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Target At-Risk Populations

The Australian College of Nurse Practitioners is proud to showcase how Nurse Practitioners are changing the face of healthcare.  Below is a vignette which demonstrates how we target at-risk populations:

Elissa O’Keefe, Nurse Practitioner – Sexual Health

My role as a Sexual Health Nurse Practitioner (NP) was established in 2004 and provides screening and treatment for people of all ages who have sexual health concerns. It has had a strong outreach focus to reach at-risk populations who may not feel comfortable attending a hospital-based clinic or GP for care.  Since the establishment of the role there has been a second nurse practitioner employed. Outreach clinics are performed in community settings such as sex on premise venues, brothels and youth health services. Our clinic works in collaboration with the Registered Nurse from ACT Medicare Local’s HIV Program, ACT Aids Action Council, and the Sex Workers Outreach Program.

My role includes:

  • Screening, treatment, contact tracing, counselling and referral for sexually transmitted infections (STI) such as chlamydia, gonorrhoea, syphilis and blood-borne viruses such as HIV and Hepatitis B & C
  • Vaccination to protect against Hepatitis A, B, genital warts and influenza
  • Pap smears, pregnancy testing and referral for termination of pregnancy

Case Study: Anabella

I saw 21 year old Anabella [actual identity and place names have been changed] one Wednesday afternoon at a youth health service.  She had been living in Brisbane and was passing through Canberra to briefly visit her family. She had not seen any healthcare providers in the previous year and dropped into the nurse practitioner (NP) clinic for a Pap smear. 

Anabella and I had an extensive discussion where she disclosed the following:

  • She had been sexually assaulted by three men concurrently in Brisbane three weeks previously. She came to see me as she thought she should have a Pap smear, because she believed that this routinely checked for sexually transmitted infections (STIs).  I explained the differences between Pap smears and STI testing and provided emotional support, counselling and advice. Whilst she had made a report to police just over a week after the incident, this was outside the timeframe to collect forensic evidence, and she said she had declined medical care at the time.
  • She revealed that she and her flatmate had been using a variety of drugs and had witnessed the result of her flatmate fatally setting herself alight in the garden after a psychotic episode
  • She also revealed that her teenage sister (whom she had brought with her to the consultation as a ‘mentoring experience’ to demystify seeking sexual health care for her kid sister) had been sexually assaulted by a family member with an intellectual disability.

After providing reassurance and guidance on how the examination would be performed, and ensuring a safe and comfortable environment for her, I performed a full sexual health screen and Pap smear both of which were clinically appropriate.  I assessed Anabella’s mental health and coping strategies and felt she would benefit from mental health services for emotional support, for which I provided a referral to expedite her entry into appropriate mental health care. She was referred internally to an adolescent psychologist on staff at the youth health service. I was able to ascertain that Child Protection Services in the ACT were already involved with the care of her sister and family, and I liaised with this service to ensure continuity of her sister's care.

Thankfully, Anabella’s tests revealed that she had no evidence of an STI or BBV and her Pap smear was normal.  She was able to receive her results over the phone as she had left Canberra after a short visit with her family. Our service provided further information about accessing similar services in Brisbane for ongoing care, to ensure that she received care in her local community.

Like many of my clients, Anabella may not have sought care from a GP or attended a health service for her sexual health needs.  Because of her assertiveness and resilience, she was able to share this experience with her younger sister, who now also knows how to access sexual and emotional health care resources in her local community.  Anabella related that the immediacy, appropriateness and non-judgmental consultation with me met her needs perfectly.

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