Teen pregnancy is one of the many problems that afflict the United States that is preventable. Unintended pregnancies span across all levels of age, race and creed, with a specific negative impact among the teenage population. In 2006 $11 billion was spent on births ( prenatal care and 1 year of infant health care) from unintended pregnancies (Sonfield, Kost, Gold, & Finer, 2011). These pregnancies have been connected to many social, health, and financial consequences. When unintended pregnancies occur in the younger age group, negative outcomes occur at a higher rate as compared to women of older age. As a national statistic, 1 out of every 5 unintended pregnancies are from the teenage demographic, with a staggering 82 percent belonging to the ages between 15 and 19 (Finer & Henshaw, 2006). The resulting outcome of the pregnancy bears a large financial, emotional, and educational hardship on the mother, her child, and the local community. In order to reduce the prevalence of a teenager becoming unintentionally pregnant, prevention through education and awareness is vital in reducing this statistic that burdens our local community. This paper focuses on the Healthy People 2020 Objective of reducing pregnancy among adolescent female’s ages 15 through 17.
Target Population & Setting
The Target populations for this Healthy people 2020 objective are adolescent females in the age group of 15 to 17 years old. The setting where education for prevention of unintended pregnancies for this demographic includes the teenagers home, schools, community outreach centers, media outlets, clinics, hospitals, and their primary care provider (Pediatrician’s office). Education can be given virtually anywhere but the primary setting where these adolescents spend the majority of their time at this age is in school or at home so these are the places where education and interventions need to begin and be followed through. At this time the United States is ranked with the highest number of teenage pregnancy and sexually transmitted diseases, and in 2005 the Health Indicators Warehouse (HHS) determined that nationally there were 40.2 pregnancies per 1,000 females from the demographic age group of 15 to 17 years old.
Reducing pregnancy in adolescent’s ages 15 to 17 years old is a problem that applies to advanced practice because education needs to be started early at the primary care providers and during every encounter with the patient and their parents. Advanced Practice Nurses (APNs) need to assess the patient’s sexual activity, education on contraceptives, pregnancy intentions, and receptivity of education and interventions. To have a successful outcome for this problem not only do the teenagers need education as well as the parents. The parents need education on how to talk to their children about safe sex, birth control methods, and sexually transmitted disease (STD’s). There has been great debate over how and where sex education should be given, and whether or not safe sex or abstinence only approach should be used. The parents also need to be assessed to find out their views on sex education and if they know how and if they are comfortable with talking to their child about safe sex and contraception. Identification of adolescent females whom are at high risk of getting pregnant is a key to prevention. Education needs to be given no matter what setting the teen is in whether at the clinic, primary care office, Emergency room, or at school. Teens are afraid to talk to their parents or teachers for fear of being judged and getting in trouble. That is why it is so important for APNs to always take the time to discuss sexual education, contraception, and sexually transmitted infection (STDs) at every visit with the teenager (ask the parent to leave the room for this part of the visit) because then they will feel more comfortable to talk knowing that it is confidential, and there is greater chance of helping to modify risky behaviors and providing interventions that could help decrease the number of unintended pregnancies and STDs.
Eriksson carative theory is a model of nursing that distinguishes between caring ethics and the practical relationship between the patient and the nurse, along with nursing ethics. Caratative caring (caritus) is made of love, charity, respect, and reverence for human dignity and holiness (Nursing Theory, 2011). Eriksson developed her carative factors in the hopes to balance the cure orientation of medicine. This theoretical framework can be used to apply interventions to help decrease the amount of pregnant adolescents. Wikberg (2007) found that caring nursing is caring for the ill or suffering human being without prejudice, through caritas, which is love and charity. These adolescents will need to be approached with a carative caring strategy because at this age they are very emotional and are trying to find out who they are as a person. The APN must always use a caring approach and talk to the patient with respect and without prejudice, rather than the cure orientation approach of medicine that is more cut and dry with no time being spent to address their emotional and physical needs. Eriksson believed that if a patient suffered as a result of lack of caratative care, it was a violation of human dignity (Nursing theory, 2011). Eriksson developed the caratative theory to bridge the gap between curative and caratative care and to help bring nursing back to being a nursing theory driven profession, by which caring nursing is the fundamental core. APNs know from experience that you cannot just look at labs and read the machines while taking care of your patient you need to actually look, touch, and listen to the patient to get the whole picture. Erikson (2002) found that no matter much technology advances, nurses will always be the ones to assess the patients suffering and feelings. It is this interaction and communication between the patient and the nurse or APN that defines the carative theory.
Review of Literature
Nationally the rate of adolescent unintended pregnancies are climbing at a staggering rate, but the appropriate intervention to these growing statistics is overturned due to debate over how sex education should be given (Carter, 2012). There are federal laws that promote abstinence only education and provides funding for abstinence based programs thus prohibiting these programs from providing education on safe sex and contraception. A recent study by Stanger-Hall and Hall (2011) found that this abstinence only education approach not only fails to prevent unintended pregnancy among adolescents, but has been positively correlated with an increase in the amount of pregnancies and births among teenagers. The study consisted of a data analysis of the sex education laws and policies of 48 states excluding North Dakota and Wyoming. The states were given a number from 0 to 3 covering the amount of emphasis stressed on abstinence: no emphasis (0), abstinence discussed (1), abstinence promoted (2), and abstinence stressed (3) (Stanger- Hall & Hall, 2011). The data analysis used the 2005 national reports on teenage pregnancy, births, and abortion rates among ages 15 to 19 years of age. The results showed that the more emphasis was placed on abstinence-only education, the greater the amount of teen pregnancy and births. The most effective approach was the level 1 style which covered a comprehensive safe sex or STD education (or both) and also covered the use of birth control, condoms, and abstinence (Stanger- Hall & Hall, 2011). With the results of this study Nurse Practitioners (NPs) can be confident that providing comprehensive safe sex education to adolescents is not only appropriate but also effective. They can also educate the parents and reassure them that by providing this education on safe sex and the use of contraceptives will not encourage them to have sex but will lessen the chance of these adolescents having an unintended pregnancy, or contracting an STD (Carter, 2012). School-based health centers (SBHCs) are a wonderful community resource for adolescents that provide teen friendly primary care health services to this population. However, current restrictions on contraceptive services are keeping them from responding to the diverse needs of this population. Therefore limiting the opportunities for providing comprehensive sexual education and reproductive care which creates missed opportunities for unintended pregnancy and STD prevention (Daley, 2012). With the rise of unintended pregnancy and STDs among the adolescent age group in the United states, it validates that many adolescents are engaging in unprotected sexual activity. Compounding these issues, many adolescents also go without health care interventions due to lack of insurance, access to services, and concerns of their confidentiality which makes it very difficult for them to get preventative care and stay in the health care system. With the countries current economic status and health care reform, safe sex education and contraceptive services for teens are going to continued to be limited, which compounds the importance of making the existing health programs for teens more efficient and effective as possible (Daley, 2012). APNs must advocate for their teen patients and provide the evidence of the effectiveness of the SBHC services. If the many restrictions at the local, state, and national level remain we will continue to see a steady increase in the rate of unintended pregnancies among adolescents.
There are many interventions needed to help decrease the amount of unintended pregnancies in the adolescent age group. The first intervention is to change the sexual education standards in the schools which means having to change some of the laws at the local, state and federal level. The Future of Sex Education created new National Sexuality Education standards which were released in January of this year. The adolescents need to have a comprehensive safe sex education that includes abstinence, contraception, STD prevention, and pregnancy prevention. Studies have proven that when abstinence is the only thing that is taught there is a rise in unintended pregnancies. The National Survey of Family Growth found that teens age 15-19 who received safe sex education were 50 percent less likely to report an unintended pregnancy than those who received abstinence-only education (Kohler, Manhart, & Lafferty, 2008). Another intervention is to open more SBHCs across the nation and release there restrictions from providing contraceptive services. Contraception such as condoms and birth control should be offered at a more affordable or discounted price. Until the day that the federal, state, and local laws change, the interventions will have to come from the parents at home, school nurse, and Primary care provider’s office. It is the NPs job to identify the adolescents whom show high risk behavior and intervene. Education on safe sex and pregnancy and STD prevention need to be given at every office visit. The NPs need to develop a trusting relationship with their patients and ensure their confidentiality. They also need to give the parents education and refer them to teen pregnancy prevention websites and or groups. The NPs need to ensure them that safe sex education does not encourage the teens to participate in sexual activity it decreases the chances of them becoming pregnant or contracting and STD. The U.S Preventive Services Task Force (USPSTF) recommends person to person interventions targeted at caregivers to help them improve their parenting skills. These interventions are done via telephone or face to face outside of the clinical setting and can be done in group sessions or one-on-one training. Some examples of the interventions given are strategies to improve communication, recommendations for parental monitoring of adolescents, and information on how to speak to adolescents bout topics such as sexual behavior (The Guide to Community Preventive Services: The Community Guide, 2007). The USPSTF recommends that adolescents become involved in community service or outreach programs that provide them with opportunities to interact with other students and adults in the community. This experience will give them an opportunity to have membership in a group and it will help them develop better communication skills, improved decision making, self-determination, and responsibilities. These approaches have been found to be effective in reducing risky sexual behavior in adolescents. Last but not least is intervention through mass media and social marketing. The USPSTF recommend health communication campaigns that use multiple markets such as mass media to deliver message such as always use protection when you have sex and combine it with the distribution of free or reduced price health products such as condoms (The Guide to Community Preventive Services: The Community Guide, 2007). All of these interventions have been shown to reduce the number of unintended pregnancies among adolescents. NPs, school nurses, and parents all have to work together to help our teens get the education they need to make healthy risk free choices.
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Outcomes The goal of this objective is to have a 10% improvement of 36.2 pregnancies per 1,000 adolescent females (Healthy People 2020, n.d.). The intended outcomes for these interventions are to educate the adolescents in the age group of 15-17 and their parents about safe sex and STD prevention. Changing the abstinence – only education in school to comprehensive safe sex education therefore decreasing the amount of unintended pregnancies and STDS. By opening more SBHCs and removing restrictions on contraceptives we are providing the adolescents a community resource, a place to get education and reproductive care. Encouraging the adolescents to do community outreach, they are getting a chance to meet new people and learn communication skills and most importantly staying away from risky behaviors. Stressing the importance of sexual health education at every visit with the primary care provider helps the patient develop a trusting relationship but also educates them on the importance of safe sex. Therefore decreasing the unintended pregnancy rate among teens which has become a major public health concern in our communities in United States.
To evaluate if the 2020 objective interventions produced the intended outcomes data will need to be collected on how the goals were met, if the plan chosen for the objective worked, were any changes made, and after these questions are answered the data will have to be analyzed. Evaluations on the interventions will need to be measured and tracked (Healthy People 2020, n.d.) This type of study would most likely be a quantitative study because the goal is to reduce the number of pregnancies among adolescents age 15-17 years old. Partnering with a University to help with data tracking is helpful and the university can use a statistician to help with checking the validity and reliability of the data. Data quality is also very important the researcher will need to use a valid tool so that the data collection method, analysis, and research questions are all standardized (Healthy People 2020, n.d.). There are also evaluation guides or toolkits that states can use to evaluate their progress. The evaluation plan should include the Process evaluation and Outcome evaluation. The evaluation plan is used when applying for funding for your interventions for the objective (Centers for Disease Control and Prevention, 2011). To evaluate the effectiveness of the interventions to reduce the number of pregnancies of adolescent females ages 15-17 the outcomes of the interventions will be collected and the results of the data analysis will be compared to other states to see what the national average is and if it has decreased from the last study and if the 2020 goal of a 10% decrease to 36.2 pregnancies per 1,000 adolescent females has been achieved.
In conclusion, adolescent pregnancy is a preventable problem that is burdening our communities and is costing the United States billions of dollars a year. The healthy people 2020 objective of reducing pregnancy among adolescent females aged 15 to 17 years old is a goal that is easily obtainable. Early comprehensive safe sex education including contraceptive prevention is the key and it needs to start at home by the parents and be continually reinforced at school, the primary care office, and in the community.
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