GUEST EDITORIAL
Breaking down silos: The future of sexual and reproductive health care—An opinion from the women’s health expert panel of the American Academy of Nursing
The traditional model of healthcare delivery in the United States has been to provide sexual and reproductive health (SRH) care as a separate service in private settings, in clinics, such as Planned Parenthood, and in underfunded community health centers and public health departments (Auerbach et al., 2012). Deemed too fragmented, the more contemporary approach is to integrate SRH into primary care specialties. However, there is concern among women’s health leaders about the adequacy of SRH preparation for nurse practitioners (NPs) educated in primary care specialties, such as Family, Adult/Gerontology, and Pediatrics. This editorial highlights our concerns about SRH content for women and men in NP primary care curricula and outlines the steps that need to be taken to assure competency of primary care NPs to care for the SRH needs of the population. Previously thought of as maternal and child health care, contemporary opinion is that SRH should be available and accessible for all men and women, including ethnic and sexual minorities, throughout their life span (World Health Organization [WHO], 2009). This expanded view includes preconception care, sex education, contraception, pregnancy and unplanned pregnancy care, gynecological and other women’s health care, genitourinary conditions of men, infertility, sexual health promotion, and care coordination with public health and other primary care services (Auerbach et al., 2012). We support the WHO’s recommendation that SRH be integrated into existing primary care in ways that reduce barriers to access (WHO, 2011). This healthcare delivery model is utilized extensively and successfully in the United Kingdom (Royal College of Nursing, 2009). Of concern, however, is whether or not primary care education for NPs in the United States includes sufficient content to prepare these primary care providers to assume the full array of SRH care. Implementation of the Patient Protection and Affordable Care Act 2010 is predicted to strain healthcare delivery resources, in that persons currently without health insurance will have access to health insurance on healthcare exchanges and care may be provided through accountable care organizations. In addition, the total number of adults of reproductive age (18–44) in the United
States is expected to increase from 112 million to 125 million by 2025. SRH services will surely need to increase proportionately. NPs are central to SRH care in this country; however, a number of workforce changes threaten the supply of NPs appropriately educated and trained to provide these services (Auerbach et al., 2012). For example, the RAND study (Auerbach et al., 2012) identified a reduction in programs that prepare Women’s Health NPs. Instead, the preponderance of programs prepares NPs in the primary care specialties already specified. Although recent forecasts by Auerbach et al. (2012) predict a large growth in the supply of NPs, most will be educated in primary care specialties. This then begs the question as to whether or not these NPs will be adequately prepared to meet the SRH needs of the burgeoning patient population. It is no longer feasible or desirable to provide SRH care in a fragmented fashion that necessitates women and men seeing multiple providers. With the projected growth in NPs educated in primary care, we need to redouble our efforts to insure they are adequately prepared to meet the increasing demands for SRH care in primary care settings. It has been well established there is a direct relationship between safe and quality care and a nurse’s education and training (Aiken, Clarke, Cheung, Sloane, & Silber, 2003). Further, the ever-changing evidencebased science and clinical understanding of SRH demands that we must be careful not to throw the baby out with the bath water. Hence, discontinuing Women’s Health NP programs and courses (Auerbach et al., 2012), and limiting SRH content to NP primary care focused curricula is certainly a serious concern. It is critical that nurses and particularly educators in NP primary care specialties carefully look at the following:
C 2014 The Author(s) Journal of the American Association of Nurse Practitioners 26 (2014) 3–4
C 2014 American Association of Nurse Practitioners
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■
Assess the adequacy of SRH content in current educational programs preparing primary care NPs to develop the necessary competencies for SRH care as determined by the WHO and Royal College of Nursing. Obtain feedback from graduates about the adequacy of their preparation to meet the SRH needs of men and women in their practices. 3
Guest Editorial
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Ascertain whether or not SRH care in the context of primary care is meeting the needs of women and men themselves. Work with certification and accreditation programs to establish educational standards to measure SRH competencies in primary care specialties. Consider offering residency programs to augment SRH knowledge among primary care NPs.
As a first step, several members of the Women’s Health Expert Panel of the American Academy of Nursing are undertaking research to determine the adequacy of SRH curricular content in primary care NP programs in the United States. Until all of this important work has been completed, we cannot be certain that NPs are prepared to address women’s and men’s SRH needs in primary care settings. Stay tuned!
Judith A. Berg, PhD, RN, WHNP-BC, FAAN, FAANP (Clinical Professor)1 , Nancy Fugate Woods, PhD, RN, FAAN (Dean Emerita and Professor)2 , Elizabeth Kostas-Polston, PhD,
4
J. A. Berg et al.
APRN, WHNP-BC, FAANP (Assistant Professor & Coordinator of Curriculum Development)3 , & Versie Johnson-Mallard, PhD, ARNP, MSN, MSMS (Assistant Professor)4 1
The University of Arizona College of Nursing, Tucson, Arizona University of Washington School of Nursing, Seattle, Washington 3 Curriculum Development, University of South Florida School of Nursing, Tampa, Florida 4 University of South Florida School of Nursing, Tampa, Florida 2
References Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290, 1617–1623. Auerbach, D., Pearson, M., Taylor, D., Battistelli, M., Sussell, J., Hunter, L., . . . Schneider, E. (2012). Nurse practitioners and sexual and reproductive health services: An analysis of supply and demand. Santa Monica, CA: RAND Corporation. Royal College of Nursing. (2009). Sexual health competences: An integrated career and competence framework for sexual and reproductive health nursing across the UK. London: Royal College of Nursing. World Health Organization (WHO). (2009). Sexual and Reproductive Health Strategic Plan 2010–2015 and proposed programme budget for 2010–2011. Geneva: World Health Organization. World Health Organization (WHO). (2011). Sexual and reproductive health core competencies in primary care. Geneva: World Health Organization.
Breaking down silos: The future of sexual and reproductive health care—An opinion from the women’s health expert panel of the American Academy of Nursing
The traditional model of healthcare delivery in the United States has been to provide sexual and reproductive health (SRH) care as a separate service in private settings, in clinics, such as Planned Parenthood, and in underfunded community health centers and public health departments (Auerbach et al., 2012). Deemed too fragmented, the more contemporary approach is to integrate SRH into primary care specialties. However, there is concern among women’s health leaders about the adequacy of SRH preparation for nurse practitioners (NPs) educated in primary care specialties, such as Family, Adult/Gerontology, and Pediatrics. This editorial highlights our concerns about SRH content for women and men in NP primary care curricula and outlines the steps that need to be taken to assure competency of primary care NPs to care for the SRH needs of the population. Previously thought of as maternal and child health care, contemporary opinion is that SRH should be available and accessible for all men and women, including ethnic and sexual minorities, throughout their life span (World Health Organization [WHO], 2009). This expanded view includes preconception care, sex education, contraception, pregnancy and unplanned pregnancy care, gynecological and other women’s health care, genitourinary conditions of men, infertility, sexual health promotion, and care coordination with public health and other primary care services (Auerbach et al., 2012). We support the WHO’s recommendation that SRH be integrated into existing primary care in ways that reduce barriers to access (WHO, 2011). This healthcare delivery model is utilized extensively and successfully in the United Kingdom (Royal College of Nursing, 2009). Of concern, however, is whether or not primary care education for NPs in the United States includes sufficient content to prepare these primary care providers to assume the full array of SRH care. Implementation of the Patient Protection and Affordable Care Act 2010 is predicted to strain healthcare delivery resources, in that persons currently without health insurance will have access to health insurance on healthcare exchanges and care may be provided through accountable care organizations. In addition, the total number of adults of reproductive age (18–44) in the United
States is expected to increase from 112 million to 125 million by 2025. SRH services will surely need to increase proportionately. NPs are central to SRH care in this country; however, a number of workforce changes threaten the supply of NPs appropriately educated and trained to provide these services (Auerbach et al., 2012). For example, the RAND study (Auerbach et al., 2012) identified a reduction in programs that prepare Women’s Health NPs. Instead, the preponderance of programs prepares NPs in the primary care specialties already specified. Although recent forecasts by Auerbach et al. (2012) predict a large growth in the supply of NPs, most will be educated in primary care specialties. This then begs the question as to whether or not these NPs will be adequately prepared to meet the SRH needs of the burgeoning patient population. It is no longer feasible or desirable to provide SRH care in a fragmented fashion that necessitates women and men seeing multiple providers. With the projected growth in NPs educated in primary care, we need to redouble our efforts to insure they are adequately prepared to meet the increasing demands for SRH care in primary care settings. It has been well established there is a direct relationship between safe and quality care and a nurse’s education and training (Aiken, Clarke, Cheung, Sloane, & Silber, 2003). Further, the ever-changing evidencebased science and clinical understanding of SRH demands that we must be careful not to throw the baby out with the bath water. Hence, discontinuing Women’s Health NP programs and courses (Auerbach et al., 2012), and limiting SRH content to NP primary care focused curricula is certainly a serious concern. It is critical that nurses and particularly educators in NP primary care specialties carefully look at the following:
C 2014 The Author(s) Journal of the American Association of Nurse Practitioners 26 (2014) 3–4
C 2014 American Association of Nurse Practitioners
■
■
Assess the adequacy of SRH content in current educational programs preparing primary care NPs to develop the necessary competencies for SRH care as determined by the WHO and Royal College of Nursing. Obtain feedback from graduates about the adequacy of their preparation to meet the SRH needs of men and women in their practices. 3
Guest Editorial
■
■
■
Ascertain whether or not SRH care in the context of primary care is meeting the needs of women and men themselves. Work with certification and accreditation programs to establish educational standards to measure SRH competencies in primary care specialties. Consider offering residency programs to augment SRH knowledge among primary care NPs.
As a first step, several members of the Women’s Health Expert Panel of the American Academy of Nursing are undertaking research to determine the adequacy of SRH curricular content in primary care NP programs in the United States. Until all of this important work has been completed, we cannot be certain that NPs are prepared to address women’s and men’s SRH needs in primary care settings. Stay tuned!
Judith A. Berg, PhD, RN, WHNP-BC, FAAN, FAANP (Clinical Professor)1 , Nancy Fugate Woods, PhD, RN, FAAN (Dean Emerita and Professor)2 , Elizabeth Kostas-Polston, PhD,
4
J. A. Berg et al.
APRN, WHNP-BC, FAANP (Assistant Professor & Coordinator of Curriculum Development)3 , & Versie Johnson-Mallard, PhD, ARNP, MSN, MSMS (Assistant Professor)4 1
The University of Arizona College of Nursing, Tucson, Arizona University of Washington School of Nursing, Seattle, Washington 3 Curriculum Development, University of South Florida School of Nursing, Tampa, Florida 4 University of South Florida School of Nursing, Tampa, Florida 2
References Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290, 1617–1623. Auerbach, D., Pearson, M., Taylor, D., Battistelli, M., Sussell, J., Hunter, L., . . . Schneider, E. (2012). Nurse practitioners and sexual and reproductive health services: An analysis of supply and demand. Santa Monica, CA: RAND Corporation. Royal College of Nursing. (2009). Sexual health competences: An integrated career and competence framework for sexual and reproductive health nursing across the UK. London: Royal College of Nursing. World Health Organization (WHO). (2009). Sexual and Reproductive Health Strategic Plan 2010–2015 and proposed programme budget for 2010–2011. Geneva: World Health Organization. World Health Organization (WHO). (2011). Sexual and reproductive health core competencies in primary care. Geneva: World Health Organization.
