Case Study for Classroom: Emergency Contraception and IPV at College Health Clinic 1

QSEN competencies of primary emphasis in the case study:

Patient-centered care
Evidence-based practice
Informatics

Case study may also generate discussion pertinent to QSEN competencies for Teamwork and Collaboration, Quality Improvement, and Safety.

NCLEX Categories of Client Needs

Physiological Integrity
Health Promotion and Maintenance
Psychosocial Integrity
Safe and Effective Care Environment

Concept-Based Learning

Case Study for Classroom: Emergency Contraception and IPV at College Health Clinic 1

Health and Illness
Comfort
Infection
Self
Sexuality
Stress and Coping
Tissue Integrity
Violence
Professional Nursing
Advocacy
Caring
Communication
Evidence-based practice
Informatics
Quality

Case Study for Classroom: Emergency Contraception and IPV at College Health Clinic 1

Strategy Overview

This unfolding case study was developed as a group learning activity to replace the lecture on contraception in a Nursing Care of the Childbearing Family course. Students are expected to prepare for class by reading the contraception content in the assigned textbook prior to class. Previous courses in the program addressed sexually transmitted infections, and Behavioral Health. As the case study progresses students identify the current standard of care, develop nursing diagnoses, plan interventions, and locate resources online.

Suggestions for use of the case study as a classroom group activity:

Students should be prepared to use their smartphone, tablet, and/or laptop to research answers to prompts on the internet and through school library throughout the case study.
Faculty should assign 3 or 4 students to each group integrating students from multiple clinical sections into each group to facilitate ready collaboration across students’ existing social and study relationships.
It will be helpful if students have been informed about Healthy People 2020 objectives, clinical guidelines, and the role of the Agency for Healthcare Research and Quality (AHRQ) prior to the case study.
Before printing or copying the case study, cut and paste a “headshot” of a worried, college-age female into the photo square. Attribute photographer as appropriate.
Students should work on the case study for approximately an hourwith faculty supervising and rounding in the classroom for questions. Faculty should anticipate debriefing the case study for an additional half hour. A debriefing technique could be proceeding line by line through the case study with a general classroom discussion throughout.

Palisades River University Health Clinic

Role: Nurse (RN) at college health clinic

Ashley Brown

Nursing Assessment

Prompts for Discussion:

Does Ashley know if Colin is STI negative? Did Ashley consider the potential of acquiring an STI from the “great-looking, funny guy” she’s become involved with? Was she considering STIs as a possibility when she came to clinic?

Weight? Is “not eating in the morning” typical for Ashley? Typical of college students? Is Ashley’s weight a significant issue at current visit or an opportunity for teaching or follow-up?

Probable Health Care Provider treatment plan:

Emergency Contraception; Counseling for contraception choices and warning signs; Counseling re unprotected sex, testing/monitoring for STIs; abusive relationships; depression (PTSD)

Anticipated Health Care Provider requests:

GYN exam tray;female RN presence in room during GYN exam; medication administration; witness for IUD consent

Prompts for Discussion:

What if Ashley asks the HCP “Can you test me now for all those STIs?” What’s the answer? What alternative does Ashley have instead of waiting to test for HIV? Could she/would she ask Colin to get tested?

Discuss the possible licensure and scope of practice of various health care providers who may be employed at the college clinic. Compare and contrast roles, responsibilities, accountabilities in the care of Ashley.

What is Ashley’s potential for post-traumatic stress or depression as a result of being informed of potential long-term health consequences as a result of her choices the previous evening? Is she at risk of self-harm? What kind of counseling might be available through the college? How can the nurse ensure follow-up? Are there safety considerations and if so, when might they develop?

Does the consent to treat which Ashley signed when she arrived at the PRU Health Clinic cover all procedures? What is the nurse’s role regarding informed consent for the insertion of an IUD?

Which Healthy People 2020 objectives apply to developing a plan of care for Ashley at this visit?

Suggested:

FP 8 Reduce pregnancies among adolescent females

FP 10 Increase the proportion of sexually active persons age 15-19 years who use condoms to both effectively prevent pregnancy and provide barrier protection against disease

HC/HIT-1Improve the health literacy of the population

HIV-2 Reduce the number of new HIV infections among adolescents and adults

HIV-14Increase the proportion of adolescents and adults who have been tested for HIV in the past 12 months

HIV-17 Increase the proportion of sexually active persons who use condoms

IPV-39 Reduce violence by current or former intimate partners

MHMD-11Increase depression screening by primary care providers

SA-14.3Reduce proportion of persons engaging in binge drinking during the past 30 days—adults aged 18 years & older

STD-1Reduce the proportion of adolescents and young adults withChlamydia trachomatisinfections

STD-6 Reduce gonorrhea rates

Search for the evidence to base nursing practice. Is there a clinical guideline that supports the HCP probable treatment plan?

Suggested:

Society of Obstetricians and Gynecologists of Canada (revised 2012) Emergency Contraception

New York State Department of Health (revised 2010) HIV prophylaxis following non-occupational exposure including sexual assault

Search library database and locate two peer-reviewed journal articles which support or compliment the treatment plan or nursing interventions.

Suggested:

Bosworth, M. C., Olusola, P. L., & Low, S. B. (2014). An update on emergency contraception. American Family Physician, 89(7), 545-50.

Oldenburg, C., Barnighausen, T., Harling, G., Mimiaga, M., & Mayer, K. (2014). Adherence to post-exposure prophylaxis for non-forcible sexual exposure to HIV: a systematic review and meta-analysis. AIDS & Behavior, 18(2), 217-25

Locate online resources to facilitate Ashley’s understanding of the treatment plan.

Suggested:

The emergency contraceptive that keeps going… and going… Which emergency contraceptive method is most like the Energizer bunny? Bedsider Insider Blog by Sara Kennedy MD

How does an IUD work? mDhil Health episode 19

Mayo Clinic. Paragard Copper IUD.

Sexually Transmitted Diseases. CDC website:

Warning Signs of an Abused Person

Nursing Diagnoses and Interventions

Prompts for Discussion:

Has a nursing diagnosis and interventions directed at educating Ashley about the benefits of other contraceptive choices going forward been included in the teaching plan?

Investigate the One Love MyPlan app on the One Love Foundation website. Will the app facilitate Ashley’s knowledge about her relationship with Colin? If the nurse discusses the app with Shelby also, is that a HIPAA violation? What should the nurse say/do to introduce Ashley and Shelby to the One Love MyPlan app?

Prompts for Discussion:

Who was Yeardley Love and what happened to her?

Health Care Provider Orders

Prompts for Discussion:

Why were the diagnostic tests Urine HCG and cervical swabs for Gonorrhea and Chlamydia ordered? Will the results identify whether Ashley was exposed to these STIs from Colin?

Health Care Provider Notes

Prompts for Discussion:

Reasons for the time lapse: waiting for effectiveness of ibuprofen pre-procedure; possibly waiting for patient to reflect on her decision.

Discharge Teaching:

Prompts for Discussion:

Does effective discharge teaching demonstrate progress in meeting the Healthy People 2020 HC/HIT objective of improving health literacy?

Reflection/Evaluation:

Students should be directed to identify and discuss QSEN and NCLEX competencies achieved throughout the case study.

Requesting students’ evaluation of group dynamics and group member contribution and productivitymay facilitate those attributes in future group learning activities.