The Advanced Practice Nursing Role Of Change Agent:

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  An Analysis Of Implementing Change Related To Childhood Sexual Abuse Sequelae In A Family Practice Clinic

by Loredana Clemente

 

The use of evidence-based practice necessitates the implementation of change. The advanced practice nursing (APN) role of change agent is explored in this practicum in reference to a change related to screening for childhood sexual abuse (CSA) prior to more sensitive physical examinations, i.e., pelvic, breast and rectal examinations. The literature describes a very high prevalence of CSA. One in three to four women and one in six to eight men have lived through a sexual abuse situation. Concurrently, the literature outlines substantial practitioner apprehension in screening for and addressing sexual abuse issues.

Goals of this project were to assess the process of an APN implementing a change in a family practice clinic composed mainly of physicians, and to increase practitioner sensitivity to this issue. Assessing the feasibility of implementing a brief assessment intervention during sensitive physical examinations and determining practitioner concerns relating to addressing issues of childhood sexual abuse were also explored.

The intervention consisted of an educational session to the physicians at the Family Medical Centre addressing issues surrounding the long-term effects of CSA. The evidence supporting the need for survivors of sexual abuse to have these issues addressed was also presented followed by an introduction to my own project asking those attending the session to implement two screening questions, "Is there anything about your past experiences that makes this exam particularly difficult for you?" and "What can I do to make it easier for you?" Those wishing to participate were then asked whether they had made a change in practice based on the intervention.

The data was analysed using content analysis. The Dracup-Breu and Bridges' change theories served as models to both guide the process and organize the results. Results indicated that a change agent's professional skills and personal attributes, active participation of participants, attention to the barriers and facilitators of change, and multiple strategies for change are all factors in the successful implementation of a change in practice.