D025 Task 1 Advocacy and At-Risk Population Example

Advocacy for an At-Risk Population: Congenital Syphilis in a Composite County and the Advanced Professional Nurse's Role

Student Name

Leavitt School of Health, Western Governors University

D025: Essentials of Advanced Nursing Roles and Interprofessional Practice, Task 1

Course Instructor

Month Day, Year

Advocacy for an At-Risk Population: Congenital Syphilis in a Composite County and the Advanced Professional Nurse's Role

Introduction

Congenital syphilis, the transmission of syphilis from a pregnant person to the fetus, was close to elimination in the United States two decades ago and has since returned at a rate that public health agencies call a crisis. It is almost entirely preventable with timely testing and treatment during pregnancy. This paper examines how an advanced professional nurse advocates for the population at risk, how the nurse can build interprofessional collaboration on an advocacy team, what the data show in a composite county in the southern United States, and what characterizes the pregnant people most affected.

Advocating for a Population Versus an Individual Patient

The first difference is the client and the evidence used. When an advanced professional nurse advocates for an individual patient in clinical practice, the client is one person, and the evidence is that person's history, test results and wishes. For a pregnant patient with a positive syphilis test, advocacy means making sure the patient receives benzathine penicillin G on time, that their partner is treated, and that care is not delayed by missed appointments or pharmacy shortages. When the nurse advocates for an at-risk population in the community, the client is a group, such as all pregnant people in the county, and the evidence is surveillance data, rates and trends. The question shifts from what this patient needs to why so many patients are missed.

The second difference is the partners and the tools. Individual advocacy works through the care team: the nurse speaks with the obstetric provider, the pharmacist and the social worker, and uses tools such as care plans, orders and referrals. Population advocacy works through coalitions and policy: the nurse partners with the health department, community organizations, professional associations and legislators, and uses tools such as testimony, policy briefs, public education and changes to screening law. A nurse can resolve one patient's barrier with a phone call; changing the screening schedule for every pregnant person in the state requires a bill.

Strategies to Promote Interprofessional Collaboration on the Advocacy Team

An advocacy team for congenital syphilis would include an advanced professional nurse, an obstetric physician, a pharmacist, a health department disease intervention specialist, a community health worker and a representative of a local organization serving people who use drugs. The first strategy is structured interprofessional meetings with a shared agenda and defined roles. A Cochrane review of practice-based interprofessional collaboration reported that practice-based approaches, among them regular meetings across professions, joint rounds and shared checklists, can produce small gains in how professionals work and in some patient outcomes, though the evidence was of low certainty (Reeves et al., 2017). The nurse would convene monthly meetings in which each member brings one piece of data from their own work, such as missed follow-up appointments from the clinic or treatment gaps from the health department, and the team agrees on actions and owners before closing.

The second strategy is building the team around shared competencies rather than professional hierarchy. The national core competencies for interprofessional practice emphasize values and ethics, understanding roles and responsibilities, communication and teamwork (Interprofessional Education Collaborative [IPEC], 2023). In practice, the nurse would begin the team's work with a session in which each member explains what they can do and what limits their role; the community health worker, for example, may be the only member who can reach patients who avoid clinics. That shared understanding lets the team assign tasks to the member best placed to do them, not the one with the most authority.

Data Validating the Health Issue

Nationally, congenital syphilis cases increased 755% between 2012 and 2021, and 3,761 cases were reported in 2022, including 231 stillbirths and 51 infant deaths (McDonald et al., 2023). The same analysis found that lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases, and that testing and treatment gaps existed across all races, ethnicities and regions of the country. In other words, the problem is not that treatment does not work; it is that too many pregnant people are not tested at the right times or not treated in time.

In the composite county used for this analysis, a largely rural county of about 210,000 residents, the health department recorded 3 cases of congenital syphilis in 2019 and 17 in 2023, while cases of syphilis among women of reproductive age tripled over the same period. In a review of the 2023 cases, 11 of the 17 mothers had been tested in the first trimester with a negative result and were not tested again, and four had no prenatal care before delivery. The state's current law requires syphilis testing only at the first prenatal visit, while national guidance recommends repeat testing at 28 weeks and at delivery for those at higher risk, and many states have yet to write that guidance into law (Darcy et al., 2025).

Characteristics of the At-Risk Population

The first characteristic is limited or late prenatal care. In the county's review, a large share of affected pregnancies had a first prenatal visit after 20 weeks or no prenatal care at all, often because of transportation barriers, work schedules that do not allow time off, lack of insurance before Medicaid coverage began, or fear of judgment. People who enter care late, or not at all, miss the testing and treatment windows that prevent transmission.

The second characteristic is a higher likelihood of reinfection or new infection during pregnancy, linked to substance use, unstable housing and partners who are not tested or treated. Many affected mothers in the county tested negative early in pregnancy and acquired syphilis later, a pattern a single first-trimester test cannot detect. These characteristics also carry stigma, which makes people less likely to disclose risk and more likely to avoid care, and they explain why a screening policy that depends on self-reported risk will miss many of the people it is meant to protect.

Conclusion

Congenital syphilis in this county is a population problem with a clear cause: pregnant people who enter care late or acquire infection after an early negative test are not being tested again. The advanced professional nurse's role is to move from treating individual cases to changing the system that produces them, working with an interprofessional team built on shared competencies and structured collaboration. The data point toward a specific policy change, universal repeat syphilis testing during pregnancy, which is the subject of the next part of this work.

References

Darcy, R., Ayala, L., Quinlan, M., Brikshavana, D., Statton, A., Tabidze, I., Cejtin, H., Jao, J., Sutton, S., Madden, N., Espinal, M., & Yee, L. M. (2025). Prevention of congenital syphilis: The current state of legislation and public health guidelines. Pregnancy, 1(5), e70110. https://doi.org/10.1002/pmf2.70110

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/ipec-core-competencies

McDonald, R., O'Callaghan, K., Torrone, E., Barbee, L., Grey, J., Jackson, D., Woodworth, K., Olsen, E., Ludovic, J., Mayes, N., Chen, S., Wingard, R., Johnson Jones, M., Drame, F., Bachmann, L., Romaguera, R., & Mena, L. (2023). Vital signs: Missed opportunities for preventing congenital syphilis, United States, 2022. MMWR: Morbidity and Mortality Weekly Report, 72(46), 1269-1274. https://doi.org/10.15585/mmwr.mm7246e1

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 2017(6), CD000072. https://doi.org/10.1002/14651858.CD000072.pub3