Sexual transmitted Infection - Essay Example

Sexual transmitted Infection Introduction Health is a complex system that is constantly changing. Nurses are essentially educated to practice nursing in health care settings and it may be difficult to practice and define community focused nursing care. Community health nursing is accountable for meeting the populations’ health care needs and has changed with the dynamic care delivery system. For effective delivery of health care in the community, a nurse must be aware of the culture, social trends and economics. The practice of promoting and protecting the health of populations using nursing knowledge is public health nursing. This paper is focused on the role of the nurse in health promotion of health in regard to chlamydia in people aged 15 to 25 years. Effective strategies and interventions to reduce chlamydia infections, influencing factors, impact policies on the provision of care, theories and models of health in understanding chlamydia patients within the high risk group and their holistic needs will be discussed. In the United Kingdom, sexually transmitted infections are a public health concern especially among young sexually active persons particularly those aged between 15 and 25 years. According to Public Health England (2015), there were 440,000 diagnoses of sexually transmitted infections in England. 1.6 million tests were carried out and 138,000 chlamydia diagnoses were made for young people between 15 and 24 years old. Chlamydia trachomatis is one of the most commonly diagnosed bacterial sexually transmitted infection. In women, it causes endometritis, mucopurulent cervicitis and urethritis. Mucopurulent cervicitis can cause of pelvic inflammatory disease, salpingitis, ectopic pregnancy, tubal factor infertility, chorioamnionitis, puerperal and neonatal infections and epididymitis. In men, untreated chlamydial infections can cause epididymitis and proctitis. Chlamydia is associated with an elevated risk of transmission of HIV and for the development of cervical carcinoma. Women are the potential source of infection to their partners since they carry the major burden of the disease (Malhotra, et al., 2013). In men, C. trachomatis can cause acute epididymis, nongonococcal urethritis and urethral strictures (Shaw, et al., 2011). Chlamydia is often asymptomatic but patients may experience pain during urination, unusual discharge from the vagina, penis and rectum. Women may experience abdominal pain, bleeding during or after sex and bleeding in between periods while men have swelling in the testicles. Chlamydia trachomatis diagnosis is done through nucleic acid amplification tests such as polymerase chain reaction, ligase chain reaction, and transcription mediated amplification assays since they are non-invasive and perform well. The tests are highly specific and are more sensitive compared to the traditional method of tissue culture. Enzyme immune assays and direct nucleic acid probe assays can also be used in detecting chlamydial antigen and in evaluation of large number of samples. Treatment is by single dose therapy with antibiotics with their sexual partners to prevent reinfection. It is essential for partners to be notified and contract treatment. Single dose is cost effective since compliance is improved on (Malhotra, et al., 2013). However, many people remain untreated since infection with chlamydia because they are unaware that they are infected. After administration of treatment, follow should be done. In case of failure, possibility could arise from failure to finish or take medication appropriately, re-exposure to an untreated partner and rarely, resistant strains of C. trachomatis. Role of the nurse in promoting health and well-being of patients with chlamydia in non-hospital settings Nurses are the primary group in care delivery in health care institutions. To meet the demands of the public health, nurses are key members in the inter-professional team. They are the main stem of assessment and management in sexual health services, family planning, obstestrics, and gynecological services. In prevention of sexually transmitted infections at primary, secondary and tertiary levels, sexual health promotion through nursing practice is directly equated. Primary prevention involves educating the high risk group on chlamydia infections. Secondary interventions include use of screening methods to identify new infections. Tertiary levels involves administration of antibiotic therapies to treat those infected with chlamydia. In sexual health protection and promotion, nurses provide health education and screening which are one of the key components of public health interventions. They understand the clinical implications of public health interventions on chlamydia and have knowledge on the etiology of chlamydia and natural history of the disease due to their education and former experience (Savage & Kub, 2009). Nurses should offer accurate, comprehensive sexual education while building skills for negotiating sexual behaviour while giving precautions to prevent the spread of chlamydial infections. A study by established that many young people did not seek advice on sexually transmitted infection due to the issue of confidentiality. Thus, nurses should be trained on how to provide information to the high risk group adequately and effectively. The nurses should also be educated that early diagnosis of chlamydia has major health benefits. Nurses need to acquire the necessary skills to speak about sexual health concerns with their patients without feeling uneasy (McNutty, et al., 2004). In addition, the nurses should be trained on counselling patients to refer all sexual partners for medical evaluation and adhere to medication, and promote following of recommended treatment guidelines. Nurses must stress on the importance of compliance to antibiotic therapy to avoid drug resistance to this infection. Nurses can conduct screening to control chlamydial infection. Early detection and control of chlamydial infections would enable timely treatment. Chlamydial infection and related morbidity in sexually active women under 25 years could reduce with opportunistic testing and screening for genital chlamydia. Moreover, screening would be useful because many cases are asymptomatic and it is likely for the infection to go undetected. Factors influencing chlamydia infections Potential risk factors that may be associated with chlamydia infection in young women could be related to the disease outcome or a marker of certain sexual behaviour that affects a person directly. Anatomy structures, poor socio-economic conditions, unmarried status, large number of sexual partners and new sexual partners, nulliparity, non-use of barrier contraceptive methods and concurrent gonococcal infections are risk factors associated with cervical chlamydial infections (Malhotra, et al., 2013). High prevalence of chlamydial infection of women between 15 to 25 years is due to the differences in the anatomy of the cervix of younger women. The squamo-columnar junction is the basic target for C. trachomatis since it is more exposed. Changes in the vaginal flora and mucus production also supports the growth of C. trachomatis. Previous infections in the past may cause older women to gain immunity. There is an increasingly high number of adolescents engaging in premarital intercourse. Early onset of sexual intercourse is strongly associated with higher risk of infection. There is also a direct relationship between individuals who engage in sexual intercourse at a young age and a greater number of sexual partners. There is an increased likelihood of encountering a partner with chlamydial infection when having multiple partners. The high number of sexual partners can be attributed to the unmarried status. New partners is also a causal risk because there is reduced familiarity between the partners. In addition, young people may be unable to implement the correct form of condom use or seek information regarding sexual health. Use of barrier methods has been established to have a reduced risk of infection compared to other contraceptive methods (Navarro, et al., 2002). Social economic status has influence on the risk of chlamydial infections. Poor, uninsured patients are less likely to seek medical care compared to people from affluent areas. They are also less likely to have routine examinations and screening. Concurrent genital infections such as trichonomiasis and bacteria vaginosis increase the risk of having chlamydial infection. Patients should seek treatment for these genital infections to prevent chlamydia infections. Strategies to meet health promotion needs Effective prevention and promotion strategies need to be put in place to reduce the prevalence of chlamydia among young people. In regards to chlamydia, control and prevention strategies should include; accurate risk assessment and education of individuals in the high risk group, identification of asymptomatically infected persons with chlamydial infections, effective diagnosis, treatment, counselling and follow up of the infected people and evaluation, treatment and counselling of sex partners that have been infected with chlamydia (Workowski & Bolan, 2015). Moreover, diagnostic and therapeutic approaches to infected individuals. Proper interventions should consist of an education programme that will impart knowledge on the high risk age group on the importance of early diagnosis and use of condoms. Chlamydia screening has been limited due to difficulty in accessing the high risk populations. Control of chlamydia requires interventions that reduce the probability of transmission can be decreased by having fewer sexual partnerships and concurrent relationships. Screening can be opportunistic or systematic. The different screening methods are adopted for different health care settings and different screening approaches are selected to suit the particular health care setting. In prevention of sexually transmitted infections, structure and content of health service programs are vital. The programs should be sensitive and specific to individual needs of the young people to have significant impact. Nurses need to develop strategies that build self-esteem, healthy choices and self-advocacy particularly among persons aged 15 to 25. Social networking sites can be used as an intervention in promotion of sexual health especially in regard to chlamydia. Study by Gold, et al., (2011) indicate that these sites can also be used in delivery of campaigns and interventions. Use of well-established social networking sites has an added advantage because the target audience is already present. Since young people are at a risk of sexually transmitted infections, new technologies and internet will be beneficial in promoting health. Social media platforms greatly influence young people and help strengthen group norms around safe sexual behaviour. Walker, (2002) conducted a study to find out whether inviting the high risk group for health consultation and appropriate follow up care is an effective intervention. The study was done to determine whether the intervention would provide service that is useful, enabling health problems to be identified and addressed by use of appropriate information and healthy lifestyles to be encouraged. It was established that the group that attended made plans to improve on behaviour that related to their health. For the interventions to be effective, intervention mechanisms need to be well designed, long term and research based. The strategies need to be assessed for all potential benefits, harms and costs. Prevention and control of chlamydia requires surveillance as an evaluation for policies and new management strategies. Identification of the novel risks for C. trachomatis would inform the strategies for the control of C. trachomatis. Collection, analysis and interpretation of statistical information provides direction for planning and evaluating policy and programs (Shaw, et al., 2011). Impact of policies on sexual health and well-being of an individual Policies that are directed at reducing chlamydial infections should incorporate access and quality of health care services equipped to determine and manage people with the infection and those risk of infection especially for individuals in the high risk group. Sexual education policies implemented in schools have significant affirmative impact on sexual health of young people. Publicising policies on confidentiality provides an enabling environment for patients between 15 and 25 years to seek treatment. In enacting policies and legislature in organizations, nurses should contribute into the input of making them. Leadership and commitment from health care policy makers for effective resourcing and implementation of national chlamydia control strategies (Shaw, et al., 2011). Sexual health is also patterned by socioeconomic inequalities with people from deprived areas, women, young adults, and ethnic minorities. Policies should incorporate socioeconomic inequalities in sexual health service to ensure equitable service provision (Sheringham, et al., 2009). In addition, making policies may be complicated since they may fall on different groups. Policies of health in regard to chlamydia will aid reduce the number of infections. The policies will ensure increased access to testing and treatment of people at a risk of infection, notification and treatment of the partner and opportunistically or organized screening of a population. In general, policies will reduce the prevalence of chlamydia infections and the burden of disease (Shaw, et al., 2011). Policies improve on provision of care of chlamydia patients because the nurse follow appropriate guidelines for treatment. Implementation of policies should recognize gaps in assessment or risk, screening of Chlamydia, management practices of nurses, inadequacies in the available services and barriers in structure and attitude to routine screening. Theories and models in understanding experience and behaviour of individual population In health protection and promotion, understanding human behaviour plays the central role. Models of behaviour change are used by health care practitioners to guide development strategies and interventions to influence individual behaviours. A multifaceted approach is required in an effective program to help people adopt, change, and maintain positive sexual behaviour. Learning and conditioning, cognitive social learning, human belief model, theory of reasoned action, trans theoretical model, social action theory are strong conceptual models that guide development , implementation and evaluation of health related behaviour change interventions for chlamydial infections. Previous studies have established that young people living in areas with highly deprivation socially and economically are at a high risk of contracting chlamydia. The theory of planned behaviour established that attitude, subjective norm, perceived behavioural control, self-identity all significantly predicted testing for chlamydia testing intentions in high-risk groups. While targeting predictors of testing chlamydia, theory based intervention may improve on chlamydia testing uptake in a high risk group (Booth, et al., 2013). There is significant efficacy of interventions to establish health protective behaviours such as use of barrier contraceptive methods and reduce health risk behaviours such as having a high number of sexual partners. Since behaviour change are difficult to maintain, it poses a major challenge in sexual health (Institute of Medicine Committee on Health and Behaviour, 2001). Holistic and cultural needs of a chlamydia patient requiring health care intervention Nursing practice is based on a holistic approach and provides an ideal bridge between care for an individual and populations or communities. Holistic nursing involves caring for a person physically, psychologically and mentally. The interventions need to consider individual in the context of culture and the community. For instance, individuals from deprived areas have are greatly affected by sexual transmitted infections therefore nurses need to develop health care interventions that are appropriate for them. Efficacy of assessment and care planning to identify the concerns and the needs of high risk individuals to chlamydia may lead to early interventions, positive impact of diagnosis, improved communication and equity of care. For a chlamydia patient requiring a health care intervention, it is important that they are educated on the importance of self care and avoiding the risks that may make them susceptible to infection. Nurses should integrate self-responsibility, and reflection of the patient’s lives. Patients should be asked about their cultural beliefs and the nurses should find interventions based on them. Cultural competence is essential in delivery of patient centered care especially to people at a high risk of infection. Cultural differences have an influence on sexual behaviours of individuals from the high risk group of chlamydia. Nurses should pay special attention to needs of young people coming from minority cultural backgrounds. It is necessary for staff to have appropriate training on cultural needs so that the issues of these youth and their families can be addressed holistically. Holistic treatment is efficient, inexpensive, no side effects, lasting positive impacts and preventive dimension. In planning health care delivery knowledge of development of individuals between 25 years is critical. This group experiences dynamic change physically, psychologically, and socially. Conclusion Proper intervention methods to reduce chlamydial infections should be established especially for the risk group individuals from deprived areas. It is a challenge testing and implementing a screening program, therefore there is need for leadership and clear direction on testing chlamydia which is essential in control of chlamydia. As discussed, the quality of sexual transmitted infection care for individuals in high risk group can be improved on by targeted provider education, interventions that increase compensation for prevention, testing and treatment services. The control of chlamydia is significant because it will reduce the rates of pelvic inflammatory disease, poor reproductive outcomes, and sub fertility. Moreover, the will be a reduced impact of the burden of disease that has been associated with chlamydia infection such as expensive costs that may arise due to tubal surgery and in vitro fertilization. Control will be through primary prevention of high risk group, promotion of condom use, effective diagnosis and treatment of infected persons and identifying and treatment of partners of the infected persons. Further studies are needed to find out the vaccine for chlamydia. Additionally, researchers need to investigate more on the developing antibiotic resistance of C. trachomatis. Some researchers have suggested that resistance may arise from the interference of early intervention with antibiotics on the body’s development of protective immune responses. Approaches to control infection of genital chlamydia in such instances needs to be explored. Research also needs to focus on management of chlamydia particularly in men because most research dwells on women. Host immunology, bacterial antigens, duration and role of pathogen role during and after infection with chlamydia should also be the focus of research (Taylor & Haggerty, 2011). Bibliography Booth, A. R. et al., 2013. Pilot study of a brief intervention based on the theory of planned behaviour and self-identity to increase chlamydia testing among young people living in deprived areas. 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