Video Case Study - Sexual Health

Nurse Sarah works in an urgent care clinic and is caring for Gia, a 24-year-old female who wants to be tested for sexually transmitted infections, or STIs, after her partner told her he tested positive for chlamydia.

After settling Gia in the exam room, Nurse Sarah goes through the steps of the Clinical Judgment Measurement Model, or CJMM, to make clinical decisions about Gia’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

To begin, Nurse Sarah recalls how sexual health encompasses a patient’s well-being related to their sexual orientation, gender identity, and intimacy with others.

With this in mind, Nurse Sarah performs a sexual health assessment and recognizes important cues, including Gia’s report of increased vaginal discharge and dysuria over the past four days.

She notes Gia has no previous history of STIs or pregnancies, has had three sexual partners in the last month, doesn’t use contraceptives, and reports feeling safe in her current relationship.

Nurse Sarah ensures Gia’s privacy and stays in the room while the health care provider performs Gia’s pelvic exam and collects specimens for testing.

Next, Nurse Sarah analyzes the cues. She notes the health care provider’s documentation of Gia’s exam, including the presence of copious vaginal discharge, with no signs of bruising or forced vaginal entry.

So, using the information she’s gathered, along with Gia’s social and medical history, Nurse Sarah selects the priority hypothesis of acute STI.

Then, she generates solutions to address Gia’s STI which will include treatment with the prescribed antibiotics and education on STI treatment and prevention; and she establishes the expected outcomes that Gia will accurately describe how to complete her antibiotic prescription and choose a reliable method to prevent future STIs by the end of today’s visit.

Nurse Sarah then takes action to implement these solutions. First, she teaches Gia about the prescribed antibiotic.

She underscores the importance of completing the full course of antibiotics even if she starts to feel better, while also abstaining from sexual intercourse until she has completed her course of antibiotics.

Then, she teaches Gia about reliable methods for STI prevention using open communication and a nonjudgmental approach. Nurse Sarah says, “Gia, if it’s okay with you, I'd like to talk about ways to prevent sexually transmitted infections, or STIs, in the future.” Gia responds, “Ugh, I feel so embarrassed, I hope this never happens again.” Nurse Sarah: It’s normal to feel embarrassed, and we’re here to help you.

First, it’s important to talk openly with your sexual partners about their sexual history, including how many partners they’ve had and whether they’ve had any STIs in the past.

Also, limiting the number of sexual partners you have can reduce your risk of transmission. Gia: Okay, I understand.

Nurse Sarah: Now, there are a lot of contraceptive options available to help prevent pregnancy, but not all of them help prevent STIs.

Condoms are a type of contraceptive that provide a physical barrier to protect you from STIs. Using a new latex condom for each sexual encounter before oral, vaginal, or anal contact is recommended for optimal protection.

To prevent the breakdown of condoms, keep them stored in a cool, dry place, and avoid using them with oil-based lubricants.

Also, make sure the condom is unrolled to the base of the penis and that space is left at the end of the condom to allow room for semen to collect.

Gia: Thank you, Nurse Sarah. Next, Nurse Sarah gives Gia a brochure with information about a free STI clinic and encourages her to schedule a visit there for more information on contraceptive options, the HPV vaccination, and annual screenings.

Before Gia leaves the clinic, Nurse Sarah evaluates the outcome of her care. She says, “I want to make sure the information I shared made sense and clarify any questions you have.” Gia responds, “I don’t have any questions.

Thank you for taking the time to explain all of this to me.” Nurse Sarah: Of course. Based on our discussion, what are some ways you can prevent sexually transmitted infections?

Gia: I plan to talk with my sexual partners about their sexual history, use a new condom every time I have sex, and schedule annual screenings for STIs.

Nurse Sarah also ensures that Gia knows where to pick up her prescription and that she can accurately describe how to complete her antibiotic.

She documents her nursing actions, and Gia’s response to these interventions. Then, before Gia leaves the clinic, Nurse Sarah gives her discharge papers that include the prescription and the teaching provided.

Alright, as a quick recap... Nurse Sarah recognized and analyzed cues related to Gia’s STI.

She prioritized hypotheses of acute infection related to STI exposure and lack of knowledge related to STI treatment and prevention and generated solutions to address these problems.

Nurse Sarah took action by providing education on the prescribed antibiotic and STI prevention. Then, Nurse Sarah evaluated outcomes and noted Gia met the expected outcomes of accurately describing how to complete her antibiotic and choosing a reliable method to prevent future