Urban Adolescent Sexual Health Education: An Innovative, Nursing Student-Led Initiative

Problem Statement

A large urban school district resides in a county that reported the highest rates in the nation of gonorrhea, second highest rates of both chlamydia and syphilis, as well as a 43% increase in HIV diagnoses among 15-19 year-olds since 2000.  Teens served by this district were also twice as likely as other teens in the same state to engage in sex before the age of 13, and to give birth (Chicago Public Schools, 2013a).  Due to this high rate of sexually transmitted infections (STI) and pregnancies, the district adopted a policy requiring district-wide sexual health education by 2016 (Chicago Public Schools, 2013b).  The school district developed an evidence-based curriculum and teacher certification program to meet this policy.  This presented a challenge for some schools to find the resources necessary to deliver the curriculum. 

During the same time period, a college of nursing was seeking a clinical site to integrate women’s health (WH) and public health (PH) objectives within the Generalist Entry Master’s (GEM) nursing program. As schools of nursing are expanding enrollment, it has become more challenging to find adequate sites for clinical education (Aponte and Agues, 2010).  Early in 2014, eight GEM students were selected to pilot curriculum delivery at two schools to fulfill indirect hours required for graduation and to sit for the Clinical Nurse Leader certification boards.  The initial group of GEM students found the experience valuable to their nursing education and unanimously reported that the content was “relevant” to the nursing role but there was no long term plan to continue the opportunity.  

            To address these problems, two student leaders in the GEM program worked with faculty to develop and implement an integrated WH/PH practicum by preparing GEM students to deliver sexual health education within the school district.  Curriculum delivery is important because it meets the short-term needs of both the school district and GEM nursing students, and has long-term potential to reduce rates of STIs and teen pregnancies. This interprofessional experience also serves to broaden a student nurse’s exposure to professional opportunities in the community that focus on prevention and emotional/physical wellness. These roles are crucial to meet the needs created by a changing healthcare system.  The purpose of this presentation is to assess the GEM students’ perceptions of success in meeting practicum objectives and measure change in knowledge, skills, and attitudes related to age and culture- appropriate teaching, leadership, and working with youth to promote healthier attitudes toward sex and sexuality.

Theoretical/conceptual framework

This project was guided by Benner’s novice to expert model to measure student perceptions of increased proficiency in the role of a nurse outside of the hospital (Benner, 1984).

Methodology

A post-practicum survey design was used. GEM students were recruited by flyers and informational sessions. Interested students were interviewed by the student leaders and faculty. The 15 selected students completed on-line school district sexual health training, and then delivered the eight-week sexual health program (100 to 200 minutes a week) as part of their integrated practicum.  Sixteen 5-9^th grade student groups from three schools took part. GEM student pairs taught the program with each pair teaching two student groups. Post-practicum questionnaires assessed: success in meeting practicum objectives, comfort level discussing sensitive topics, and perception of nursing knowledge, skills, and attitudes. 

Results

Ninety-eight percent of GEM students reported meeting practicum objectives; 93%  reported feeling comfortable speaking about sensitive topics; 92% identified with attributes consistent with Benner’s classification of competent or expert nurses.

Implications

An integrated practicum provides a way for GEM nursing students to leverage their skills teaching sexual health, meet both WH/PH objectives, and gain experience in the community. Such a practicum could result in a cost effective way for high-risk schools to deliver sexual health programs and lower rates of STIs and pregnancy.