Advanced Practice in Community Health Nursing - Essay Example

?Running head: ADVANCED PRACTICE IN COMMUNITY HEALTH NURSING Advanced Practice in Community Health Nursing (school) Advanced Practice in Community Health Nursing Introduction Various health programs are being implemented in the community level and these programs are meant to address major health issues that have a significant impact on the community. The application of advanced practice in community health nursing provides a strong basis for the establishment of programs to address major health issues. This paper shall analyze the human papilloma virus (HPV) vaccination program being implemented in Singapore in response to the increase of cervical cancer cases. The proposed response to the selected health issue shall then be considered. Finally a proposed action plan to establish the current response to the selected issue close to the ideal best practice response shall be presented. Body Cervical cancer is considered the seventh most popular form of cancer among women in Singapore (National Registry of Diseases, 2008). All of these cases of cervical cancer have been attributed to the Human Papilloma Virus; this virus has also been associated with the development of tumour growths in the vulva, vagina, anus, and the penis. It has also been associated to genital warts (Obstetrical & Gynaecological Society of Singapore, 2011). There are two types of HPV vaccines being used in Singapore, namely, the Gardasil and the Cervarix. Gardasil is used for females aged 9 to 26 years and Cervarix is used for females aged 10 to 25 years (Obstetrical & Gynaecological Society of Singapore, 2011). With these numbers, the importance of setting up a health program to reduce these cases has been considered vital for the global community, and certainly for Singapore. Human Papilloma Virus Vaccination in Singapore Merck was the first who was able to gain approval from the US Food and Drug Administration in the distribution of Gardasil, its first HPV vaccine (Parry, 2007). Since then, it has been approved in other countries and is being distributed worldwide. GlaxoSmith followed Merck’s success by finally gaining approval for its HPV vaccine known as Cervarix. In the meantime, the World Health Organization has been active in its information dissemination about this vaccine and in establishing guidelines for the distribution and use of this vaccine. It has been tested in various parts of the globe, and so far, consistent results have been seen (Parry, 2007). The WHO has also provided all countries seeking to utilize this vaccine with the guidance and technical notes in introducing these vaccines. The WHO acknowledges the importance of educating the governments and health professionals about the vaccine and the virus itself, its risks, and the possible preventive measures which they can apply in order to reduce its impact (Parry, 2007). The benefits of this vaccine have been apparent in relation to HPV 16/18 related pre-cancer lesions; their long-term benefits however have yet to be established. Nevertheless, both vaccines have proven to be generally safe and tolerated without any serious negative events observed (Obstetrical & Gynaecological Society of Singapore, 2011). Minor side-effects observed include pain, swelling, redness at the site of injection. In injections, these are common side-effects which are usually expected and pose no alarming risks and implications. In Singapore, the Ministry of Health is recommending HPV vaccination among females aged 9 and 26 years (Obstetrical & Gynaecological Society of Singapore, 2011). Ideally, it must be given to females who have never had sexual intercourse because it is a vaccine which does not provide protection against already existing HPV infections (Obstetrical & Gynaecological Society of Singapore, 2011). Sexually active women can also be vaccinated, but they must first undergo Papanicolaou Smear tests in order to rule out the presence of the virus or any other neoplastic growths. The efficacy of the HPV vaccine is also expected to be lower among sexually active women because of their possible existing exposure to the HPV virus (Obstetrical & Gynaecological Society of Singapore, 2011). Issues have been observed in the implementation of the widespread coverage for this vaccination, mostly issues which relate to inadequate knowledge on the part of potential recipients of the vaccine (Farzaneh, et.al., 2011). The lack of knowledge about the vaccine has been seen as a stumbling block in efforts towards increasing the vaccine program’s coverage. Health professionals note that many females did not know about their possible risks of getting cervical cancer or the HPV (Farzaneh, et.al., 2011). These females are also not aware that a vaccine is available to safeguard their health. This lack of knowledge means that these women do not and actively seek the use of the vaccine to protect their health. Another problem is that Singapore ministers believe that promoting cervical cancer vaccination among teenagers sends the message to the teenagers that sexual intercourse is condoned by the community (Reuters, 2009). Once again, this implies a failure of knowledge about cervical cancer and the HPV vaccination among the teenagers and also among the officials involved. Moreover, there is an ethical consideration which must be evaluated in the local context where the ethical beliefs revolve around the fact that vaccination programs against cervical cancer seems to acknowledge that teenagers are already engaging in sexual intercourse. Without the proper information, these teenagers may be encouraged to consider sexual intercourse after they are vaccinated against the virus. With these considerations, the HPV vaccination program in Singapore needs to undergo some adjustments. Proposed response to improve the program In order to improve the implementation of the HPV program in Singapore, it is important to consider the processes employed by different countries. In Scotland, the Scottish Child Health Surveillance Programme – Schools (CHSP-S) is the primary health information system. It is a system which is meant to ensure that all school-age children and adolescents gain the appropriate data regarding the disease against which they would be vaccinated as well as the vaccine which would be administered to them (Whittle, 2008). This system contains data about HPV through the Scottish Child Health Surveillance Programme Information System and with the support of the National Health Services Boards, they also seek to promote effective information systems. With these processes, the schools are ensuring that proper data is disseminated to the concerned parties. The vaccine procurement is also carried out through the Department of Health and such procurement is carried out through government transactions with the manufacturer, with major efforts made towards obtaining a national campaign for availing the vaccine (Whittle, 2008). In Australia the government provides subsidies in order to ensure that the vaccines are properly distributed to the people. The government subsidises the use of Gardasil for use in schools for target groups, and in catch-up groups in the community (Department of Health and Ageing, 2006). The Pharmaceutical Benefits Advisory Committee (PBAC) has reviewed all vaccines, including the HPV vaccines available in the market and has established their efficacy. This committee also gains support from the Australian Technical Advisory Group on Immunisation whenever a vaccine is considered. A school-based implementation of this program has been implemented in Australia and it was able to gain the support of the Commonwealth, as well as the state, territorial governments, and vaccine suppliers (Department of Health and Ageing, 2006). Australia’s HPV vaccination program was also set-up with three complete doses within a seven-month period. This made the compliance and monitoring of the program easier. The purchase by the Commonwealth Government of the vaccines made the vaccines easily available to the students regardless of their economic and social standing. Within the community setting, girls past the school age were coordinated with their general practitioners and local health leaders (Department of Health and Ageing, 2006). Pap smears for females 18 to 69 years old, vaccinated or unvaccinated, and those who were sexually active were also prescribed with the assistance of community health leaders. In the United Kingdom, the British National Health Service included HPV vaccines in the various routine vaccinations carried out for girls 12 to 13 years of age with a two-year catch up campaign to be implemented for girls up to 18 years of age (International AIDS Vaccine Initiative, 2007). The government was able to estimate a significant cost in the implementation of this program, depending on the price of the procurement process carried out with the manufacturers. Despite these financial concerns, the government was able to establish flexible and affordable prices for the vaccines with the manufacturers. This program has been set-up within the school system and has been conceptualized as a continuous system for the female students (IAVI, 2007). It has been established in order to cover as many females as possible, and as many unattached and sexually inexperienced females as possible. The educational process which is part of the vaccination program is also meant to educate the students on the dangers of HPV, and the importance of the vaccination they are participating in. A better understanding of the program is meant to ensure improved compliance with future Pap smear tests. Proposed action plan In order to improve the implementation of the HPV vaccination plan for Singapore, a more extensive application of the program is needed. In order to achieve this, the program must first be integrated into the school system (Stretch, et.al., 2008). Coordination with the Department of Education is therefore needed. Allocations for the government subsidization of the vaccines shall have to be made by the Singapore government, especially to subsidize vaccines for those who would not be able to afford it. These allocations ensure adequate financial support for the program (The China Post, 2007). Discussions between the Department of Education and the Department of Health shall then be considered with the end goal of reviewing the World Health Organization guidelines on the implementation of the HPV vaccination program. Guidelines on the age of students to be included in the program as well as other inclusive qualities shall be reviewed and discussed by the concerned agencies (World Health Organization, 2005). Issues on informed consent shall also have to be addressed. The parents of the female students shall have to be considered during the planning stages of the programme (Women’s Health, n.d). Widespread information dissemination shall be carried out with the teachers and the students. The dangers of cervical cancer and sexually transmitted diseases shall be discussed with the students (World Health Organization, n.d). The preventive measures, including the HPV vaccination program shall also be discussed with the students. Age range for the students included in the discussion and the vaccinations shall be from 9-18 years. A permission slip indicating all pertinent details of the vaccination shall be given to the parents. Female children aged 9-18 who are not sexually active shall be included in the program. Without permission from their parents, these children shall not be included in the vaccination program. Children who cannot afford the fee for the vaccine shall still be included under government subsidy. Parents refusing vaccination for their children shall not be pressured by the school. Nevertheless, they shall be invited to attend educational information campaigns about HPV, cervical cancer, and the vaccination program. Within the community setting, the health authorities shall also target females aged 18 to 26 who are not sexually active (Stretch, 2008). The program in Scotland expanded the educational program on HPV to the community leaders, coordinating the coverage for schools beyond the school age years that are no longer covered under the HPV vaccination school program. Applying this to the community level in Singapore can potentially prove to be effective because it covers the female at-risk patients who are no longer covered by the school program for the vaccination (Centers for Disease Control and Prevention, 2011). The program can also expand the educational campaign for females because it would continue to remind them to get regular Pap smears, to practice safe sex, and to be aware of the warning signs for cancers (Cervical Cancer Actions, n.d). Conclusion The HPV vaccination program in Singapore has been implemented for several years now. It has managed to cover a significant population, but has not been extensive enough to reach favourable outcomes within the female population of Singapore. Other countries like the United Kingdom and Australia have gained much progress in HPV vaccination by integrating their program to the school system, targeting females aged 9-16 years. These methods can also be applied to Singapore. Firstly, government funding for the acquisition of the vaccines must be provided. Secondly, the coordination of the Department of Health and the Department of Education shall have to be established. Thirdly, the informed consent of parents needs to be gained. Lastly, all other females covered by the program needs to be included in the community setting for the implementation of the vaccination program. References Centers for Disease Control and Prevention. (2011). Genital HPV Infection - Fact Sheet. Retrieved 23 February 2012 from http://www.cdc.gov/std/hpv/stdfact-hpv.htm Cervical Cancer Action. (n.d). Strategies for HPV Vaccination in the Developing World. Retrieved 23 February 2012 from http://www.rho.org/files/CCA_HPV_vaccination_strategies.pdf China Post (2007). Gov’t urged to subsidize HPV vaccination: private foundation. Retrieved 23 February 2012 from http://www.chinapost.com.tw/taiwan/2007/10/21/127516/Gov%27t-urged.htm Department of Health and Ageing (2006). Australian Government Funding Of Gardasil. Government of Australia. Retrieved 23 February 2012 from http://www.health.gov.au/internet/main/publishing.nsf/Content/gardasil_hpv.htm Farzaneh, F., Shirvani, H., Barouti, E., Salehpour, S. Khodakarami, N., & Alizadeh, K. (2011). Knowledge and Attitude of Women Regarding the Human Papillomavirus (HPV) Infection, Its Relationship to Cervical Cancer and Prevention Methods. Med J Malaysia 66(5), 468-473. International AIDS Vaccine Initiative (2007). HPV Vaccine Adoption in Developing Countries: Cost and Financing Issues. Retrieved 23 February 2012 from http://www.rho.org/files/IAVI_PATH_HPV_financing.pdf National Registry of Diseases. (2008). Singapore Cancer Registry Interim Report. Trends in Cancer Incidence in Singapore 2004-2008. Retrieved 23 February 2012 from http://www.nrdo.gov.sg/uploadedFiles/NRDO/Publications/Cancer_Trends_Report0408_web_v2.pdf Obstetrical & Gynaecological Society of Singapore (2011). Professional O & G guidelines on HPV Vaccination in Singapore. Retrieved 23 February 2012 from http://www.sccps.org/Professional%20O&G%20Guidelines%20on%20HPV%20Vaccination%20in%20Singapore.pdf Parry, J. (2007). Vaccinating against cervical cancer. World Health Organization. Retrieved 23 February 2012 from http://www.who.int/bulletin/volumes/85/2/07-020207/en/index.html Reuters (2009). Singapore questions cervical cancer vaccine for teens. Retrieved 23 February 2012 from http://www.reuters.com/article/2009/04/03/idUSSIN407899 Stretch, R. et al (2008). Parental attitudes and information needs in an adolescent HPV vaccination programme. British Journal of Cancer Stretch, R., Chambers, G., Whittaker, J., Critchley, T., Jackson, F., Montgomery, M., & Roberts, S. (2008). Implementing a school-based HPV vaccination programme. Nursing Times. Retrieved 23 February 2012 from http://www.nursingtimes.net/implementing-a-school-based-hpv-vaccination-programme/1938038.article Women’s Health (n.d). Informed choice and mass immunization programmes. Retrieved 23 February 2012 from http://www.womens-health.org.nz/uploads/pdf/Informed%20choice%20and%20mass%20immunisation%20programmes.pdf World Health Organization. (2005). Report of the Consultation on Human Papillomavirus Vaccines. Retrieved 23 February 2012 from http://www.who.int/vaccine_research/documents/816%20%20HPV%20meeting.pdf World Health Organization. (n.d). Summary of Bill & Melinda Gates Foundation-supported HPV Vaccine Partner Activities. Retrieved 23 February 2012 from http://www.who.int/immunization/sage/HPV_partner_info_gates.pdf Read More