Human papillomavirus (HPV) includes over 150 viruses that affect the skin and moist membranes lining the body. It can be transmitted through intimate skin contact and sexual intercourse (Human Papillomavirus (HPV) Vaccines - National Cancer Institute, 2015). The epidemiologic triangle is a model developed to help study health problems. It helps develop an in-depth understanding of infectious diseases and how they spread. The triangle expresses a correlation between three aspects; agent, host, and the environment. In the context, an agent is defined as the cause of the disease, in this case, the Human Papilloma Virus. The host, on the other hand, is defined as organisms exposed to and harbor a disease. Adolescents are the hosts in our case. The environment is defined as the favorable surroundings and conditions that cause or allow the disease to be transmitted. Time is in the center of the triangle and is defined as the incubation period. Most infectious diseases have a specified time between infection and the onset of symptoms. The aim of using the triangle is to discontinue the cycle by breaking one of the vertexes of the triangle thus mitigating the spread.
The experimental method is the most suitable when conducting HPV epidemiological study. The first step entails the extent of proving that the disease exists. According to research, anogenital HPV infections are prevalent among adolescents affecting over 50 percent of the sexually active teens. The second step is confirmation of homogeneity of events. The third step involves the collection of all the facts necessary for investigating various risk factors. The fourth step includes a description of the homogeneity events in relevance to epidemiological factors such as predisposing factors. The fifth step entails the searching for patterns collective to the patients and may involve utilizing epidemic curves. Then, the final step is the formulation and testing of a hypothesis followed by a publication of the findings.
In the United States, over 6.2 million residents acquire HPV annually. The virus is credited with 70 percent of the cervical cancer cases and 90 percent genital wart cases. 47 percent of high school students are sexually active (Moscicki, 2007). According to the report, 28 percent of the girls and 31 percent of the boys have had more than a single partner (American Teens' Sexual and Reproductive Health, n.d.). It is then not surprising that the prevalence of HPV among adolescents is at 25 percent. According to a report by the Australian research center, 28 percent of the respondents were not aware of the disease. This ignorance/unawareness is the cardinal predisposing characteristic.
Various cultures have different health beliefs that clearly outline the causes of illnesses, treatment, and individuals who should be involved in the treatment process. In some communities illness is a natural phenomenon that warrants spiritual intervention while in other communities malady is a culmination of a scientific phenomenon that constrains medical intervention. Individuals form perceptions reflective of their commitment to contested views of a good society, hence such individuals are more receptive to treatment practices that are consistent with community principles. For example, HPV vaccines have been principally endorsed by public health officials for girls aged between 11 and 12 however; research has shown that there are discords on the risks and benefits of the vaccine which can be traced back to cultural cognition (Ayonrinde, 2003). Additionally, some cultures such as the Asian places great emphasis on respect for authority hence patients are inclined to desist from confrontations with distinguished members. In medical institutions, Asian patients have been guilty of avoiding disagreements with physicians. This avoidance implies that the recommendations may not suit their needs; furthermore, there is a high chance that the recommendations will not be followed. The Chinese on the other hand view behavior as a reflection on the family and any behavior that predicates a lack of self-control is considered shameful. Therefore, Chinese patients with sexually transmitted diseases are reluctant to visit healthcare facilities and even when they do; they are disinclined to divulge symptoms.
Treating adolescents in the United States raise several nonpareil challenges on consent, confidentiality, and legal issues. A healthcare professional's legal responsibility to adolescents and their families differs across the states. However, all states have laws regulating circumstances when an adolescent may consent healthcare and when this care is confidential. Adolescents in Oregon are allowed to give consent for both contraceptive services and STI treatment. According to the Health Insurance Act Portability and Accountability Act (HIPPA) an adolescent maintains the right to control medical information if the treatment is allowed under state laws, the minor legally requires the treatment without parental consent or when a parent has explicitly allowed confidentiality. The majority states allow but do not necessarily require the physician to divulge the information to the adolescent's parents. This ambiguity raises an ethical dilemma (Joffe, 2005).
The primary role of all medical practitioners is to establish a trusting and respectful relationship with the patient to provide excellent healthcare. However, personal values and biases may consciously or unconsciously affect healthcare provision. The bias may either be affective or cognitive. Emotional bias can be managed by familiarizing with specific issues or patients groups. For example, a practitioner may embark on learning about health problems or risk factors among adolescents rather than prejudging them. The practitioners are further required to follow CMPA recommendations that require them to be fair, objective and nonpartisan when providing medical opinions. Cognitive bias on the other hand, often results from heuristics; it diminishes the accuracy of medical observations. The most effectual way of managing cognitive bias is through familiarizing with the concept and its manifestations from which one can learn how to avoid this type of bias (CMPA, 2012).
Evidence-Based Nursing is the punctilious utilization of available evidence to make decisions about patient care. The problem-solving approach integrates a systematic search and appraisal of relevant evidence, clinical expertise and patient preferences and values. The practice involves seven steps, cultivating a spirit of inquiry is step zero. The first phase involves formatting the question in PICOT format (Patient, Intervention, Comparison Intervention, Outcome, and Time). The second step is conducting the actual research using reliable databases such as Medline and CINAHL. The third phase is critically appraising the evidence to determine relevance, validity, reliability and applicability. The appraisal should be followed by an assessment of all studies to assess whether they have homologous conclusions. For example, did vaccination against HPV yield similar results? After the assessment, the evidence should be integrated into practice based on expertise and patient preferences. Upon application, an evaluation should be conducted to evaluate the outcomes of the change. The final step is the dissemination of the findings for the benefit of others (Melnyk & Fineout-Overholt, 2011).
The surest way to prevent HPV is abstinence from all forms of sexual activities. Abstinence is 100% effective; however, it is not a realistic option especially among teens. Current studies estimate that on average young people engage in intercourse for the first time at about the age of 17. Therefore, additional prevention mechanisms have been suggested and utilized. These include advice to limit the number of sexual partners, using latex condoms, circumcision, pap test, adopting a healthy lifestyle and the HPV vaccines. HPV vaccinations have become the most prevalent mechanism for prevention. There are three HPV vaccines as approved by the FDA; Gardasil, Gardasil 9 and Cervarix. Gardasil (Quadrivalent) prevents from four types of HPV, Gardasil 9 (nonvalent) prevents nine while Cervarix (Bivalent) targets two. All the three vaccines are administered over a six-month period through a series of three muscle tissue injections. HPV vaccines are highly efficacious in preventing the targeted HPV type as long as they are administered before exposure. Research conducted before their approval showed that Gardasil and Cervarix provide nearly 100 percent protection while Gardasil 9's efficacy was estimated at 97 percent (Harper, 2012).
References
American Teens' Sexual and Reproductive Health. (n.d.). Retrieved from http://www.guttmacher.org/pubs/FB-ATSRH.html
Ayonrinde, O. (2003). Importance of Cultural Sensitivity in Therapeutic Transactions. Disease Management & Health Outcomes, 11(4), 233-248. doi:10.2165/00115677-200311040-00004
CMPA. (2012, December). CMPA - Overcoming bias in medical practice - Duties and responsibilities. Retrieved from https://www.cmpa-acpm.ca/-/overcoming-bias-in-medical-practice
Harper, D. M. (2012). Prevention of HPV-Associated Diseases in the United States. HPV and Cervical Cancer, 211-255. doi:10.1007/978-1-4614-1988-4_9
Human Papillomavirus (HPV) Vaccines - National Cancer Institute. (2015, February 19). Retrieved from http://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet
Joffe, A. (2005). Legal and Ethical Issues in Adolescent Health Care. Pediatrics, 1428-1430. doi:10.1016/b978-0-323-01199-0.50225-5
Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
Moscicki, A. (2007). HPV Infections in Adolescents. Disease Markers, 23(4), 229-234. doi:10.1155/2007/136906
