Hesitancy In Taking History From A Female Client
Sexuality assessment and counseling are part of the nurse’s professional role, but only few nurses integrate this awareness into practice in a proper way. Getting a sexual history is an inbuilt piece of the client meeting, however, numerous health care professionals neglect to address this subject with their clients. This could be credited to distress that numerous healthcare professionals may have with the subject (Shukla, Yourchock & Coutcher, 2013).
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During my community rotation of reproductive health at Salimabad colony, the family I was assigned to was a 4 membered family living in 2 adjacent apartments with 4 bedrooms. Only one lady was at home with whom I conducted my interview. She was the mother of 3 daughters. I started with the general components of history, such as information about their family members, their education, and their health status etc. She was responding to my questions in a decent manner without any hesitation. After that I asked the client about the problems related to her reproductive health. Her reply was pretty awkward. She replied that I don’t know how to explain it to you because you are a male student. I felt very uncomfortable with her reply that I didn’t even try to intervene in between and explore more about her concerns.
At the time of the incident I felt terrible and disregarded. I found the response of the client very bizarre. I also felt helpless because at that time I was not able to figure out that what I should say to the client to make her comfortable. In the wake of confronting the dismissal from the patient, numerous questions popped into my brain. First and foremost, what made the client so uncomfortable? After all I told her that the information won’t be disclosed to an irrelevant person. Secondly, why did I hesitate to intervene to make the client comfortable? Moreover, why didn’t the client realize that I was there to help her? If she’d tell me about her problems than I could’ve guided her about the solutions.
I reflected and analyzed the possible causes because of which the incident occurred. According to Magnan, Reynolds & Galvin (2005), various hindrances exist to consolidating thought of patient sexuality into nursing practice, including individual, institutional, patient-related variables and Personal elements, for example, nurses’ attitudes about sexuality and sexual behavior. There are a lot of barriers concerning poor healthcare like, social, religious, cultural and economic. Among these socio-cultural is the most crucial. In a developing country like Pakistan, the culture and religion have more significance than any other aspect of life. According to Walston (2005), Involving men in reproductive health is particularly challenging in countries whose culturally defined gender roles may hinder men’s participation.
For establishing an effective and therapeutic communication, it is necessary for a healthcare professional to overcome these barriers. To overcome these issues, the healthcare professional shouldn’t be hesitant while taking the history about reproductive health. According to Jayasuriya & Dennick (2011), there are many barriers within the learner. The first and the foremost is the deficiency of knowledge. A few students omit a sexual history in light of the fact that they don’t comprehend its applicability to a specific clinical situation. It is less demanding to ask an “intrusive” question if one comprehends the pertinence of the inquiry and is thus ready to advocate it – both to oneself and to the client.
The second barrier within the learner is problems with terminology. In sexual history-taking, students may be confronted with vocabulary or behavior with which they are unfamiliar. According to Jayasuriya & Dennick (2011), students may be hesitant to seek clarification, particularly where sexual activity is concerned, for fear of appearing sexually inexperienced, or unversed in sexual behavior. The third barrier is the concern about patient’s perception of student. Students some of the time express worry about picking up clients’ trust or bringing on offense by their inquiries (Jayasuriya & Dennick 2011).
The other set of barriers is barriers within the learning environment. The most significant barrier of this set is cultural barriers. According to Jayasuriya & Dennick (2011), in some cultures, sex is allied by shame. This feeling of taboo penetrates into ‘medical culture’ as well. Indeed, healthcare professionals who do talk about ‘sexual wellbeing’ may limit themselves to “medical’ issues such as infections, while evading issues relating to sexual lifestyle.
While reflecting on my role, I realized that I shouldn’t have kept quiet. I shouldn’t have hesitated and should’ve intervened and said something to make the client comfortable. I should’ve shown professionalism which might have helped the client understand and realize the purpose of taking the sexual history.
If I encounter similar situations in the future, I’ll try not to hesitate and along with that I’ll try to make the patient comfortable by telling her the significance of taking the reproductive health history. After studying the literature now I know that for an effective communication, health care providers should respect the feelings, sexual values, lifestyle and social norms and limitations of the client. And they should have the current knowledge about regarding sexual health. In addition, talking about reproductive health can be difficult for clients and health care providers as well, but continuous practicing and use of effective skills can promote communication and it will also help to ensure the best possible care (Association of reproductive health professionals April, 2008). As we know that students learn a lot from clinical experiences so for that purpose, students could watch a specialist take a sexual history from a client or they could watch a video of the same methodology or they could partake in a role-play activity (Jayasuriya & Dennick 2011).
In conclusion, involvement of male in reproductive health is also necessary as female health care providers to promote a healthy sexual life. Male involvement in reproductive health can be achieved through the use of effective therapeutic communication skills, training and practice, current knowledge regarding reproductive health so that a better role can be played as a nurse.
References
Magnan, M., Reynolds, K., & Galvin, E. (2005). Barriers to addressing patient sexuality in
nursing practice.Medsurg Nursing,14(5), 282.
Shukla, V., Yourchock, B., & Coutcher, M. (2013). Overcoming Barriers Regarding Sexual
History Taking: Case Reports.Journal Of Therapy & Management In HIV
Infection,1(2), 36–39.
Walston, N. (2005). Challenges and opportunities for male involvement in reproductive health in
Cambodia.Phnom Penh: POLICY Project/Cambodia.
Jayasuriya, A., & Dennick, R. (2011). Sexual history-taking: using educational interventions to
overcome barriers to learning.Sex Education,11(01), 99–112.
Association of Reproductive Health Professionals. (2008, April).What You Need to Know
Talking to Patients About Sexuality and Sexual Health. Retrieved from
http://http://www.arhp.org/uploadDocs/sexandsexfactsheet.pdf
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