Introduction
This evidence-based project will be about Sexually Transmitted Disease or STD and its impact on adolescents and young adults. The main difference this EBP will have with other typical research project is that it will have tangible results instead of simply taking scholarly resources and just rephrasing them.
STD is an infectious disease transmitted through unprotected sexual activities such as anal sex, vaginal penetration, intravenous drug use, or IV, and can also be passed to a baby from a mother during pregnancy or breastfeeding. This issue has been affecting over 100 million people in the United States alone (Brown, Macintyre, & Trujillo, 2003). Centers for Disease Control and Prevention or CDC has recorded that 19 million people are infected with the disease per year. An effective intervention focused on this EBP is prevention which involves testing on an annual basis to ensure the status of a sexually active individual. For those who have multiple partners, it is recommended of them to take the test every 6 months. Also, an information drive should be improved in schools to ensure that adolescents and young adults are alerted that they have a place to go whenever they need to be tested (Aral, Fenton, & Lipshutz, 2013).
The expected outcome of this project is to encourage more STD prone individuals to come out in the open and to not be ashamed of coming to health centers, clinics, or hospitals that cater to STD’s to have a test. This could help at least lessen the number of infected per year. This EBP will help to protect the young adults and adolescents to contract the disease; thereby decreasing the psychological and emotional impact of STD on this particular group of individuals (Paul-Ebhohimhen, Poobalan, & Teijlingen, 2008).
Description of the Problem
According to the World Health Organization (WHO), over one million Sexually Transmitted Diseases (STD) are acquired daily worldwide. This alarming statistic calls for new or modified medical practices in order to treat and prevent further transmissions. It is within the scope of this study to formulate information drive strategies to warn people, especially young females, not to engage in unsafe or unprotected sex (WHO, 2016).
Desired Results
The desired results include the cooperation and participation of the adolescent and young adult females in an information drive formulated and conducted by a nursing practitioner instead of a social worker who does not have a background in nursing or medicine.
PICOT Question
Among adolescent and young adult females who are susceptible to STD (P) will nurse practitioners disseminating information about the disease and educating on prevention measures through an information drive (I) compared to social workers, (C), resulting in reduced disease transmission and enhanced prevention care (O) over 6 months (T)?
The Process Model
The process model to be used in the study is the Stetler model of evidence-based practice wherein nursing practitioners are expected to assess the outcome of the experiment by comparing it to existing evidence. This model aids in finding the internal and external factors that surround the subject of the research.
The significance of the problem is that it can provide means and ways to improve information drive to prevent transmission and spread of STD among adolescents and young adult females, especially those who belong to the group who are most susceptible to the disease – particularly those who actively engage in polygamous relationships or those working as a hostess in clubs and bars who openly and voluntarily disclosed information about having sexual relationships with various men (Melynk&Fineout-Overholt 2011).
In conclusion, the use of the model and the methods prepared will result in findings that will be immediately incorporated into patient care practices. This enables the nurse practitioner to improve nursing practices. Such practices include information drive and proper dissemination (Philbrick, 2013).
Evidence Review and Synthesis
Sexually transmitted diseases (STDs) are a common health problem in modern society. Some of the common STDs are Syphilis, Gonorrhoea, Human Papilloma Virus (HPV), Human Immunodeficiency Virus (HIV), Herpes Simplex Virus (HSV) 1 and 2, Hepatitis B and C. Some of these diseases have been prevailing for a long time while the others have gained importance more recently.
The prevalence is higher than what is actually seen. The main problem is that people are still not comfortable with discussing these matters in public. This has led to the more vulnerable parts of the population like women and teenagers to have a limited understanding of the importance of knowing how to prevent sexually transmitted diseases.
A good example is a study done by a group of researchers headed by Hossain, in Bangladesh in 2011. Here they have studied 10,996 women in six divisions in Bangladesh and evaluated their knowledge and awareness on STDs. Their findings were published in 2014 and what they found was that the awareness was significantly affected by certain factors such as geographical location, whether rural or urban, age, education level, whether they listened to the radio, or watched television. (Hossain, Mani, Sidik, Shahar, & Islam, 2014)
The above study was a serious wakeup call to any health practitioner who is involved in the preventive role in association with STDs. The study showed older women in more rural areas with limited formal education and limited access to mass media had the least knowledge on STDs. This information can be used when planning awareness campaigns, to educate people in the more remote parts of the country. The mass media has a main role to play in educating people on the spread and the prevention of STDs.
Women are mostly considered victims of STDs as they get contacted through their legal partners. Men have a high tendency to associate with commercial sex workers, who in turn have the highest chances of having STDs. The knowledge among females, therefore, is very much important in preventing the spread of STDs as well as to protect themselves from getting infected.
A nurse’s role in preventing the spread of STDs mainly comes down to educating the community in which they serve. Nurses are a first contact person in most healthcare setups and they have a direct approach to openly discuss the healthcare problems of the people they come across. STDs being a hidden entity in the healthcare system may cause many to have unanswered questions. These areas can be addressed and resolved by a nurse.
The role of a nurse is not only limited to prevention but also to manage STDs. The main challenge is to make people seek healthcare when they think they have an STD. Another part of the challenge is to make the patients continue the treatment. Many people do not seek medical help until a very later stage. At the same time, another group of people may drop out of treatment due to various reasons. A nurse can actively be involved in this process to keep the patients go through the full course of medical treatment.
In another study published in 2013, the association of the STDs and the sexual practices were tested. 7,296 women aged 24 – 32 years took part in this study. The study was aimed to find out the STD prevalence among sexual minority groups in the USA. The study showed the women having 2 or more female partners had more chance of getting STDs than ones with only one male partner. (Lindley, Walsemann, & Carter, 2013)
This study is evidence that sexual practices have a direct role in the prevalence of STDs. Therefore, it is important that the prevention methods should focus on the careful observations of finding out the sexual orientation. This can be easily done by a nurse, who is generally considered a more approachable person than most other healthcare workers. Especially the female nurses will have a better chance of approaching women, who may hide vital details from a male interviewer.
Male homosexuality and STD risk are more deeply studied. But it is equally important that the female homosexual practices are looked at and addressed in the STD prevention campaigns. The chances are that female homosexuality is overlooked in comparison to male homosexuality.
The knowledge of STDs differs from country to country. A 2014 study was carried out among Latino adolescents in the USA and the Dominican Republic. 242 US students and 122 Dominica Republic students took part in this study. And they were aged 13 – 18 years with a mean age of 15. (Brito, Davis, & Chakrabarti, 2014)
This study revealed that the male students and those who were sexually active had more risk of STDs. At the same time, girls and those from the Dominican Republic had better knowledge of STDs. This study brings out a few important facts. As much as 40% of the adolescents were admitting that they were sexually active. And the knowledge on STDs and its prevention is still lacking. Education should start from an early age and health support should be freely available.
The education systems of most countries do not directly approach STD prevention. The social stigmata prevent the teachers from openly discussing these matters in the classroom. Some may feel those things can wait up to the college level. But it is quite evident that the sexual activities are started at a much earlier age. Adolescents are especially vulnerable as they will seek to experiment more on their sexuality, falling prey to those who are already having STDs.
So far we have discussed the STD knowledge in females and adolescents. So what about the males?
A study was published in 2017, by a group of Chinese researchers on the treatment-seeking behavior among homosexual men. (It is common knowledge that homosexuals are more vulnerable to STDs than heterosexuals.) 4,496 men took part in this research. The blood samples were taken and screened for HIV, Syphilis, and HSV-2. (Xu et al., 2017)
The results of this study were alarming. Among the suspected STD infected individuals, only 35.7% sought medical treatment. This was worse among the low-income groups. This is a clear indication that men are at higher risk and the negligence of the STDs is going to cause serious harm in the long run.
These are some of the studies done on the STDs over the past years. In recent times, more and more interest has been shown to study these diseases. The STDs are hard to cure and the more focus should be on prevention. It is important that the general public has more awareness of prevention and how these diseases are transmitted. As the Chinese study on homosexual men pointed out, society should be educated to seek out medical help in case of contracting an STD.
Adding a final word, the challenge of limiting and preventing STDs is upon the healthcare system of the modern world. It is a huge burden than what is superficially seen. The role of a nurse in battling the STDs is large. It partly involves in the management of STD patients and at the same time involves preventing at a community level. Unless tackled at an early stage, STDs can lead to a major health problem in the coming years, especially with the more liberal approach to sexual practices and homosexuality in modern society.
Clinical Question
Sexually transmitted diseases (STD) affect the world’s population greatly nowadays. According to the World Health Organization (WHO), about a million of them are acquired every day (WHO, 2016). Rather often, people are not even aware of their condition until the moment they experience adverse effects. Thus, it is vital to prevent further transmissions, encouraging adolescent and young adult females to avoid unsafe sex. It will be advantageous to start preventive measures on a research study that answers this clinical question:
Is more advantage obtained from patient education regarding STD when it is maintained by nurses than by social workers?
It is presupposed that education provided by nursing professionals will have better outcomes because they have a background in nursing and medicine, unlike social workers.
Type of the Study
Considering the peculiarities of the research question, a study that should be conducted will be identified as a quasi-experimental one. If a true experiment were used, it would be critical to assign groups randomly so that every participant included in a sample has an equal chance of being in both groups. However, quasi-experiment allows a researcher to avoid this element and make a study simpler and less resource-consuming even though they also test causal hypotheses. In this case, groups that already have a particular educator assigned to them will be approached so that the sample will not be divided into groups by the researcher.
Still, those biases that may be observed in this situation can be minimalized using various techniques, such as propensity score matching. What is more, the absence of time and logistical constraints is another important characteristic of this design. It allows a researcher to save time and focus on those initiatives that have been already implemented. In addition to that, quasi-analysis is often used when a study deals with some vague concepts, including morale and sexual education (White & Sabarwal, 2014).
Theoretical Framework
Considering the issues under discussion and proposed intervention, the self-care nursing model seems to be the most appropriate option. It was developed by Dorothea Orem to provide a theoretical framework for those cases when patients take care of their health themselves and nurses turn out to be only a mechanism that facilitates this process. According to it, all people should maintain those activities that promote their well-being. However, nurses are in charge of ensuring this ability.
They are expected to educate clients on how they can prevent illnesses or what they should do if they have some health problems, etc. These professionals should guide patients and create a positive environment for them to increase their self-care abilities. Nurses maintain a supportive educative role, providing assistance but not direct services. This theoretical framework meets the project perfectly because it is based on patient education. Future research will discuss its influence on the prevalence of STD among women. The way obtained information will change their well-being will be considered, which aligns with this nursing theory.
Thus, it can be concluded that quasi-experimental research is the best option for the proposed study because it provides an opportunity to test hypotheses just as a true experiment but, at the same time, allows a researcher to streamline and simplify this process. The self-care nursing model will be used to provide a theoretical framework for research because it allows professionals to focus on their role as educators.
Study Design
As indicated by the question, the study will take an experimental design. This is a research design whereby experiments are done and results are arrived at after a comparison of variables from the experiment group and a control group (Bordens, K. S., & Abbott, B. B., 2002). The participants will be grouped into two, a group that will be educated by experienced nurses on the control and prevention of STDs and a control group that will be educated by community health workers who are not as experienced. The results of the experiment will then be compared to existing evidence for the validity of the conclusion arrived at.
Setting/Sample
The study sample will consist of young adolescents who are sexually active and especially those who have more than one sexual partner. If the random sampling method is used, it will be hard to get a group consisting of only the target participants (Castillo, J. J., 2009). A convenience sample will, therefore, be the most appropriate sampling method to use in this study.
It will involve identifying a group that looks more susceptible to STDs, such as young sex workers or any other young person who is willing to disclose their sex life and who has multiple sex partners (Castillo, J. J., 2009). A large sample will first be selected and questionnaires distributed to them. The first questionnaires will include in the questions a question about their sexual relations. After the questionnaires are returned, they will be used to identify those who have multiple sex partners and are willing to participate in the study.
Confidentiality
To protect the confidentiality of the participants, the questionnaires will be designed in a manner that does not require the participants to disclose any information about them. Information such as names, year of birth, and place of residence will not be required. Those who will be selected to attend the education program will also remain anonymous. They will not need to disclose any personal information. Information obtained during the study will also be safely kept to avoid it getting into the wrong hands.
Procedures/Intervention
The “STD Free Youths Program” will be aimed at educating the youths about the issue of STDs and methods through which they can take care of themselves. It will be an interactive program where a group of youths will be educated by health nurse on the various STDs, their symptoms, effects on health and treatment methods. Most importantly, they will be taught about how to avoid contracting STDs by practicing safe sex.
Instruments/Scales and Measurement of Outcomes
The study will employ both quantitative and qualitative outcome measurement techniques (Mixed design). The quantitative design will be used to compare numerical data obtained from the experiment while the qualitative design will be used to compare the outcomes to those of other existing studies so as to come up with a concrete conclusion. The test results will be compared to outcomes of other similar studies to ascertain the reliability and validity of data.
Proposed Intervention
As it stands, education regarding STDs is performed largely by social workers, who may or may not have an in-depth understanding of the disease that a nurse professional has. The proposed intervention involves nurses offering sexual education and information about STDs, possible symptoms, and measures of protection, followed by comparing the results of the performance with those achieved by social workers within a period of 6 months.
Potential Outcomes
The expected potential outcome is that the education provided by nurses would be more effective than those offered by social workers. Nurses have a deeper understanding of STDs due to medical education and are able to offer more insight on the subject. In addition, the social status of a nurse as a medical worker could potentially have an impact on the populace, as any information provided by them would be taken more seriously.
The null hypothesis for this research states that there will be no significant statistical difference between the results lent by either nurses or social workers. Should the null hypothesis be supported by the results of the research, it could be theorized that the level of understanding and the social position of the information provider does not play a role in sexual education and that there are other factors that contribute to the quality of education.
The outcomes will be analyzed depending on the results of the questionnaires filled out by the participants before the intervention and 6 months after the intervention.
Statistical Analysis and Data Collection Tools
This research uses convenience sampling in order to gather participants, who would be willing to participate in the study. It is a forced measure, due to the delicate and highly personal nature of the inquiry. The participants would be picked among sexually active adolescents and young adults who indulge in frequent sexual activities involving one partner or more, as well as people engaged in prostitution.
The main data collection tool would be the questionnaire. It will be used to measure the participants’ knowledge before and after the intervention. The results of the questionnaires would be processed via specialized statistical software in order to get the results. The main statistical method applied for this research would be the Z-test (Philbrick, 2013). It is a standard statistical tool used to determine the population means in large samples. It is preferable to the Student’s T-test, as that one is preferable for samples with 30 participants or less (Philbrick, 2013).
Demographic Data
As this research deals with highly sensitive and confidential information, it is paramount to protect the anonymity of the participants. As such, any demographic data used in the research will be kept to a minimum, and include only the participants’ gender. Additional data, such as year of birth, locality of birth, social and economic backgrounds, and other information would be entirely optional, and the respondents would not be obligated to include these in their questionnaires.
Expected Outcomes
It is expected that the general level of knowledge about sexually transmitted diseases and ways of protection would increase in both groups. While general levels of knowledge before the intervention are likely to vary, the overall scores after the intervention should be somewhat similar among the participants of either group. At the same time, it is expected that the test group, where the nurses provided sexual education and information, would show better results 6 months after the intervention.
This is due to the fact that nurses have a deeper understanding of the subject when compared to the social worker and would be able to answer more difficult and elaborate questions. It is also theorized that having a doctor or a nurse instead of a social worker would improve the attention span of the participants, which would lead to better long-term results. Alternatively, it is possible that the social worker group would show better results when compared to the nurse-led group due to the fact that social workers have more hands-on experience in dealing with sexually reckless young adults.
Stakeholders
The stakeholders for this project proposal include patients, medical practitioners, as well as social workers. The group of medical professionals would include hospital floor nurses and nurse practitioners. As stated earlier, their main role would be in providing medical information to the patients, answering questions, and promoting a more accepting view of sexually transmitted diseases with the goal of increasing awareness and hospital visits for checkups of people who are at risk of being infected with an STD.
Their second role would be to compare the data gathered from the meetings with previous data. Social workers would serve a similar function, but due to their larger availability, their role would be in spreading the information to a larger number of people. The patient group would include people at risk of being infected and those already dealing with an infection. By receiving this information, they should gain an understanding of preventative measures for this issue.
Potential Barriers that Stakeholders May Represent
One of the most likely barriers is the lack of time on the part of the nursing group. Understaffing is a real issue, and it can severely limit the available time for additional projects such as this (Longhurst, 2015). To address this issue, additional substitute nursing groups should be considered. Another barrier might lie in the lack of effective messaging from social workers. The social worker group has less authority in the eyes of the patients than the nursing group. This could lead to a lesser adoption rate of preventative measures. To resolve this issue, social worker presentations should be either accompanied by a member of the nursing group, or an official message from the nursing group to establish the information provided by the social workers as valid (Walrath, Immelt, Ray, Graafeiland & Himmelfarb, 2015).
References
Aral, S.O., Fenton, K.A., & Lipshutz, J.A. (2013). The new public health and STD/HIV prevention. GA, USA: Springer.
Bordens, K. S., & Abbott, B. B. (2002). Research design and methods: A process approach. McGraw-Hill.
Brito, M. O., Davis, M., & Chakrabarti, A. (2014). A cross-national study to compare the knowledge, attitudes, perceptions of sexually transmitted diseases and the sexual risk behaviors of Latino adolescents. Int J Adolesc Med Health, 26(2), 203-208. doi: 10.1515/ijamh-2013-0509
Brown, L., Macintyre, K., & Trujillo, L. (2003). “Interventions to Reduce HIV/AIDS Stigma: What Have We Learned?” AIDS Education and Prevention, 15(1), 49-69.
Castillo, J. J. (2009). Convenience sampling. Retrieved on October, 2, 2013.
Hossain, M., Mani, K. K., Sidik, S. M., Shahar, H. K., & Islam, R. (2014). Knowledge and awareness about STDs among women in Bangladesh. BMC Public Health, 14, 775. doi: 10.1186/1471-2458-14-775
Lindley, L. L., Walsemann, K. M., & Carter, J. W., Jr. (2013). Invisible and at risk: STDs among young adult sexual minority women in the United States. Perspect Sex Reprod Health, 45(2), 66-73. doi: 10.1363/4506613
Longhurst, C. (2015). Compassion fatigue in palliative nursing is due to understaffing. Nursing Standard, 30(4), 9-9.
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Paul-Ebhohimhen, V.A., Poobalan, A., & Teijlingen, E.R. (2008). “A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa.” BMC Public Health, 8, 4.
Philbrick, V. (2013). John Hopkins nursing evidence-based practice: Model and guidelines, 2nd ed. AORN Journal, 97(1), 157-158.
Walrath, J., Immelt, S., Ray, E., Graafeiland, B., & Himmelfarb, C. (2015). Preparing patient safety advocates. Nurse Educator, 40(4), 174-178.
White, H., & Sabarwal, S. (2014). Quasi-experimental design and methods.
WHO. (2016). Sexually transmitted infections fact sheet.
WHO. (2016). Sexually Transmitted Infections Fact Sheet. World Health Organization.
Xu, J. J., Yu, Y. Q., Hu, Q. H., Yan, H. J., Wang, Z., Lu, L.,… Shang, H. (2017). Treatment-seeking behaviour and barriers to service access for sexually transmitted diseases among men who have sex with men in China: A multicentre cross-sectional survey. Infect Dis Poverty, 6(1), 15. doi: 10.1186/s40249-016-0219-5.