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Latest News & EventsNurses Leading Innovation

A Nurse’s Pioneering Tool to Navigate Contraceptive Counseling

Mentor. Women’s health advocate. Innovator. Meet Rachel Preiss, nurse practitioner, educator and graduate of the Sigma Theta Tau International Honor Society of Nursing's Maternal-Child Health Nurse Leadership Academy, who developed a pioneering tool to help women and healthcare professionals embrace shared decision-making.

Contraceptive counseling can be a complex topic for both healthcare providers and patients. There are many options available for women who are either trying to conceive or avoid getting pregnant, but each woman comes into a health setting with their own needs, health concerns and goals. And healthcare professionals are tasked with working with the women to figure out the best option for their needs in the short amount of time they are there in that health setting.

Enter Rachel Preiss, MS, RN, WHNP-BC, IBCLC, SANE – nurse practitioner at the Dimock Center in Boston, Massachusetts, nurse educator at The National TeleNursing Center, and 2016-2017 Fellow of the Sigma Theta Tau International Honor Society of Nursing’s Maternal-Child Health Nurse Leadership Academy (MCHNLA). Drawing from her experience as a nurse, her passion for women’s health, the concept of shared decision-making and her team in the MCHNLA program, Rachel developed an innovative tool to help healthcare professionals ask the right questions during contraceptive counseling to better understand and address the needs of the patient.

The Johnson & Johnson Notes on Nursing team recently spoke with Rachel to learn more about her tool, how it can help improve patient outcomes, how it feels to return to MCHNLA as a mentor and what she’s excited for in the Year of the Nurse and Midwife.

J&J:
What led you to create your tool that guides reproductive healthcare counseling and decision-making for women?
Rachel:
The inspiration for the “Guide for Choosing a Birth Control Method” booklet came when I was in a meeting one day discussing the complexities of family planning conversations and shared decision making. One of my team members asked, “Why isn’t there an algorithm for this?” and a light bulb of sorts went off in my head. There are some patient handouts and tools available to healthcare providers regarding contraceptive choices, but most focus primarily on efficacy, not the patient’s goals and experiences. They can be used for shared decision making, but they don’t show the provider how to do it. I knew a booklet that offered a holistic view of a patient’s contraceptive needs could be helpful for both healthcare professionals and patient outcomes. I thought through what such a tool could look like and our team worked on what questions it could include.

Utilizing the concept of shared decision-making in healthcare was the crucial component to developing the tool. For an intervention to be successful, patients need to be a part of the process. After asking a series of questions ranging from the patient’s desire to become pregnant, to their behavioral habits and relationship dynamics, the healthcare provider reviews how different methods are rated against their answers on topics such as efficacy, ease of use, privacy and side effects and suggests how specific contraceptive methods might suit their reproductive goals.[1]
J&J:
How did the MCHNLA Program help you develop your idea?
Rachel:
I had the idea for the tool before the program and participating as a Fellow really helped me to develop it. The program provided me with mentorship and advised me on what kind of team I would need in order to make my idea successful. They told me the secret to a successful healthcare innovation is the combination of lots of experiences and perspectives, it isn’t a one person show. Originally, I set out to create a comprehensive two-pager of sorts, but one team member told me there was no way I could fit everything on two pages – you can’t create patient education materials with size 10 font! I ended up creating a booklet that captures a series of questions and steps that could help anyone who does contraceptive counseling with patients.
J&J:
How can a tool like this improve health outcomes for mothers and their children?
Rachel:
Unplanned or mistimed pregnancy affects the health of both mothers and children—we see a correlation with low birth weight babies, preterm birth and late entry to prenatal care. [2][3][4]. In some cases, mothers who experience an unplanned pregnancy are more likely to use tobacco or alcohol during their pregnancy and there is a greater risk of maternal depression and postpartum depression.[5][6][7]. Access to and use of contraception can even affect a woman’s ability to meet their educational and career goals.

The goal of the booklet is to help patients find the right contraceptive choice by providing an easier way to understand the pros and cons of each method, therefore giving women more control over their pregnancy potential. When women feel more in control of their options, you are empowering them. They may be more willing to trust their healthcare provider and return to the clinic to receive other types of healthcare. Going through the booklet only takes about ten minutes, and the hope is that by finding the right contraceptive choice for patients, it could reduce time and costs required down the road.
J&J:
Why are nurses uniquely positioned to lead in this area of healthcare?
Rachel:
I’ve found that patients are more open when you ask the right questions, and collaboration with patients is intrinsic to the nursing practice. Nursing philosophy is all about treating the whole person – it is core to our beliefs and engrained from day one of being a nurse. Shared decision making is all about finding out where the patient is as a person, which is why nurses are really the “x” factor in helping tools like mine to grow and improve. The tool is designed for anyone who does contraceptive counseling, but I think nurses are well-equipped to lead in executing the tool I developed because in many settings they spend the most time speaking with patients, and therefore get to know the patient and their needs more than any other healthcare provider.
J&J:
What’s next for your tool?
Rachel:
Right now, my tool is only being used in one healthcare center, but I’m working with other clinics to help expand it. I believe the potential for expansion with this tool is huge. I’ve worked with medical interpreters to help translate all the steps into Spanish and would love to expand to other languages. I’ve received a grant to conduct a small study to see how patients respond to this tool in its booklet form, and I’ve created a poster version, which may be a lower cost option for some clinics. And without a doubt, I’m looking to take this digital. Creating an app is a huge lift, but I’m excited about getting this tool in front of as many healthcare providers as possible. I’m partnering with a several community health centers and providers in Boston to work through what might work best for their patients and providers.
J&J:
Can you tell us about your time as a Fellow in the Sigma Theta Tau International Honor Society of Nursing's Maternal-Child Health Nurse Leadership Academy and what being a mentor now means to you?
Rachel:
When I first learned about the program, I was so excited that something like it existed. It was a great opportunity to sharpen my leadership skills and develop my ideas, and now I try to encourage nurses as much as possible to seek out and apply to programs like it. To have come full circle in the program and now act as a mentor has been amazing. I couldn’t be prouder of my Fellow, Danielle Grimm, MS, MPH, CNP, WHNP-BC, and her important project aiming to improve screening for substance abuse in the OBGYN setting. It's been amazing watching her growth and how this program is helping to strengthen her skills as a leader. It’s been an honor to participate in a program that is committed to helping nurses develop in their careers, as well as improving health outcomes for mothers and their babies.
J&J:
In your own words, can you share with us the importance of quality mentorship for nurses and nurse innovators?
Rachel:
Nurses can be there to support each other by acting as sounding boards. I think there is so much value in having a fellow nurse say, “You can do it!” It’s important that nurses know there are other nurses that have their backs, not only to maintain our workforce but to push nurses with new ideas to explore how they can improve patient care. I would tell today’s nurses that it’s important to be someone who can help your fellow nurses grow because our profession is vital to healthcare as a whole.
J&J:
Do you have any advice for nurses interested in bringing their great ideas for healthcare programs forward?
Rachel:
I would tell nurses that even small ideas can have a major impact. I know a nurse who was passionate about massage therapy. I encouraged her to pursue a grant to study the effects of massage therapy on patients, but at first, she was hesitant and wasn’t sure if anyone would see the value in her idea. She ended up going for it and now she’s a published author and continuing to expand that work. We need to have faith in our ideas and each other. I would also say that finding the right team is incredibly important. It might take a while to find the right people but having a team behind you is key to sustain you and to lead you to new places and ideas.
J&J:
What does nurse innovation mean to you?
Rachel:
Nurses are closest to the patient. This means they are often let into those private moments and struggles, which provides nurses with unique opportunities to see just how problems in healthcare affect patients. To me, nurse innovation means combining one’s experiences with patients and healthcare know-how to create incredible solutions.
J&J:
What does 2020 being the Year of the Nurse and Midwife mean to you? What would you like to see come out of 2020 for the nursing profession?
Rachel:
I believe it’s so important to shine a light on the critical role nurses play throughout the globe. I believe this spotlight can help push many advancements in our profession further. I would love to see more investments in nursing education in governments around the world. I would also like to see nurse practitioners granted full practice authority in all 50 U.S. states because it would improve patient access to safe, cost effective care.[8] It’s an exciting time and I look forward to watching the progress, advancements and great ideas that come out of the Year of the Nurse and Midwife!

Johnson & Johnson partnered with the Sigma Theta Tau International Leadership Institute to develop the Sigma Theta Tau International Honor Society of Nursing's Maternal-Child Health Nurse Leadership Academy program. To learn more about Sigma Theta Tau International Honor Society of Nursing and their new Nurse Leadership Academy for Practice program, visit here.

[1] Preiss, RM. Arterberry, K. & Tucker, J. (2017). Development and Evaluation of a Shared Decision Making Tool for Contraceptive Counseling. Poster, Sigma Theta Tau Biennial Conference, Indianapolis, IN. https://sigma.nursingrepository.org/handle/10755/623319
[2] Eggleston, E., Tsui, A. O., & Kotelchuck, M. (2001). Unintended pregnancy and low birth weight in Ecquador. Social Science & Medicine, 51(7), 808-810.
[3] D'Angelo, D. V., Gilbert, B. C., Rochat, R. W., Santelli, J. S., & Herold, J. M. (2002). Differences between mistimed and unwanted pregnancies among women who have live births. Perspectives on Sexual and Reproductive Health, 36(5), 192-197.
[4] Korenman, S., Kaestner, R., & Joyce, T. (2002). Consequences for infants of parental disagreement in pregnancy intention. Perspectives on Sexual and Reproductive Health, 34(4), 198-205.
[5] Barber, J. S., Axinn, W. G., & Thornton, A. (1999). Unwanted childbearing, health, and mother-child relationships. Journal of Health and Social Behavior, 40(3), 237-257.
[6] Orr, S. T. (1997). Unintended pregnancy and the psychosocial well-being of pregnant women. Women's Health Issues, 7(1), 38-46.
[7] D’Angelo, D., Williams, L., Morrow, B., Cox, S., Harris, N., Harrison, L., . . . Zapata, L. (2007). Preconception and interconception health status of women who recently gave birth to a live-born infant—Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004. MMWR: Surveillance Summaries, 56(10), 1–35.
[8] American Association of Nurse Practitioners. (2015). Quality of Nurse Practitioner Practice. Retrieved from https://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practice

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