One of the important domains of nursing care is to counsel the clients to promote their health and well-being. Counseling can be done for different purposes including personal hygiene antenatal care, and Family planning. Counseling about family planning is a challenging skill which is learnt by nurses during their training period and later on they use their skill as one of the essential parts of their job to ensure that client’s reproductive health is maintained.
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During my reproductive health community rotation, I came a cross with a 33 year old female, having 3 children and was living with her husband and in laws. I started my interview by greeting her and her family members and started doing family assessment by asking her about health status of the family members. During the interview, I came to know that the lady has one son and two daughters with the gap of hardly one year. Due to such little space between the children, the mother was not able to breast feed her children in an appropriate way. As I moved further during the interview and tried to explore the reason of least gap between her children. She explained this phenomenon by saying that however she used the contaceptive pills and injections to space her upcomimg pregnancy but the usage was not appropriate and she could not continue the pills and injections due to side effects. Due to this interrupted usage of short term contarceptive methods, she ended up with a preganncy without an appropriate gap. Moreover, based on literature it has been found that shor term methods like condoms, injections and pills are prone to failure during typical usage and due to incorrect usage (Kost, Singh, Vaughan, Trussell, & Bankole, 2008), while failure of long term methods like depot preparations or intrauterine devices is less and these methods are safe, with few side-effects and have with high continuation rate (Searle, 2014). There are multiple reasons for method failure including incorrect or inconsistent usage or uncertain effectiveness of the chosen method (Trussell & Portman, 2013). When I asked her future plans about the usage of family planning methods, she was found to be very willing and ambitious for using appropriate methods for planning her next pregnancy with an appropriate gap. However, I got confused for a moment and became hesitant about discussion on such sensitive topic with my client but I advised her to use male method (condom) and she said her husband had been using this method but it was also not that much effective. As she said this sentence, my level of confidence went down and I got diverted from the actual topic of interest and started asking her about other health problems. In this way, the interview with client ended and I recognized that I was unable to help my client.
After coming back from this community rotation, on one hand, I was happy to found a cooperative client who helped me to complete the assessment form and on the other hand, I was dissatisfied as I wasn’t able to ease my client to resolve her concern. Although, I was aware about family planning methods that might had helped my client but my counseling skills were not up to mark, therefore I could not help my client to develop insight for her problems. Furthermore, I could not prove to be a helpful person for her family as I could not address the needs of the family despite knowing that the client was supposed to be counseled for family planning in an appropriate way. Although, the concept of holistic approach for a client is comprehensible from theoretical aspect but sometimes it becomes difficult to apply the same concept in real life. This meeting with my client helped me to reflect on my limitations to assess the needs and counsel the family in an appropriate way.
When I reflected , I identified several reasons of inappropriate counseling. The important and foremost reason was that it was my first experience therefore I wasn’t enough confident about the appropriate way of counseling particularly for such sensitive topics like Family Planning. In addition to this, I also found that before counseling the clients on such sensitive topics, one need to have appropriate skills and mastery which were lacking in me during the time of interview. I also realized that I had advised mother to use a family planning method which was not basically counseling rather a suggestion which was not enough to develop insight in my client about her problem. Secondly, I was not aware about different types of family planning methods, therefore I could not convince my client to use the methods which were suitable for her as I had not learned much about family planning and nor I have visited any family planning center at that point in time. Moreover, being a student I was not comfortable to discuss such issues with my client which was related to reproductive and sexual health.
In addition to this, I should have built strong rapport with my client that would have definitely assisted me to resolve the concern of my client. Apart from this, I should have allowed my client to deal with her feelings and make her own informed choices. This could have been supported by in-depth assessment of my client regarding the use of short term methods like pills, condoms and injections. This could have helped me to do a root cause analysis of method failure and which in turn would have helped me to come up with suitable solutions for her. I could have taken support from my theory class content regarding family planning before setting time with the client in the community.
Moreover, I should have involved the husband during the counseling because pregnancy planning is not entire responsibility of woman herself but it is the joint responsibility of husband and wife. The support from partner is very important for adapting any contraceptive method. Quality of couple’s relationship and inter-spousal communication and its effect on contraceptive use has also been supported by literature (Akanbi,et al., 2011). Moreover spousal communication has been identified as a good predictor of contraceptive use and fertility preferences (Link, 2011).
Secondly, the involvement of expert counselor of family planning would have become an excellent approach and I should have taken some ideas or skills from my reproductive health faculty before visiting the client herself. Besides this, integrated counseling frameworks of family planning such as GATHER or REDA frameworks could have applied practically in the community (The Acquire Project, 2008).
These frameworks guide the health care providers to explore the problems of client systematically without breeching their confidentiality. Moreover, it also helps clients to make informed choices for themselves after having the in-depth knowledge about the suitable family planning methods. Due to my insufficient knowledge and experience, I could not apply these frameworks practically. Moreover, I should’ve done a mock exercise of counseling by taking help from my faculty who must have helped me by providing a platform for mock before going to community.
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For future, I would try to do the in depth assessment of the needs of a client by involving spouse as well. Moreover, I would try to get the expert opinion regarding family planning counseling by integrating different approaches of family planning counseling. This would enhance my knowledge about family planning counseling skills. Additionally, I would try to discuss such sensitive issues with the client by having enough knowledge about the family planning methods. I would also try to build a strong rapport with the client in order to discuss the issues related to sexual and reproductive health very openly and freely.
In conclusion, I was very much satisfied because I was able to reflect on the whole event and also identified my limitations. This whole reflection and critical thinking helped me to develop future plan which would assist me in future to counsel the women regarding family planning methods in an appropriate way.
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