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Systematic Review of Sexual and Reproductive Health Care Content

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Systematic Review of Sexual and Reproductive Health Care Content I N F OCUS 1 57 2 58 3 A Systematic Review of Sexual and 59 4 60 5 61 6 Reproductive Health Care Content in 62 7 63 8 Nursing Curricula 64 9 65 10 Joyce Cappiello, Leah Coplon, and Holly Carpenter Q11 66 11 67 12 68 13 Correspondence ABSTRACT 69 14 Joyce Cappiello, PhD, FNP, 70 Objective: To examine whether and to what extent pre-licensure nursing programs include sexual and reproductive 15 FAANP, 4 Library Way, 71 University of New health (SRH) content in their curricula. 16 72 Hampshire, Durham, Data Sources: Electronic databases, including CINAHL, MEDLINE, PubMed, Web of Science, Science Direct, 17 NH 03824. 73 Google Scholar, ProQuest, and CAB Direct were searched for relevant literature. We also reviewed the reference lists 18 [email protected] 74 19 of all studies, nursing organization Web sites, and the personal files of the authors. Keywords 75 Study Selection: Inclusion criteria were studies focused on SRH content in pre-licensure nursing education, written in 20 nursing curriculum 76 21 nursing education English, and published between January 1990 and November 2016. We identified 632 articles, and of these, 22 met 77 22 reproductive health the inclusion criteria. Duplicates were discarded, and 13 articles were reviewed (9 quantitative descriptive, 2 modified 78 23 sexual health Delphi, 2 mixed methods). systematic review 79 24 Data Extraction: Data extraction and subsequent analysis were guided by the Preferred Reporting Items for 80 25 Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted and organized under the following 81 26 headings: author and year to establish a historical timeline, study purpose and design, sample size, data collection 82 27 methods, main study findings, and limitations. 83 28 Data Synthesis: We found the following: (a) most studies focused on baccalaureate education; if associated degree 84 29 programs were reviewed, findings were not reported separately; (b) definitions were not consistent, which affected the 85 30 scope of study results; (c) the SRH topics taught were similar; (d) there is a recent interest in sexual orientation and 86 31 gender identity curriculum; (e) barriers to including content were time constraints, competing demands with other 87 32 curriculum priorities, and a need for creative curriculum tools. 88 33 Conclusion: Documentation of SRH content in pre-licensure nursing education is limited. Faculty should conduct 89 34 ongoing evaluation of their curricular strategies and clinical experiences and publish results in the literature. 90 35 JOGNN, -, -–-; 2017. http://dx.doi.org/10.1016/j.jogn.2017.04.132 91 36 Accepted April 2017 92 37 93 38 94 39 95 40 96 41 Joyce Cappiello, PhD, FNP, urses in the United States are on the front transmitted infections, including chlamydia, 97 42 FAANP, is an assistant N lines of delivering health care that includes gonorrhea, and syphilis, ever recorded. Abortion 98 43 professor in the Department of Nursing, University of sexual and reproductive health (SRH) care and rates remain close to 1 million per year 99 44 New Hampshire, Durham, services. Sexual and reproductive health issues (Guttmacher, 2017). Demand for sexual and 100 45 NH. are present in many health care settings, and for reproductive health care services in the United 101 46 Leah Coplon, MPH, MS, almost all people, SRH is a concern at some point States is expected to grow between 10% and 102 47 CNM, is the Director of in their lifetimes. For instance, 99% of women in 20% by 2020 (Auerbach et al., 2016). Q10 103 48 Abortion Services, Maine the United States have used a contraceptive 104 49 Family Planning, Augusta, ME. method at some point in their lives and overall Among hospitals, outpatient clinics, school- 105 50 may spend 30 years using contraception based health centers, in-home care, rehabilita- 106 51 (Continued) (Guttmacher, 2016b). Unintended pregnancies tion facilities, and other health care settings, 107 52 represent 45% of total pregnancies (Guttmacher, almost all nurses will interface with individuals 108 53 2016b), and close to half of all teenagers are who have SRH concerns. Whether they are labor 109 54 sexually active (Guttmacher, 2016a). In 2016, the and birth nurses who counsel women on family 110 The authors report no con- 55 flict of interest or relevant Centers for Disease Control and Prevention planning options or school-based health center 111 56 financial relationships. reported the greatest number of sexually nurses who help teens access sexually 112 http://jognn.org ª 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. 1 Published by Elsevier Inc. All rights reserved. FLA 5.4.0 DTD JOGN236_proof 24 June 2017 6:40 pm ce I N F OCUS Health Care Content in Nursing Curricula 113 disease. The review was based on guidelines 169 114 Although ideally positioned to interact with women articulated by the Preferred Reporting Items for 170 115 regarding sensitive health matters, nurses may not be well Systematic Reviews and Meta-Analyses 171 116 prepared to discuss sexual and reproductive health. (PRISMA; Moher et al., 2009). We reviewed 172 117 descriptive research, government reports, and 173 118 conference proceedings to clearly understand 174 transmitted infection screenings, nurses 119 the research question. 175 frequently deal with concerns related to SRH. 120 176 Although ideally positioned to interact with 121 Our inclusion criteria were original research 177 women regarding sensitive health matters, nurses 122 published in English in the United States from 178 may not be well prepared to discuss sexual and 123 1990 through 2016 that showed the historical 179 reproductive health. 124 evolution of the inclusion of SRH content in 180 125 nursing curricula. We excluded studies that 181 In this review, we examine the current state of 126 focused on continuing education or advanced 182 SRH content in nursing education and current 127 practice nursing education. Electronic searches 183 ways that pre-licensure nurses can gain experi- 128 were conducted using Cumulative Index to 184 ence in SRH care in clinical settings. We explore 129 Nursing and Allied Health Literature (CINAHL), 185 the National Council Licensure Examination 130 MEDLINE, PubMed, Web of Science, Science- 186 (NCLEX) as a barometer for the content areas 131 Direct, Google Scholar, ProQuest, and CAB 187 deemed important for entry-level nurses and 132 Direct for grey literature. We manually reviewed 188 recommendations to improve SRH content in 133 the reference lists of retrieved articles, personal 189 pre-licensure nursing programs. 134 files of the authors, and nursing education Web 190 135 sites. We searched Google using the keywords 191 136 Methods and the term government and found a pertinent 192 137 We reviewed the literature about whether and to government document. Keywords included the 193 138 what extent pre-licensure nursing programs in the following: sexual health, reproductive health, 194 139 United States include SRH content. Initially we nursing education, nursing curriculum, pre- 195 140 reviewed accreditation standards that focused on licensure nursing education, and sexuality plus 196 141 broad concepts of education for clinical exam- MeSH terms of sexual health, reproductive health, 197 142 ples. The National League for Nursing (2010) education nursing, and education nursing 198 143 publishes an educational competency model for baccalaureate. We used the term United States to 199 144 all levels of nursing, including pre-licensure. Four help filter appropriate articles, but this term was 200 145 competencies form the basis of all levels of not useful in other databases (see Figure 1). The 201 146 nursing education, and these are addressed in literature includes many articles regarding clinical 202 147 Q1 greater depth for licensed practice nursing, pre- SRH topics, policies, and mandates, for example, 203 148 licensure nursing, graduate, and doctoral Reproductive Life Planning (Centers for Disease 204 149 nursing education. We found that specific clinical Control and Prevention, 2006), preconception 205 150 topics are not addressed in the National League wellness (Frayne et al., 2016), and the five Ps for 206 151 for Nursing competencies. In the Essentials of taking a sexual history (Centers for Disease 207 152 Baccalaureate Education (American Association Control and Prevention, 2015). In other articles, 208 153 of Colleges of Nursing, 2008), nine essentials of researchers focused on the need for practicing 209 154 education are articulated in broad terms. How- nurses to be skilled to address sexuality with 210 155 ever, specific clinical care issues are often given specific populations, such as individuals with 211 156 as examples of broad concepts. We found one cancer. We excluded these articles and those in 212 157 reference to an SRH topic in the Essentials of which the authors described specific strategies 213 158 Baccalaureate Education that illustrated a social to incorporate SRH content into nursing educa- 214 159 justice issue. Sexual orientation is referenced as tion if the intervention was not evaluated. We 215 160 an example of fair treatment of patients. The identified 632 articles, and of these, 22 met the 216 161 Holly Carpenter, MSN, review of accreditation standards did not yield inclusion criteria. Duplicates were discarded, and 217 162 CNM, is a clinician for significant data to inform our research question. 13 articles were reviewed. 218 Planned Parenthood of the 163 Greater Northwest and the 219 164 Hawaiian Islands and a Design 220 165 member of the Board of For this systematic review, we used the World Results 221 166 Directors for Nursing Health Organization (2011) definition of SRH for Thirteen studies met the inclusion criteria 222 Students for Sexual and 167 Reproductive Health, women and men across the life span with an (see Supplemental Table S1), including nine 223 168 Anchorage, AK. emphasis on wellness, not merely the absence of quantitative descriptive, two mixed-methods, and 224 2 JOGNN, -, -–-; 2017.
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