2016-2017 DNP Cohort

1. Improve Screening to diagnose vitamin D deficiency in a rural Kansas clinic
2. Improve the quality of life and self-efficacy in ostomy patients by implementing a support group in a rural Kansas community
3. Increase vaccine uptake of pneumococcal vaccine for patients 65 and older
4. Implementation of sepsis guidelines in a rural emergency room

1. Retrospective Chart Review to Assess a Walk-In STI Clinic in a University Health Center
2. Community Collaborative to Increase STI Testing and Access
3. Revision of the EMR to Improve Efficiency in Patient Scheduling

Purpose: La Crosse County Wisconsin reported a 33.6% increase in chlamydia (n=524), a 45% increase in gonorrhea (n=35), and a 25% increase in syphilis (n=5) between 2013 and 2016. The local health department completed an analysis of the data and found that the largest concentration of infections were isolated to an area close to both schools of higher education in La Crosse. The goal was to identify areas where educational programming could be developed and implemented through a community collaboration to address the health concern. Through a community grant, the health department funded a survey that was conducted at the local university, which provides health care to both schools of higher education, and at a local community reproductive clinic

Method: Community stakeholders were identified which included a registered nurse from the health department, the staff at the University of Wisconsin-La Crosse Student Health Center, a representative from a community based reproductive health clinic, and project managers at University of Wisconsin Survey Center to provide project support and statistical analysis. A web-based open survey using a convenience sample of 18 to 24 year-olds was conducted to assess the self-efficacy and protective sexual behaviors of patients that sought care through the campus health center.

Results: Eight-hundred and thirty-three respondents began the survey, 779 completed the majority of questions. Of the 603 patients surveyed at the campus clinic and found that females showed greater self-efficacy in their ability to discussion STI prevention and in showing protective behaviors except in relationship to “walking into a store and purchasing condoms.” Only 41.9% of females reported being extremely confident in their ability to walk into a store and purchase condoms versus 63.1% of males.

Limitations: The major limitations of the study were that over 95% of respondents were Caucasian and less than 22 years of age (N=520).

Conclusions: Although females showed greater self-efficacy, the number of respondents that reported they were extremely confident in their protective sexual behaviors were consistently less than 50 percent. Based on this information, the team has determined that education needs to focus on overall improvement in starting the dialogue regarding STI prevention, condom use, and refusal of intercourse with a focus on the youngest cohort of 18 to 19 year olds, both male and female. When seeing patients, providers and nurses should also be opportunistic at all office visits and offer women condoms frequently and utilize motivational interviewing techniques to improve their self-efficacy regarding purchasing condoms.

Submitted to the Wisconsin Public Health Nurses Association Conference August, 2017