvic exam, and STD screening on the same day. Letting the teens leave the facility without these services could be a missed opportunity for teaching. If the teens do come back for another visit, treating them with respect, assuring confidentiality and having them see the same practitioner eases their anxiety. The researchers wanted to ensure the teens with a NPT got the same care a teen with a positive pregnancy test would receive (Daley, Sadler, Leventhal, Cromwell, & Reynolds, 2002).

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS In 2010 Friedman and Bloodgood (2010) conducted a study using participants in ten different metropolitan areas in two different states, Texas and Illinois. Their research was on the

knowledge of teenagers about Chlamydia and the dangers it can cause if left untreated; can cause pelvic inflammatory disease which can lead to ectopic pregnancies, chronic pain, and infertility. The intended outcome was to encourage teens to be tested once a year for STDs, including Chlamydia. Ethnographic interviews were used to obtain the information needed for this qualitative study; private discussions were less intimidating. The findings of this study proved that less then one fifth of the 125 women knew a little bit about Chlamydia, most of the teens did not know anything but the name. They concluded that there should be a Chlamydia testing campaign because of its importance. These teens need a place to go in the community that will be free of stigma, free of cost and is easily accessible and confidential (Friedman & Bloodgood, 2010). In 2008 there was a published study regarding nurse led family planning clinics and contraceptive education. The aim of this qualitative study was to explore how well women were given instructions on contraceptive use; how they worked, correct usage and the risk of STDs. Hayter (2008) used videos of the interactions with nurses and patients regarding contraceptive consultations. His study concluded that the nurses gave good information on the usage, slightly lower on the side-effects and was lacking in the teachings for STDs. Hayter also concludes not teaching women about STDs at every opportunity will be a negative affect on the sexual health of women (Hayter, 2008). All of these research studies have suggested that in order to encourage teens to go to a clinic they have to be teen friendly, confidential, accessible, free of cost and staffed by clinicians that are experts at interacting with teens (Daley et al., 2002). With the autonomy of nurses

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS increasing, they are taking over roles that use to be for physicians only. Nurses with proper training are more capable of running clinics all over the world (Hayter, 2008). Key Stakeholders The reason to engage the stakeholders for this program is to gain their resources, networking, encourage local buy-ins, to understand the community, get assistance in decisionmaking, and to explore new ideas. Having stakeholders with different interests gives a wide range of information for the planning, organizing, implementing and evaluating stages of the program (The Robert Wood Johnson Foundation [FWJF], 2009). After choosing the potential stakeholders, present this change theory program with the statistics from other programs that have been successful and how it can be beneficial in this community. The key to keeping the interest of stakeholders is to get them involved from the very beginning. Allow the stakeholders to add their input, have deadlines for each goal, and be

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mindful of costs. Take into consideration that each stakeholder has their own agenda for what the outcome will mean (Cornett, 2010). For example a doctor may receive referrals for the prenatal care of the teens, whilst the politician may get the votes from the younger generation. Along with doctors and politicians, other stakeholders would be other prenatal providers, local schools, law enforcement, local businesses and companies, local and state governments, welfare agencies, social service programs, parents and community members ("Meeting the needs," 2009) and the Family Planning Council ("Integrating Services: State ," n.d.). The local schools and law enforcement agencies should be an easy sell since this clinic will keep the teens healthy so they can stay in school and out of trouble. When local businesses get involved with community projects it increases the communitys awareness of their business and could increase their revenue. Because of the negative impact a teens pregnancy has on the communitys

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS economy, state and local governments should be easily persuaded to become stakeholders ("About teen pregnancy," 2011). The CDC listed The Family Planning Council, a non profit

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organization located in Philadelphia, as having received funding of over $800,000 to implement plans to decrease teen pregnancies by 10% in that area. This group will provide assistance to nurse led clinics that provide evidence-based care to teens, with the goal of decreasing teen pregnancies ("Integrating Services: State," n.d.). Although each of these stakeholders may benefit differently, collectively they can benefit by having a sense of doing something good for the community, gain respect and recognition, meet other members of the community, and even learn new skills ("Stakeholders," n.d.). Improving the teens health can only better the community. The stakeholders can do this by supporting the nurses role in recognizing the problem, finding what needs to be changed, finding a solution, selecting a goal, planning the change, implementing it, evaluating and then maintaining it (Allender et al., 2010). Having a nurse led sex clinic is the goal to increase the sexual health of the teens in this community. After identifying the key stakeholders, it is important to identify who will represent the stakeholder if it is an organization or business. For example, if it is a doctors office, it could be the doctor or an office manager or a board of representatives from an organization or business. Give the stakeholders information regarding expectations and the contributions from each group or persons. Some stakeholders may be able to contribute more than just their time, such as supplies, meeting places, and equipment. The invited stakeholders may have ideas on other potential stakeholders. It is necessary to reevaluate the stakeholders list throughout the program to add or delete do to changes in needs from either party ("Stakeholders," n.d.).

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS Even with the best intentions, there could be problems with the stakeholders. Cultural,

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religious and political differences may arise. This may strike up arguments between some of the stakeholders, redefining the goal of the program could change the focus back to the program. Allowing our culture to influence decisions can impede our critical thinking. When our culture teaches us to believe in something, we are conditioned to think it to be the truth. In order to be a critical thinker, we must forget about our preconceptions to investigate the real truth (Barry, 2001). Another large and difficulty subject to broach is the budget. Each Stakeholder may have their own opinion on what monies will be needed to for the start up costs and to run the clinic the first year. Having an organized detailed plan to hand out will allow the stakeholders to visualize exactly what money is needed and how it will be used. Since the bottom line of the budget may appear to be high, emphasis will be put on the money the community will save in tax money alone. Communication and Change Theory In order for the stakeholders to get involved there needs to be a change process. The change for the stakeholders would be a planned change. The unfreezing part of the change occurs when the stakeholders are made aware of the change that is needed (Grohar-Murray & Langan, 2011). The change is to have a nurse led teen clinic in the community to support the sexually health and welfare of our youth and have the stakeholders must believe that this change is needed. The second part of change is the moving process. The stakeholders are educated on the goal and outcomes of the program and agree with them. The last part is the refreezing process; this is showing evidence that the program will accomplish the outcomes. There is a continuous

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need to make sure the program is integrated and internalized by all of the stakeholders (GroharMurray & Langan, 2011). There is always the problem when you meet resistance to change (Grohar-Murray & Langan, 2011), having excellent communication skills are imperative to a successful relationship between the organization and its stakeholders ("Stakeholders," n.d.). Some of the important things to consider in effective communication are being clear, assertive, and mindful of nonverbal behavior, being an active listener, and making sure your venue is conducive for the discussions. When there is outstanding communication between the stakeholders an organizational network can be developed. This network allows for information to be analyzed so they may find solutions to any problems that may unfold. When the stakeholders share a common goal and they work together to complete the goal they are team building (GroharMurray & Langan, 2011). Team building will help launch this nurse led sexual health clinic. Communicating on the teens level will be of the upmost importance. The teens need to feel like they are talking to someone without being judged and that they are not being lectured. A supportive relationship between the nurse and the teens needs to be established so there can be ongoing communication ("Meeting the needs," 2009). Encouraging teens to change will require positive reinforcement that will be supported by a professional team that will engage the teens. The stages of change for these teens are when the teen understands a change needs to happen, the teens come to the clinic for assistance or guidance, and then the teen changes the way they behave sexually or seek sexual health advice (Allender et al., 2010). Operationalization of the Project Planning for this project started in the beginning of September. Letters will be mailed inviting potential stakeholders, potential employees, the Principal and Nurse at Upper Darby

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS School, and the Marple Library. After getting approval from both the library and the school to

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have our meetings and use the nurses office at the high school high for our clinic, preparing for the first meeting can begin. The attached power point presentation will be shown at the first meeting on September 29th, 2012, followed by a hand out on the proposal for this clinic. The last part of the meeting would be a meet and greet with a question and answering session. Hiring a Nurse Practitioner and an Office Manager/Nurses aide will be the next goal for this project. The Nurse Practitioner will need to be licensed in Pennsylvania, have at least 5 years experience in a womens health office or clinic, experience with working with the teen population and posses great communication skills, caring, self-motivated and willing to work part-time at our clinic. The office manager/nurses aide will have to need to have office skills as well as being able to draw blood and test urine samples from patients. If the population increases more employees will be hired. The clinic will be open on Tuesdays and Thursdays from 7am to 4pm starting of January 3, 2013; this is when the school nurses office is available. The school has provided one room for the nurse practitioner to perform exams and the office manager can use the desk in the waiting area to organizer her work as well as being the greeter for the patients. The role for this nurse will be project manager, overseeing the employees, the finances, and the stakeholders. Following up with emails and phone calls will keep the stakeholders abreast of everything that is happening with this project. Opening up bank accounts, making flyers and posters will be the responsibility of the office manager, nurse practitioner and the project manager. Soliciting pharmaceutical companies to donate free pregnancy tests and condoms will be an ongoing project as well. Another important aspect for the project manager will be to apply for grants to help with the start up costs.

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Investing and applying for grants maybe time consuming but definitely worth it. In 2010, The Office of Adolescent Health (OAH) awarded $75 million in grants to support evidence-based programs that aimed to decrease the incidence of teen pregnancies. The OAH also gave grants out in the amount $15.1 million for research and program development. Together with the Center for Disease Control (CDC), OAH provided $9.8 million for communities that are using the Teen Pregnancy Prevention Initiative (TPPI). The TPPI is a community wide program that is tailored to each community ("Teen Pregnancy Prevention," 2011). The U.S Department of Health & Human Services (HHS) are also awarding grants in the total amount of $155 million to school districts, non-profit organizations and colleges to reproduce programs that prevent teen pregnancy ("HHS," 2010). The grant investigation and applications will be completed before the initial meeting of the stakeholders and team members. The process for applying for grants is almost the same process as just submitting this paper. To apply you need to identify a problem in the community, target a funding source, identify partnerships, develop a timeline and budget, write a proposal, and evaluate the outcomes (Boussard & Boussard, 2010). The operationalization timeline of this project is:
Date/Time 10/15/121/15/12 9/01/12 ~ 9/15/12 9/15/12 Activity Bimonthly meeting with stakeholders and employees Location/Presenter All members of the team Debi Rafferty

Write and Submit Grant

Send out information to potential stakeholders and potential employees Follow up phone calls to potential team members

Debi Rafferty Debi Rafferty and Team members

9/22/12 ~ 3pm

9/29/12 ~ 7pm

Marple Library/ Meeting with employees to create program to present at Team members first meeting with stakeholders

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9/31/12 ~ 9am

Copy programs at staples to give out to team for first meeting First Meeting with stakeholders and employees

Appointed team member Marple Library/ Team members Debi Rafferty

10/15/12 ~ 7pm

10/16/12

Follow up email with team members/ contact more stakeholders if needed Open Bank Account/ Send out reminders for next meetings 2nd Meeting - Discuss the rolls of everyone involved

10/19/12

Debi Rafferty/ Team members Marple Library/ Team members Debi Rafferty/ Team members Marple Library/ Team members Debi Rafferty and Team members High School Art Class Marple Library/ Team members Marple Library/ Team members High School Nurses Office Team members

10/30/12

11/6/12

Prepare for next meeting/ send out reminders

11/13/12 ~ 7pm

Have speakers from Area Nurse Led Clinic talk to team members Follow up email with team members/ contact more stakeholders if needed Make flyers to hang in high schools/ flyers to send home with students/ create facebook page 3rd meeting - Discuss opening of Clinic on January 15, 2012 4th meeting - Discuss budget - Discuss last preparations before opening Allow stakeholders to walk through clinic - Finishing touches before opening Hang posters in High Schools/ send home flyers/go live with facebook page Opening Day Follow up email with team members / Evaluate opening day and if any changes need to be made

11/14/12

11/16/12

11/29/12 ~ 7pm

12/11/12 ~ 7pm

12/17/12

12/18/12 1/03/13 7am to 4pm 1/04/13

High School Nurses Office Team members

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1/15/13

5th meeting - Discuss clinic / Evaluate the changes that were made /change meeting to monthly Follow up emails / Plans for next meeting / contact new stakeholders

Team members Debi Rafferty/ Team members

1/16/13

The personal resources for this project contributed by this nurse, is over 20 years experience with pregnant teens, a passion for teenage sexuality, great communication skills and an ability to get community involvement for worthy causes. Although there is a salary for the project manager it does not cover the time that will be invested. The time invested is another personal resource. Communication to the stakeholders and employees will be the responsibility of the project manager. Posters and flyers will be developed by the employees and maybe from some of the students from the high school. A great information resource tool that will be used will be a facebook page. This is a free site that teens can access, ask questions, schedule appointments and read accurate information about their sexual health. Studies have suggested there is increasing number of people seeking information on the internet (Buultiens, Robinson, & Milgrom, 2012). An internet page on facebook will be started as soon as the stakeholders are engaged. Having a clinic that is conveniently located, convenient hours, adolescent friendly staff and a dcor attractive to teens will be some of the operational characteristics (Dehne & Riedner, 2005). The high school is convenient for students in the school and the hours are before, during and after school. Hopefully if this program is a success, other schools in the area will follow suit and open up clinics just like this one. The staff that will be hired will have had experience working with teens. Decorating the waiting area and having things for the teens to do while they

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS wait will add teen appeal. This may be as simple as teen magazines, movies to watch or video games (Lindberg et al., 2006). The proposed budget for the first year is:

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Copying Charges

Letters, flyers and posters Library Charge for Meetings $25.00 Meetings/Speakers/Opening Day For advertising on internet Clinic space to start 2 days/wk, 8 hr/day ($35/hr)salary a yr 2 days/wk, 8 hr/day ($10/hr)salary a yr Pens, paper, tape, ect 2 lap tops Microscope, slides, swabs, urine cups Try to get donated Try to get donated First Year- just salary

$100.00

First Five Meetings Refreshments Facebook page High School Nurses Office Nurse Practitioner Office Manager/Nurses Aide Office Supplies Computers Medical Equipment Pregnancy Tests Condoms Project Manager

$125.00 $200.00 $0.00 $0.00 $29,120.00 $8,320.00 $300.00 $2,000.00 $2,000.00 $0.00 $0.00 $25,000.00 =

Estimated total cost

First Year with employees

$67,165.00

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS Although the proposed budget for the first year looks like a large amount, with the

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assistance of grants, this will be a small investment for the amount of money the community will save on tax money alone. If this teen health clinic can reduce the occurrence of teen pregnancy, reduce the incidence of HIV and STDs, and refer teens to the appropriate healthcare workers it will reduce the negative affects sex has on teens health. Empowering teens with the ability to obtain sexual healthcare may increase the number of teens that seek medical attention (Brabin, 2002). Evaluation Parameters This nurse led teen sexual clinic is needed to decrease the negative effects on a teens sexuality which can have an effect on them as well as the community. In order for this clinic to be successful the participants need to meet the outcomes by changing their behavior. This change is practicing safe sex or being celibate, seeking healthcare professionals when needed, or just asking questions from reliable resources. In order to evaluate the outcomes the staff will keep records of all the patients that are seen in the clinic, for any reason. There will be data on all the teens without using their real name; but will include their sex, age, problem, treatment and outcome. This will enable the staff to compile the necessary data to prove to our stakeholders that we are reaching our outcomes or make notes on what changes need to be made to reach our outcomes. The outcomes will be measured by the number of teens that use the clinic and what services they are using. For example, if by the end of week one there were two teens that came into the clinic for condoms, by the end of 30 days there should be an increase. If needed, there can be percentages added; if there are two teens the first week, by end of 30 days increase that number by 50%. When an outcome is reached, new outcomes can be established.

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To evaluate the first outcome data will be collected on the number of teens that come into the clinic for condoms. A self reporting survey will be given to each teen that receives condoms. The survey will cover questions such as if they have ever used a condom in the passed, understanding how to use and condom, why they use them, if they use them 100% of the time, and if having the clinic provide free condoms increases their usage. These surveys will be done anonymously so that the teens can be truthful. If the data shows there is an increase in the number of teens that are using condoms accurately and 100 % of the time, we can change our outcome to expect higher numbers. The second outcome is to increase the number of teens using oral, implanted or injected contraceptives by 30 days after starting. This goal will also be followed by the data collected by the staff and a self-reporting survey. The teen girls will be asked if they used contraceptives before the clinic, if they are aware of the side-effects, proper usage and if they also use a condom. Along with a paper survey the teen may chose to go onto the Facebook group page and fill out a survey. Increasing the number of males that participate in the clinics services is the third desired outcome and will be evaluated by the data collected by the staff. If the outcome is not met, a survey can be used to develop ways to improve teen male participation. An internet survey will give access to a larger number of male teens that can participate. The fourth outcome is to increase the number of pregnant teens that will seek prenatal care by 30 days after starting while the sixth goal is to decrease the number of pregnancies. Asking the school for any statistics regarding the teens that were pregnant in the school will be helpful in having a starting point for this decrease pregnancy outcome. If the school report 10 pregnancies last year, the outcome for this clinic would be to decrease that number within 90

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days of implementing the clinic. As for the teens that are already pregnant, using a self reporting survey to find out the name of the provider and the date they started their prenatal care would provide this information. A list of providers in the area would be available for the teens at the clinic. The last outcome is to decrease the number of teens with STDs 60 days after starting. This outcome will be evaluated by the data collected from the staff on the number of teens testing positive for a STDs in the clinic. The teens will be evaluated on their condom use and the number of sexually partners. That data will be collected from a self reporting survey, since the teen may be more inclined to tell the truth during a survey rather than an interview (Sieving et al., 2011). The ultimate outcome for this program would be to increase the number of teen that use this clinic, thereby hopefully decreasing pregnancies, decrease STDs by increasing the number of teens that seek sexual heath care in our clinic. Conclusion The sexual health of a teen is important to the entire community. Each year tax payers are paying billions of dollars for teen pregnancies. With the teens exploring sex at younger ages, the need to educate them on the negative outcomes of having sex and what it can do to them physically and emotionally. This includes teaching them how to prevent STDs and unwanted pregnancies and the symptoms of both. The cycle of teens having babies needs to stop in order to better the community by saving tax money on foster care, increased incarceration, welfare, and decreased productivity of the teen parents that are unable to get a job because they can not finish their education ("About teen pregnancy," 2011). Teens learn about their sexual health from social media, television, peers, siblings, and gossip, with some adults giving their input when requested. Some teens are too afraid to ask for

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS help about their sexual health and have no where to turn (Dehne & Riedner, 2005). For that

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reason alone, it is imperative that teens have a place to go to, where they feel welcomed, safe, not judged, and treated without the fear of their family finding out. Studies have suggested that in order to encourage teens to go to a clinic they have to be teen friendly, confidential, accessible, free of cost and staffed by clinicians that are experts at interacting with teens (Daley et al., 2002). With the autonomy of nurses increasing, they are taking over roles that use to be for physicians only. Nurses with proper training are capable of running clinics all over the world without a physician present (Hayter, 2008).

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS References About teen pregnancy. (2011). Retrieved from http//www.cdc.gov/TeenPregnancy/AboutTeenPreg.htm Allender, J. A., Rector, C., & Warner, K. D. (2010). Community Health Nursing (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Barry, V. E. (2001). Blocks to critical thinking. Retrieved from

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http://www.palomar.edu/reading/Thomsons120/Blocks%20to%20Critical%20Thinking.h tm Boussard, B., & Boussard, A. (2010, Winter). Grant writing for childbirth educators: Lessons learned from the resource center or young parents-to-be. Journal of Perinatal Education, 19(1), 40-46. http://dx.doi.org/10.1624/105812410X482338 Brabin, L. (2002, November). Adolescent friendly health services: An impact model to evaluate their effectiveness and cost. Retrieved from FHI 360: http://www.ghi360.org Buultiens, M., Robinson, P., & Milgrom, J. (2012, April). Online resources for new mothers: Opportunities for perinatal health professionals. Journal of Perinatal Education, 21(2), 99-111. http://dx.doi.org/10.1891/1058-1243.21.2.99 Cornett, C. (2010). 15 Tips to help designers gain stakeholder buy-in. Retrieved from http://www.inspireux.com/2010/09/27/15-tips-to-help-designers-gain-stakeholder-buyin/ County Health Rankings. (2011). Retrieved from http://www.countyhelathrankings.org/pennsylvania/delaware Daley, A. M., Sadler, L. S., Leventhal, J. M., Cromwell, P., & Reynolds, H. D. (2002, AprilJune). Clinicians views on reproductive needs and services for teens with negative

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pregnancy tests. Journal for Specialist in Pediatric Nursing, 9(2), 41-49. Retrieved from http://ebscohost.com Dehne, K. L., & Riedner, G. (2005). Sexually transmitted infections amount adolescents: The need for adequate health services. Geneva, Switzerland: World Health Organization. Delaware County Teen Pregnancy Prevention Coalition. (n.d). Retrieved from http://www.delcoteenpregnancyprevention.org/About-Us/html Dennehy, P. (2012, February 22). Healthcare reforms missing link -- nurse practitioners. Los Angeles Times. Retrieved from http://www.latimes.com Friedman, A. L., & Bloodgood, B. (2010). Something wed rather no talk about: Finding from CDC exploratory research on sexually transmitted disease communication with girls and women. Journal of Womens Health, 19(10), 1823-1831. http://dx.doi.org/10.1089/jwh.2010.1961 Garofalo, R., & Forcier, M. (2011). Adolescent sexuality. Retrieved from http://www.uptodate.com/contents/adolescent-sexuality?view=print Grohar-Murray, M. & Langan, J. (2011). Leadership and Management in Nursing (4th ed.). Upper Saddle River, N.J.: Pearson Education, HHS awards evidence-based teen pregnancy prevention grants. (2010). Retrieved from http://www.hhs.gov/news/press/2010pres/09/20100930.html Hayter, M. (2008, August 19). The structure of contraceptive education and instruction within nurse led family planning clinics: a grounded theory guide. Journal of Clinical Nursing, 18, 2656-2667. http://dx.doi.org/10.111/j.1365-2702.2008.02651.x Institute of Medicine. (2010, October 5th). The future of nursing Leading change, advancing health. Retrieved from Institute of Medicine: http://www.iom.edu

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS Integrating services, programs, and strategies through communitywide initiatives: State- and community -based organizations. (n.d.). Retrieved from http://www.cdc.gov/TeenPregnancy/State-Community-Orgs.htm Jaret, P. (2010). The doctor cant see you now - But the nurse can. Retrieved from http://www.aarp.org/health/doctors-hospitals/info-102010/doctor_cant_see_you_but_nurse_can.print.html Lindberg, C., Lewis-Spruill, C., & Crownover, R. (2006, January 3). Barriers to sexual and reproductive health care: Urban male adolescents speak out. Issues in Comprehensive Pediatric Nursing, 29, 73-88. http://dx.doi.org/10.108 Managing a high-risk pregnancy. (n.d.). Retrieved from http://www.webmd.com/baby/guide/managing-a-risk-pregnancy Maternal health. (2011). Retrieved from http://www.who.int/topics/maternal_health/en/ Meeting the needs of pregnant and parenting teens: Local health department programs and services. (2009). Retrieved from

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http:/www.dhs.state.mn.us/main/groups/agencywide/documents/pub/dhs16_148996.pdf Miles, K., Penny, N., Power, R., & Mercey, D. (2003, April). Comparing doctor-and nurse-led care in a sexual health clinic: patient satisfaction questionnaire. Journal of Advanced Nursing, 42(1), 64-72. http://dx.doi.org/10.1046/j.1365-2648.2003.02580.x OHalloran, P. (1998). Pregnancy, poverty, school and employment. Retrieved from http://www.moappp.org/Documents/pregnancypovertyschoolandemployment.pdf Sieving, R. E., Resnick, M. D., Garwick, A. W., Bearinger, L. H., Beckman, K. J., Oliphant, J. A.,...Rush, K. R. (2011). A clinic-based, youth development approach to teen pregnancy

NURSE LED SEXUAL HEALTH CLINIC FOR TEENS prevention [Journal]. American Journal of Health Behavior, 35(3), 346-358. Retrieved from http://www.web.ebscohost.com Sollesnes, R. (2010). Exploring issues that motivate contact with adolescent health clinics. Nordic Journal of Nursing Research & Clinical Studies / Vard I Norden, 30(2), 4-7. Retrieved from http://www.ebscohost.com Stakeholders: Identifying stakeholders. (n.d.). Retrieved from

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http://www1.cj.msu.edu/~outreach/mvaa/Building%20A%20Cooordinated%20Communi tiy%20Response/Collaboration%20Toolkit/section2.pdf Teenage Pregnancy. (2011). Retrieved from http://www.marchofdimes.com/medicalresources_teenprenancy.html Teenage pregnancy prevention: Grantees. (2011). Retrieved from http://www.hhs.gov/ash/oah/oah-initiatives/tpp/grantees/index.html The Robert Wood Johnson Foundation. (2009). A practical guide for engaging stakeholders in developing evaluation questions. Retrieved from http://www.rwjf.org/pr/product.jsp?id=49951