1. Improving Access to Well Woman Screening Utilizing an Interprofessional Approach ICN INP/APN Conference 2006 Sandton, South Africa Kelly Power-Kean BN RN NP-PHC MHS(c)

2. ICN/APN Conference 2006 Newfoundland Canada

3. ICN/APN Conference 2006 Well Woman Clinics Two Rural Health Centres Two Rural Health Centres Start date March 2004 Start date March 2004 One clinic per month in both locations One clinic per month in both locations 6-8 clients per clinic 6-8 clients per clinic

4. ICN/APN Conference 2006 How it all Began Need identified by CHNs, NP and female clients Need identified by CHNs, NP and female clients Higher rate of mortality by cervical Ca in Newfoundland vs. Canadian national statistics Higher rate of mortality by cervical Ca in Newfoundland vs. Canadian national statistics Incidence of cervical Ca in Newfoundland has increased vs. national decrease Incidence of cervical Ca in Newfoundland has increased vs. national decrease

5. ICN/APN Conference 2006 Mortality Rate Canadian Cancer Society/National Cancer Institute of Canada: Canadian Cancer Statistics 2005

6. ICN/APN Conference 2006 Health Promotion Action Plan To increase the knowledge and awareness of Reproductive Health in the St. Marys Bay Area

7. ICN/APN Conference 2006 Literature Review Womens Perception of Barriers to Screening Preferred female providers Preferred female providers Valued privacy (adequate drapes/gowns) Valued privacy (adequate drapes/gowns) Treated in a caring/respectful manner Treated in a caring/respectful manner Warm surfaces (speculum/stirrups) Warm surfaces (speculum/stirrups) Preferred flexible hours Preferred flexible hours Identified a lack of counseling time ( i.e. short rushed appointments) Identified a lack of counseling time ( i.e. short rushed appointments)

8. ICN/APN Conference 2006 … Barriers to Screening Lack of understanding of need for screening Lack of understanding of need for screening Adequate explanation of procedures Adequate explanation of procedures Opportunistic screening/lack of screening options Opportunistic screening/lack of screening options Women with bilateral T/L may have poor screening compliance Women with bilateral T/L may have poor screening compliance

9. ICN/APN Conference 2006 Other Considerations Reminders increased screening rates Reminders increased screening rates Physician recommendation was significantly related to compliance with screening Physician recommendation was significantly related to compliance with screening Need to target high risk populations (elderly, economically disadvantaged, minority and rural women) Need to target high risk populations (elderly, economically disadvantaged, minority and rural women) Acquaintance with nursing staff has been shown to improve attendance at cervical screening programs Acquaintance with nursing staff has been shown to improve attendance at cervical screening programs

10. ICN/APN Conference 2006 What We Did… Networking Networking Literature review Literature review Developed Screening Guide Developed Screening Guide Promotion and advertising Promotion and advertising Decide on best locations Decide on best locations Bookings and appointments Bookings and appointments Waitlist Waitlist

11. ICN/APN Conference 2006 Interprofessional Team Clerical support Clerical support Community Health Nurses Community Health Nurses Nurse Practitioner Nurse Practitioner By Referral: Physicians Physicians Dietician Dietician Gynecologists Gynecologists Mental Health Services Mental Health Services Addiction Services Addiction Services Other Partners: Health & Community Services Western (Cervical Screening Program) Health & Community Services Western (Cervical Screening Program) Community Churches Community Churches Canadian Cancer Society Canadian Cancer Society Biochemistry, cytology & microbiology labs Biochemistry, cytology & microbiology labs Newfoundland Breast Screening Program Newfoundland Breast Screening Program Clients Clients

12. ICN/APN Conference 2006 What We Do… 1 hour appointment 1 hour appointment Complete a Well Woman Screening Guide Complete a Well Woman Screening Guide Physical Exam Physical Exam Health promotion integrated throughout Health promotion integrated throughout Health education on BSE/Pap Health education on BSE/Pap Pap smear, bimanual exam and CBE Pap smear, bimanual exam and CBE Swabs, blood work and other labs/diagnostic tests individualized Swabs, blood work and other labs/diagnostic tests individualized Provide literature Provide literature Referral and follow-up individualized Referral and follow-up individualized All participants contacted regarding Pap results All participants contacted regarding Pap results

13. ICN/APN Conference 2006 WELL WOMAN SCREENING GUIDE Demographics Demographics Menstrual/Reproductive History Menstrual/Reproductive History Risk Factors/Family History Risk Factors/Family History Social/Personal History Social/Personal History Past Medical/Surgical History Past Medical/Surgical History Medication Medication Allergies Allergies Safety Issues Safety Issues Health Maintenance Health Maintenance Physical Examination Physical Examination Recommendations & Comments Recommendations & Comments

14. ICN/APN Conference 2006 Screening Guide

15. ICN/APN Conference 2006 Physical Examination Vitals signs Vitals signs Weight Weight Height Height BMI (referral to dietitian if >40) BMI (referral to dietitian if >40) Clinical Breast Exam Clinical Breast Exam Pelvic Exam Pelvic Exam Pap Pap Swabs for C & S and Chlamydia Swabs for C & S and Chlamydia

16. ICN/APN Conference 2006 Health Promotion Use screening guide Use screening guide Offer immunization update Offer immunization update View video tape on breast self examination (BSE) or Pap Smear Screening View video tape on breast self examination (BSE) or Pap Smear Screening Demonstrate BSE on breast model and encourage practice Demonstrate BSE on breast model and encourage practice Counseling on various health issues Counseling on various health issues

17. ICN/APN Conference 2006 Blood Work/Tests Indicated Stool OB Stool OB Lipid Profile Lipid Profile Bone Density Bone Density Mammography Mammography Other Other

18. ICN/APN Conference 2006 Screening Guide Summary Record significant physical findings Record significant physical findings Record referrals made to: Record referrals made to: family physician family physician specialist (e.g. OBGYN) specialist (e.g. OBGYN) dietician dietician mental health or addiction services mental health or addiction services Prescription renewal (i.e. contraception) Prescription renewal (i.e. contraception)

19. Evaluation An integral component of any program. An integral component of any program.

20. ICN/APN Conference 2006 Telephone Survey 6 simple questions 6 simple questions Randomly selected clients Randomly selected clients Survey conducted by BN student working with CHN Survey conducted by BN student working with CHN Completed within a 2 week period Completed within a 2 week period 40% of the total participants were interviewed 40% of the total participants were interviewed

21. ICN/APN Conference 2006 How did you learn about the clinic? 0 2 4 6 8 10 12 14 CHNChurch Bulletin ClinicFriendTelephoneNurse Practitioner

22. Would you recommend the clinic to a friend? Why or why not? Yes 100%

23. Were you satisfied with the care you received at this clinic? Why/Why not? Yes 100%

24. ICN/APN Conference 2006 Would you come again? Why/Why not? Yes 100%

25. Does this clinic meet your personal health needs? All responses were positive. Recommendations for improvement? To get message out to others.

26. ICN/APN Conference 2006 What did you like best/least about the Womens Wellness Clinic? Best: comfortable, for women by women, professional, personal, convenient, met needs, private, answered questions, not rushed. comfortable, for women by women, professional, personal, convenient, met needs, private, answered questions, not rushed.Least: nothing identified by women surveyed

27. ICN/APN Conference 2006Conclusion Clinics improve access to breast and cervical screening and other health maintenance opportunities to the women of our communities. Clinics improve access to breast and cervical screening and other health maintenance opportunities to the women of our communities. Meet the needs of our female population through interprofessional collaboration. Meet the needs of our female population through interprofessional collaboration. Increased screening leads to an increase incidence of cervical cancer but a decrease mortality rate. Increased screening leads to an increase incidence of cervical cancer but a decrease mortality rate. Focus on timely and appropriate treatment. Focus on timely and appropriate treatment. Need to assess cervical screening statistics to determine if they have increased since implementation of clinics. Need to assess cervical screening statistics to determine if they have increased since implementation of clinics.

28. ICN/APN Conference 2006References: Canadian cancer statistics (2005). http://www.cancer.ca/ccs/internet/standard/0,3182,3172_14291__langId-en,00.html http://www.cancer.ca/ccs/internet/standard/0,3182,3172_14291__langId-en,00.html Castellano, P., Wenger, N. & Graves, W. (2001). Adherence to screening guidelines for breast and cervical cancer in postmenopausal women with coronary heart disease: An ancillary study of volunteers for HERS. Journal of Womens Health & Gender Based Medicine, 10(5): 451-461. Clinical Practice Guidelines. http://www.cmaj.ca/misc/service/guidelines.shtml Community accounts. http://www.communityaccounts.ca/communityaccounts/onlinedata/default.html http://www.communityaccounts.ca/communityaccounts/onlinedata/default.html Coughlin, S. et al (2002). Cervical cancer screening in the workplace: Research, review and evaluation. AAOHN Journal, 50(1): 32-39. Fitch, M. I. et al (1998). Exploring the barriers to cervical screening in an urban Canadian setting. Cancer Nursing, 21(6): 441-449. Newfoundland cancer treatment & research foundation. http://www.nctrf.nf.ca/ http://www.nctrf.nf.ca/ Rose, J. (2002). Cervical cancer screening in Newfoundland and Labrador: Status Report 2002. (unpublished report). Somkin, C.P. et al (1998). Reminder interventions increased womens use of mammography and Pap smear screening. Evidence-Based Nursing, 1(2), 59. Spradley & Allender (1996). Community health nursing: Concepts and practice. 4th Edition. Philadelphia, PA: Lippincott-Raven Publishers. Van Til, L., MacQuarrie, C. & Herbert, R. (2003). Understanding the barriers to cervical screening among older women. Qualitative Health Research, 13(8): 1116-1131. Winkler, H. et al (1999). Compliance with Papanicolaou smear screening following tubal ligation in women with cervical caner. Journal of Womens Health, 8(1): 103-107.

29. ICN/APN Conference 2006