Adolescent gestation is one of the many jobs that afflict the United States that is preventable. Unintended gestations span across all degrees of age, race and credo, with a specific negative impact among the adolescent population. In 2006 $ 11 billion was spent on births ( antenatal attention and 1 twelvemonth of baby wellness attention ) from unintended gestations ( Sonfield, Kost, Gold, & A ; Finer, 2011 ) . These gestations have been connected to many societal, wellness, and fiscal effects. When unintended gestations occur in the younger age group, negative results occur at a higher rate as compared to adult females of older age. As a national statistic, 1 out of every 5 unintended gestations are from the teenage demographic, with a reeling 82 per centum belonging to the ages between 15 and 19 ( Finer & A ; Henshaw, 2006 ) . The ensuing result of the gestation bears a big fiscal, emotional, and educational adversity on the female parent, her kid, and the local community. In order to cut down the prevalence of a adolescent going accidentally pregnant, bar through instruction and consciousness is critical in cut downing this statistic that burdens our local community. This paper focuses on the Healthy People 2020 Objective of cut downing gestation among adolescent female ‘s ages 15 through 17.
Target Population & A ; Puting
The Target populations for this Healthy people 2020 nonsubjective are adolescent females in the age group of 15 to 17 old ages old. The scene where instruction for bar of unintended gestations for this demographic includes the adolescents place, schools, community outreach centres, media mercantile establishments, clinics, infirmaries, and their primary attention supplier ( Pediatrician ‘s office ) . Education can be given virtually anyplace but the primary scene where these striplings spend the bulk of their clip at this age is in school or at place so these are the topographic points where instruction and intercessions need to get down and be followed through. At this clip the United States is ranked with the highest figure of adolescent gestation and sexually familial diseases, and in 2005 the Health Indexs Warehouse ( HHS ) determined that nationally there were 40.2 gestations per 1,000 females from the demographic age group of 15 to 17 old ages old.
Application
Reducing gestation in stripling ‘s ages 15 to 17 old ages old is a job that applies to progress pattern because instruction demands to be started early at the primary attention suppliers and during every brush with the patient and their parents. Advanced Practice Nurses ( APNs ) need to measure the patient ‘s sexual activity, instruction on preventives, gestation purposes, and receptiveness of instruction and intercessions. To hold a successful result for this job non merely do the adolescents need instruction every bit good as the parents. The parents need instruction on how to speak to their kids about safe sex, birth control methods, and sexually familial disease ( STD ‘s ) . There has been great argument over how and where sex instruction should be given, and whether or non safe sex or abstention merely attack should be used. The parents besides need to be assessed to happen out their positions on sex instruction and if they know how and if they are comfy with speaking to their kid about safe sex and contraceptive method. Designation of adolescent females whom are at high hazard of acquiring pregnant is a cardinal to bar. Education needs to be given no affair what puting the adolescent is in whether at the clinic, primary attention office, Emergency room, or at school. Teenss are afraid to speak to their parents or instructors for fright of being judged and acquiring in problem. That is why it is so of import for APNs to ever take the clip to discourse sexual instruction, contraceptive method, and sexually transmitted infection ( STDs ) at every visit with the adolescent ( inquire the parent to go forth the room for this portion of the visit ) because so they will experience more comfy to speak cognizing that it is confidential, and there is greater opportunity of assisting to modify hazardous behaviours and supplying intercessions that could assist diminish the figure of unintended gestations and STDs.
Theoretical model
Eriksson carative theory is a theoretical account of nursing that distinguishes between caring moralss and the practical relationship between the patient and the nurse, along with nursing moralss. Caratative lovingness ( caritus ) is made of love, charity, regard, and fear for human self-respect and sanctity ( Nursing Theory, 2011 ) . Eriksson developed her carative factors in the hopes to equilibrate the remedy orientation of medical specialty. This theoretical model can be used to use intercessions to assist diminish the sum of pregnant striplings. Wikberg ( 2007 ) found that caring nursing is caring for the ailment or enduring human being without bias, through caritas, which is love and charity. These striplings will necessitate to be approached with a carative lovingness scheme because at this age they are really emotional and are seeking to happen out who they are as a individual. The APN must ever utilize a lovingness attack and speak to the patient with regard and without bias, instead than the remedy orientation attack of medical specialty that is more cut and dry with no clip being spent to turn to their emotional and physical demands. Eriksson believed that if a patient suffered as a consequence of deficiency of caratative attention, it was a misdemeanor of human self-respect ( Nursing theory, 2011 ) . Eriksson developed the caratative theory to bridge the spread between healing and caratative attention and to assist convey nursing back to being a nursing theory driven profession, by which caring nursing is the cardinal nucleus. APNs know from experience that you can non merely look at labs and read the machines while taking attention of your patient you need to really look, touch, and listen to the patient to acquire the whole image. Erikson ( 2002 ) found that no affair much engineering progresss, nurses will ever be the 1s to measure the patients enduring and feelings. It is this interaction and communicating between the patient and the nurse or APN that defines the carative theory.
Reappraisal of Literature
Nationally the rate of stripling unintended gestations are mounting at a astonishing rate, but the appropriate intercession to these turning statistics is overturned due to debate over how sex instruction should be given ( Carter, 2012 ) . There are federal Torahs that promote abstention merely instruction and provides support for abstention based plans therefore forbiding these plans from supplying instruction on safe sex and contraceptive method. A recent survey by Stanger-Hall and Hall ( 2011 ) found that this abstention merely instruction attack non merely fails to forestall unintended gestation among striplings, but has been positively correlated with an addition in the sum of gestations and births among adolescents. The survey consisted of a information analysis of the sex instruction Torahs and policies of 48 provinces excepting North Dakota and Wyoming. The provinces were given a figure from 0 to 3 covering the sum of accent stressed on abstention: no accent ( 0 ) , abstention discussed ( 1 ) , abstinence promoted ( 2 ) , and abstention stressed ( 3 ) ( Stanger- Hall & A ; Hall, 2011 ) . The information analysis used the 2005 national studies on teenage gestation, births, and abortion rates among ages 15 to 19 old ages of age. The consequences showed that the more accent was placed on abstinence-only instruction, the greater the sum of adolescent gestation and births. The most effectual attack was the flat 1 manner which covered a comprehensive safe sex or STD instruction ( or both ) and besides covered the usage of birth control, rubbers, and abstention ( Stanger- Hall & A ; Hall, 2011 ) . With the consequences of this survey Nurse Practitioners ( NPs ) can be confident that supplying comprehensive safe sex instruction to striplings is non merely appropriate but besides effectual. They can besides educate the parents and reassure them that by supplying this instruction on safe sex and the usage of preventives will non promote them to hold sex but will decrease the opportunity of these striplings holding an unintended gestation, or undertaking an STD ( Carter, 2012 ) . School-based wellness centres ( SBHCs ) are a fantastic community resource for striplings that provide adolescent friendly primary attention wellness services to this population. However, current limitations on prophylactic services are maintaining them from reacting to the diverse demands of this population. Therefore restricting the chances for supplying comprehensive sexual instruction and generative attention which creates lost chances for unintended gestation and STD bar ( Daley, 2012 ) . With the rise of unintended gestation and STDs among the adolescent age group in the United provinces, it validates that many striplings are prosecuting in unprotected sexual activity. Intensifying these issues, many striplings besides go without wellness attention intercessions due to miss of insurance, entree to services, and concerns of their confidentiality which makes it really hard for them to acquire preventive attention and remain in the wellness attention system. With the states current economic position and wellness attention reform, safe sex instruction and prophylactic services for teens are traveling to go on to be limited, which compounds the importance of doing the bing wellness plans for teens more efficient and effectual as possible ( Daley, 2012 ) . APNs must recommend for their adolescent patients and supply the grounds of the effectivity of the SBHC services. If the many limitations at the local, province, and national degree remain we will go on to see a steady addition in the rate of unintended gestations among striplings.
Intervention
There are many intercessions needed to assist diminish the sum of unintended gestations in the adolescent age group. The first intercession is to alter the sexual instruction criterions in the schools which means holding to alter some of the Torahs at the local, province and federal degree. The Future of Sexual activity Education created new National Sexuality Education criterions which were released in January of this twelvemonth. The striplings need to hold a comprehensive safe sex instruction that includes abstention, contraceptive method, STD bar, and gestation bar. Surveies have proven that when abstention is the lone thing that is taught there is a rise in unintended gestations. The National Survey of Family Growth found that teens age 15-19 who received safe sex instruction were 50 per centum less likely to describe an unintended gestation than those who received abstinence-only instruction ( Kohler, Manhart, & A ; Lafferty, 2008 ) . Another intercession is to open more SBHCs across the state and release there limitations from supplying prophylactic services. Contraception such as rubbers and birth control should be offered at a more low-cost or discounted monetary value. Until the twenty-four hours that the federal, province, and local Torahs alteration, the intercessions will hold to come from the parents at place, school nurse, and Primary attention supplier ‘s office. It is the NPs occupation to place the striplings whom show high hazard behaviour and intervene. Education on safe sex and gestation and STD bar demand to be given at every office visit. The NPs demand to develop a trusting relationship with their patients and guarantee their confidentiality. They besides need to give the parents instruction and mention them to teen gestation bar web sites and or groups. The NPs demand to guarantee them that safe sex instruction does non promote the teens to take part in sexual activity it decreases the opportunities of them going pregnant or catching and STD. The U.S Preventive Services Task Force ( USPSTF ) recommends individual to individual intercessions targeted at health professionals to assist them better their parenting accomplishments. These intercessions are done via telephone or face to confront outside of the clinical scene and can be done in group Sessionss or one-on-one preparation. Some illustrations of the intercessions given are schemes to better communicating, recommendations for parental monitoring of striplings, and information on how to talk to striplings bout subjects such as sexual behaviour ( The Guide to Community Preventive Services: The Community Guide, 2007 ) . The USPSTF recommends that adolescents go involved in community service or outreach plans that provide them with chances to interact with other pupils and grownups in the community. This experience will give them an chance to hold rank in a group and it will assist them develop better communicating accomplishments, improved determination devising, self-government, and duties. These attacks have been found to be effectual in cut downing hazardous sexual behaviour in striplings. Last but non least is intercession through mass media and societal selling. The USPSTF recommend wellness communicating runs that use multiple markets such as mass media to present message such as ever use protection when you have sex and unite it with the distribution of free or decreased monetary value wellness merchandises such as rubbers ( The Guide to Community Preventive Services: The Community Guide, 2007 ) . All of these intercessions have been shown to cut down the figure of unintended gestations among striplings. NPs, school nurses, and parents all have to work together to assist our teens get the instruction they need to do healthy hazard free picks.
Outcomes The end of this aim is to hold a 10 % betterment of 36.2 gestations per 1,000 stripling females ( Healthy People 2020, n.d. ) . The intended results for these intercessions are to educate the striplings in the age group of 15-17 and their parents about safe sex and STD bar. Changing the abstention – lone instruction in school to comprehensive safe sex instruction therefore diminishing the sum of unintended gestations and STDS. By opening more SBHCs and taking limitations on preventives we are supplying the striplings a community resource, a topographic point to acquire instruction and generative attention. Promoting the striplings to make community outreach, they are acquiring a opportunity to run into new people and learn communicating accomplishments and most significantly remaining off from hazardous behaviours. Stressing the importance of sexual wellness instruction at every visit with the primary attention supplier helps the patient develop a trusting relationship but besides educates them on the importance of safe sex. Therefore diminishing the unintended gestation rate among teens which has become a major public wellness concern in our communities in United States.
Evaluation
To measure if the 2020 nonsubjective intercessions produced the intended results informations will necessitate to be collected on how the ends were met, if the program chosen for the aim worked, were any alterations made, and after these inquiries are answered the information will hold to be analyzed. Evaluations on the intercessions will necessitate to be measured and tracked ( Healthy People 2020, n.d. ) This type of survey would most probably be a quantitative survey because the end is to cut down the figure of gestations among striplings age 15-17 old ages old. Partnering with a University to assist with informations tracking is helpful and the university can utilize a statistician to assist with look intoing the cogency and dependability of the information. Data quality is besides really of import the research worker will necessitate to utilize a valid tool so that the informations aggregation method, analysis, and research inquiries are all standardised ( Healthy People 2020, n.d. ) . There are besides evaluation ushers or toolkits that provinces can utilize to measure their advancement. The rating program should include the Process rating and Outcome rating. The rating program is used when using for funding for your intercessions for the aim ( Centers for Disease Control and Prevention, 2011 ) . To measure the effectivity of the intercessions to cut down the figure of gestations of adolescent females ages 15-17 the results of the intercessions will be collected and the consequences of the information analysis will be compared to other provinces to see what the national norm is and if it has decreased from the last survey and if the 2020 end of a 10 % lessening to 36.2 gestations per 1,000 stripling females has been achieved.
Decision
In decision, adolescent gestation is a preventable job that is burthening our communities and is bing the United States one million millions of dollars a twelvemonth. The healthy people 2020 aim of cut downing gestation among adolescent females aged 15 to 17 old ages old is a end that is easy gettable. Early comprehensive safe sex instruction including prophylactic bar is the key and it needs to get down at place by the parents and be continually reinforced at school, the primary attention office, and in the community.