Well Women Visits at Any Age

Well Women Visits at Any Age

Well Women Visits at Any Age

Thinking creatively about access to women’s health care has always been part of the job for Tracie Kirkland, clinical assistant professor in the Department of Nursing at the USC Suzanne Dworak-Peck School of Social Work.

Kirkland, a former program coordinator for Johns Hopkins Pepsi Beverages Wellness Center in Mesquite, Texas set up a mobile breast screening unit at the Pepsi plant so women could take advantage of mammography screenings without having to take time off work.

“Seeking windows of opportunity to access health care may not always be in a traditional setting,” Kirkland said.

Accessing routine care may be harder for some women than others, depending on individual circumstances and institutional barriers. Scheduling and attending routine health care visits can help women care for all aspects of their physical and mental health as they age.

According to a 2018 survey by the Kaiser Family Foundation, almost half of millennials don’t have a primary care provider. Finding new ways to meet patients where they are is critical to maintaining women’s health, regardless of age.

“We plan for retirement, but how do we plan to take care of our bodies? Our health is our wealth,” Kirkland said.

What Keeps Women from Seeking Health Care?

Social determinants are environmental factors that affect how people work, live and age throughout the life span. These determinants can also be barriers to accessing care and keep women from finding a primary care provider.

Social determinants that affect women’s abilities to access health care:

Insurance coverage: Women without health care insurance will experience higher out-of-pocket payments to access and receive medical care. About 11 percent of women in the United States are uninsured, compared to 9 percent of all Americans.

Income: Women and girls in families with low income may be unable to afford copays or other fees required to see a provider. In 2017, 11 percent of women lived below the federal poverty line, compared to 8 percent of men.

Geography: People living in areas far from health providers may find it difficult to travel several hours for an appointment. In a 2017 report on social determinants, researchers found that geography contributed to differences in mortality and morbidity related to smoking, obesity, air pollution and several chronic illnesses.

Family obligations: Women who are parents of young children or caregivers for other family members may have to arrange for child care or other forms of assistance in order to make time for health visits. Data from a 2018 caregiving report from Pew Research Center indicates that women spend more time providing child care than men.

Work obligations: Taking leave from work can be a challenge for women who don’t have paid time off. The 2018 Current Population Survey from the Department of Labor shows that 57 percent of women and 71 percent of mothers are in the labor force.

Transportation: In rural communities, women without a car or public transit options may be unable to access a provider. In urban areas, residents might not find care within walking distance or be able to afford costly public transit fares.

Education: An individual’s education can affect their language proficiency, as well as their ability to understand complex medical information. Low educational attainment has been linked to higher rates of morbidity for cardiovascular disease and cervical cancer.

Health literacy: The ability to access, understand and apply health information to daily life can be a challenge for women who may be vulnerable to false information and advertising or may have limited experience with a health care provider. Only 12 percent of American adults have a proficient health literacy.

Where to Find Women’s Health Care Resources

Even after women attend a health care appointment, social determinants can keep them from being able to understand and apply health information to their lifestyles. That includes knowing how to reach a provider for a follow-up conversation or how to fill a prescription at the nearest pharmacy. Providers like nurse practitioners can make use of one-on-one time to guide patients through next steps and counsel them on how to make appointments for other visits or needs.

“Know where to seek out services that may be free of charge, like the public health department or Planned Parenthood, where you can utilize a sliding scale in order to receive services,” Kirkland said. Sliding scale services use a variable cost to determine a fee based on how much the patient can afford to pay.

Providers can also look for innovative ways to reach patients for follow-ups or spread awareness about health information.

“We need to really be savvy in the way that we’re utilizing social media to disseminate information versus our traditional face-to-face visits,” Kirkland said.

Social media can help providers reach captive audiences by promoting health information during specific health awareness months. Patients can also use social media to find locations in their community to access health care and information:

  • Places of employment
  • Sorority organizations
  • Places of worship
  • Faith-based employers
  • Local and state departments of health
  • Local school district
  • Publicly funded clinics
  • Mobile units
  • Planned Parenthood and women’s health clinics

When using any of these venues to access care, it’s important that patients find a way to follow up with a provider or keep in contact.

“Once we create a connection through rapport, we generally are able to keep bringing [patients] back on a regular basis,” Kirkland said. “Depending on what we find in the clinical examination.”

Recommended Health Screenings for Well-Woman Visits

Even when feeling healthy, women have a lot to gain from routine checkups, including screenings for future medical changes, family planning, vaccinations and healthy lifestyle maintenance.

“Do you wait until your car breaks down to have it serviced, or do you maintain it by changing your oil and your tires?” Kirkland said. “Do you wait until your body breaks down, or do you maintain it?”

A well-woman exam is an annual appointment for women throughout the life span. As women age, their health needs evolve, so the visit may include different types of exams or interviews between a patient and provider.

Similar to an annual physical for children, a well-woman visit includes assessments of physical and mental health but also includes conversations about reproductive and sexual health.

An initial visit, often done when women are seeing their provider for a physical for the first time, may just be a one-on-one to discuss what would actually take place in a well-woman visit, Kirkland explained.

Depending on age and health needs, a well-woman exam can look different for each patient.

What to Expect at a Well-Woman Visit

Teens (Ages 13-18)

       ASSESSMENTS
  • Blood pressure
  • Heart rate
  • Height
  • Weight
IMMUNIZATIONS
  • Hepatitis B
  • Tetanus, diphtheria and pertussis (Tdap)
  • Human papillomavirus (HPV)
  • Influenza (annually)
  • Chickenpox
  • Meningococcal (A, B, C, W, Y)
HEALTH SCREENINGS AND EXAMS
  • Physical
  • Vision
  • Hearing
  • Sexually transmitted infections (STIs)
CONSULTATION
  • Drug and alcohol consumption
  • Vaping and tobacco use
  • Driving and seatbelt safety
  • Menstrual cycle
  • Gender identity
  • Sexual identity and activity
  • Mental health
  • Body image
  • Exercise and nutrition
  • International travel
ASSESSMENTS
  • Blood pressure
  • Cholesterol
  • Heart rate
  • Height
  • Weight
IMMUNIZATIONS
  • HPV
  • Influenza
  • Tetanus
HEALTH SCREENINGS AND EXAMS
  • Cervical cancer
  • Pelvic exam
  • Pap smear
  • STIs
  • Breast exam/mammogram
  • Vision
  • Pre-diabetes
CONSULTATION
  • Family planning and contraception
  • Pre- and post-natal care
  • Drug and alcohol consumption
  • Vaping and tobacco use
  • Menstrual cycle
  • Gender identity
  • Sexual identity and activity
  • Mental health
  • Body image
  • Exercise and nutrition
  • International travel
ASSESSMENTS
  • Blood pressure
  • Cholesterol
  • Heart rate
  • Weight
IMMUNIZATIONS
  • Influenza
  • Tetanus
HEALTH SCREENINGS AND EXAMS
  • Cervical cancer
  • Pelvic exam
  • Pap smear
  • Breast exam/mammogram
  • Vision
  • Hearing
  • Diabetes
  • Colorectal cancer

 

CONSULTATION
  • Drug and alcohol consumption
  • Vaping and tobacco use
  • Menstrual cycle
  • Gender identity
  • Sexual identity and activity
  • Mental health
  • Body image
  • Exercise and nutrition
  • Dietary supplement intake
  • Cardiovascular health
  • International travel
  • Hearing/vision loss
  • Family relationships
  • Occupational hazards
ASSESSMENTS
  • Blood pressure
  • Cholesterol
  • Heart rate
  • Weight
IMMUNIZATIONS
  • Influenza
  • Tetanus
  • Measles, mumps, rubella
  • Varicella
  • Zoster (shingles)
  • HPV
  • Hepatitis (A and B)
  • Meningococcal (A, B, C, W, Y)
  • Pneumococcal (conjugate and polysaccharide)
HEALTH SCREENINGS AND EXAMS
  • Cervical cancer
  • STIs
  • Diabetes
  • Osteoporosis
  • Lung cancer
  • Breast exam/mammogram
  • Colorectal cancer
  • Vision
CONSULTATION
  • Drug and alcohol consumption
  • Vaping and tobacco use
  • Menstruation/menopause
  • Mental health
  • Body image
  • Exercise and nutrition
  • Dietary supplement intake
  • Cardiovascular health
  • International travel
  • Hearing/vision loss
  • Family relationships
  • Stroke Prevention
  • Sun exposure
  • Incontinence

When Should Women Seek Reproductive and Sexual Health Care?

Women don’t have to be planning a family to need reproductive health screenings and care. They should start seeking care at the age of menarche — which is when they begin having menstrual cycles — or when they start having sexual partners. “It depends individually on their desire to be intimate, and where they are in terms of maturation,” Kirkland said.

Reproductive and sexual health care are not synonymous. People of any age, gender or sexual identity can engage in sexual activity without a desire to reproduce. Birth control pills may be used for a variety of reasons unrelated to family planning. Therefore, it’s important for patients and providers to candidly discuss sexual health and reproductive plans.

Reproductive and Sexual Health Screenings:

STI and HIV testing: This screening can be a physical exam or a consultation from a provider to discuss sexual activity and test for sexually transmitted infections. The best time to get tested is before being active with a new sexual partner, and it can be done as often as a patient desires.

Breast exam: This is a physical exam that is done routinely on patients even if they have no other signs of developing breast cancer. Any abnormalities can be further tested with a mammogram, which is an X-ray screening for tumors that can’t be felt with a breast exam.

Pelvic exam: This is a physical examination of reproductive organs and is used to screen for ovarian cancer or other abnormalities that can develop as women age. The provider will inform the patient if they need to return for additional testing.

Menstrual health: A provider will ask about the regularity of a patient’s menstrual cycle, contraceptive use and any abnormalities with pain, bleeding or mood.

Pap smear: This is a physical exam during which a provider collects cells from the cervix to test for cervical cancer. This exam can also help find cells caused by HPV and is recommended every few years for women between the ages of 21 and 65.

Literacy about sexual health can be pivotal to women’s ability to control and plan for their future. Being able to afford contraception is one thing, but maintaining a treatment plan can be an issue — particularly when there is a lack of understanding about different types of contraception, their efficacy and how to use them. The more that providers can empower patients about seeking and understanding health information, the more meaningfully women can be engaged in their decision-making and health care.

Additional Resources for Women’s Health Care

 

 

 

Legal Disclaimer: Please note that this article is for informational purposes only. Individuals should consult their health care professionals before following any of the information provided.

 

Posted courtesy of [email protected], the online FNP program from the University of Southern California

What to Expect as a Correctional Care Nurse

What to Expect as a Correctional Care Nurse

Part Two of a Three-Part Series

With more than 2.1 million adults incarcerated in America’s prisons and jails, (PDF, 543 KB), there is a great need for correctional care providers to support this underserved population. Many people taken into custody are experiencing serious and preexisting health issues, while others will need medical attention to address illness and injury that occurs during incarceration.

The demand for health care professionals, especially nurses, is high and expected to grow. According to the Bureau of Labor Statistics, employment of registered nurses is expected to increase 15 percent between 2016 and 2026, while employment of nurse practitioners is set to increase 36 percent. Correctional care is no exception to this trend.

Health care is a field that requires compassion — but this is especially true for those working in correctional care. It requires the ability to see beyond someone’s criminal record and provide the best possible support for every patient, many of whom did not have access to health care prior to being brought into custody.

Understanding the Correctional System Population

Working in a correctional setting means working with a vulnerable and underserved population. A 2016 report from the Bureau of Justice Statistics on the health issues in American prisons and jails (PDF, 910 KB) found that incarcerated individuals were more likely than the general population to experience chronic conditions and infectious disease. Of those surveyed, 40 percent reported having a current chronic medical condition, while 21 percent of individuals in prison and 14 percent of individuals in jail reported a history of tuberculosis, hepatitis B or C, or other STDs (excluding HIV or AIDS). 

The prominence of health issues in correctional facilities is compounded by the fact that many incarcerated people do not have consistent access to treatment, meaning they arrive with undiagnosed conditions.

“We see our patients at their worst,” said Richard Hammel, the nursing program manager for the Denver Sheriff Department.

When an individual arrives for the intake process, Hammel and his colleagues are tasked with performing an initial medical exam. He said that many of his patients find out for the first time that they have an existing condition like hypertension or that they have contracted an infectious disease. Others may show signs of substance abuse, in which case they are taken through a detox process. Many incarcerated patients also show symptoms of mental illness, (PDF, 454 KB) which necessitates further care from clinicians.

What Is the Role of a Correctional Nurse?

Nurses are critical in the continuum of care for people who are incarcerated. While procedures can vary from facility to facility, nurses are typically the first point of contact. Correctional nurses perform intake exams, distribute daily medications and assess when a patient may need to see a specialist for further observation.

Given the responsibilities of a correctional nurse, paired with the range of health issues they encounter, it’s important to have a broad skill set that includes dealing with chronic medical conditions, substance abuse, mental health, infectious disease and injuries. Having experience in an emergency room setting, for example, may help a nurse more easily transition to working in a correctional setting.

Correctional nurses are also expected to work autonomously in most cases, which can be a desirable aspect of the job to many in the nursing profession.

As for specialized training, there is no universal standard for experience or certifications for nurses in order to be hired to work in a correctional facility. Most facilities instead institute on-the-job training to prepare their health care staff  according to the International Association of Forensic Nurses.

Correctional nurses do have the option of earning certifications from the National Commission on Correctional Health Care  or the American Correctional Association  to hone their specialized skills.

Health Care in Correctional Facilities

It takes a team to care for an incarcerated population. Below are some examples of the points care providers offer to meet the physical and psychological needs of those in correctional facilities.

Intake Exams

When individuals are incarcerated, they undergo an initial physical assessment to determine what needs they will have during their time in custody, including chronic health issues, mental health and substance abuse.

Who provides this service: nursing staff, including registered nurses, nurse practitioners

Medication Administration

Patients with chronic conditions may need daily medications, which are distributed by a provider to ensure adherence.

Who provides this service: licensed nursing practitioners, registered nurses

Chronic Care

Some chronic conditions, such as asthma or hypertension, require additional treatments and monitoring.

Who provides this service: registered nurses and specialists, including nurse practitioners

Inpatient Care

Incarcerated individuals who have sustained an acute injury or serious illness may need specialized treatment from an inpatient facility, such as a hospital.

Who provides this service: radiologists, respiratory therapists, phlebotomists, pharmacists, physical and occupational therapists, registered nurses and nurse practitioners and specialists such as surgeons, gynecologists and oncologists

Mental Health

Patients may have existing conditions such as schizophrenia or bipolar disorder or may need aid if they experience trauma within a correctional facility.

Who provides this service: behavioral health care specialists, counselors, nurse case managers, social workers, psychiatrists

How Does Working in Correctional Care Differ from Traditional Settings?

While the mission of a correctional nurse is the same as any nurse—to provide the best possible care for every patient—working in a correctional facility has some distinct differences from traditional health care settings. 

Correctional facility protocols are, in a word, strict. Because the presence of a deputy or corrections officer is required during exams, for instance, it can be difficult to maintain patient-provider confidentiality. Also, when an individual knows someone else is listening, they may feel uncomfortable or even be unwilling to speak openly about their health problems.

While the safety and security measures of a correctional facility may be unfamiliar to those who have only worked in traditional health care environments, correctional nurses can still provide compassionate care for their patients. For example, Hammel said that he and his staff are trained to assess whether it is safe to ask the officer on watch to step out briefly during an exam. This helps build trust with a patient, and makes him/her less likely to withhold any relevant information that may impede their care plan. 

The need to be vigilant and protective of one’s personal information is another aspect of the job that may feel foreign to health care providers outside of the correctional environment. Providers are advised not to share any details about their life outside of work with patients who are incarcerated, which can create some barriers for building trust and showing empathy. 

“Sometimes nurses like to use themselves as a tool in treatment and share stories [to empathize]. That is just something you can’t do here,” Hammel said. 

Instead, Hammel implements the following strategies when building rapport with his patients:

  • Ask questions to gauge a patient’s fears, concerns and general thoughts about their health issues.
  • Take time to appreciate a patient’s perspective.
  • Follow through with what you say you can do for a patient.

There is also a common perception that treating individuals in a correctional setting is less safe than working in a traditional environment. Hammel, though, says that in his experience, this perception is largely a myth.

“I have never felt afraid or been attacked [in the workplace],” he said, because “there are deputies close by to step in and make sure everyone is safe, both the patient and the health care worker.”  Other correctional nurses have voiced similar sentiments, saying that working in a correctional facility often feels safer than in a hospital. There is not current data to compare the experiences of correctional nurses to those in traditional settings, but safety and security are top priorities for correctional facilities. The presence of correctional officers, the access to call buttons in every room, and training to identify the early signs of escalating and agitated behavior are all factors in preventing incidents between patients and providers.

Correctional Health Care and Employee Burnout

While compassion fatigue is a common term known among health care providers, clinicians and other correctional care providers may experience a more specific feeling known as corrections fatigue.

Corrections fatigue is “the cumulative negative change over time of corrections professionals’ personality, health and functioning” that results from poor coping strategies or a lack of resources necessary for the requirements specific to working in correctional care, said Caterina Spinaris, executive director of Desert Waters Correctional Outreach in Florence, Colorado.

When someone experiences a series of stressors during their day-to-day life, as a result, “these stressors interact,” Spinaris said. “They are cumulative.”

How to Avoid Correctional Burnout

Build your support system
This can include your partner, family members, fellow colleagues and friends.

Practice mindfulness
Find activities that help ease your stress and process your feelings. This can include journaling, meditation, exercise and other calming activities.

Find activities that don’t intersect with work
Finding a balance and separating your personal life from your work life can help avoid burnout. Hiking and outdoor activities, for example, put you in an environment that is completely different from your job.

Get help
If serious symptoms such as depression, panic attacks or substance abuse begin to manifest, consider seeking help from a mental health professional.

For more details, visit https://nursing.usc.edu/blog/correctional-nurse-career/

Be sure to tune in for Andrew Bennie’s podcast with Sherry Cameron on the world of correctional healthcare–available on Spotify November 5!

From [email protected], the online FNP program from the University of Southern California

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