This essay will look at the role of the nurse in promoting health of female adults (25-45) in terms of sexual health and behaviour. It will give definitions of Sexual health and promotion, which will also cover areas such as health models in relation to sexual health and behaviour. It will give an overview of what the role of the sexual health nurse is and throughout the essay relate the nurse and their importance to promoting sexual health. The essay provides government initiatives that are being set in place to highlight the issues surrounding this age group and that show how these affect this specific age group. With this particular client group, which is the female adult, will look at Sexually Transmitted Infections (STI’s) and what control measures and interventions are being put in place to lower the rate in Scotland.
The Royal College of Nursing (Royal College of Nursing. 2000) defines sexual health as the physical, emotional, psychological, social and cultural well-being of a person’s sexual identity and the capacity and freedom to enjoy and express sexuality without exploitation, oppression, physical or emotional harm.
Sexual health is also a term used to associate sexually transmitted diseases such as HIV or AIDS. Whereas an individual’s sexuality is shaped by their environment, self-concept, health or disability. This in the role of nursing means that sexual health nurses must take a holistic view of the individual when assessing the client’s needs. “To focus solely on the sexual behaviour of the individual , ignores the influence of the wider social context we live in. Each society is structured by dominant gender roles, ideologies and power inequalities that appear to prescribe certain expectations and assumptions about what is ‘Normal’ or ‘Natural’ sexual expression for men and women” (Dallos et al. 1997).
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In society today with this specific age group there are large differences than that of a generation ago. There are more individuals marrying later and substantially more marriages ending in divorce. This for an older population means more individuals possibly being with more partners than what was deemed as respectable a generation ago and seeking new relationships with different partners after ending marriages. These changes to society bring an increased number of individuals with sexual health issues and a growing number of sexually transmitted diseases.
Mace (1974) defines sexual health as being a combination of the somatic, emotional, intellectual and social aspects of sexuality which enhances personality, communication and wellbeing, giving the individual an enriching positive experience. There are three basic elements of sexual health, which are, the capacity to enjoy sexual and reproductive behaviour in accordance with a social and personal ethic. Freedom from fear, shame, guilt, false beliefs and other psychological responses, freedom from impaired sexual relationships and freedom from organic disorders, disease and deficiencies that interfere with sexual and reproductive functions.
All individuals consider sexual health and wellbeing differently, this is usually determined by their own sexual experiences and /or by their interactions within the healthcare system. Within the healthcare system there are nurse led sexual health clinics. These clinics are run by specialist nurses in sexual health and are available to any individual seeking advice or guidance in relation to their sexual health needs. These clinics provide patients/clients with one stop specialist sexual health screening, family planning advice, sexual transmitted infection tests which when results are given can also provide prescribed medication that can be given free of charge. They can also use a referral system for counselling and hospital admission.
Sexual health is a sensitive area, set in a rapidly changing society and health care system. Providing sexuality and sexual health care can be an intimate process.
Scotland has a history of poor sexual health with rising incidents of STI’s, which include HIV.
The sexual health nurse practitioner must have the skills to give the client the best informed care available. There is an abundance of research studies available to the sexual health nurse in improving their knowledge and the latest changes to policy and procedures within the NHS healthcare system. Taking a holistic view approach to the individual sexual wellbeing but at the same time recognising the individuals diversity of moral, cultural and ethical view of their sexual health. The skills involved in this area are, being able to identify the needs and priorities of the individual. Being able to set aims and objectives that are acceptable and which are seen as a reachable target by the individual. The sexual health nurse must always include the client in all decision making, consulting and negotiation of the client needs and care. This cannot be obtained unless the practitioner has up to date knowledge of policies and available resources within the clients graphical area. Being able to plan, act and evaluate the care and treatment of the individual, is vital in the aim of empowering the individual to gain control of their sexual health. But of the most vital skills required, is a skill that is used across all areas of nursing, which is communication, without this the client will not feel trust and care, thus will not improve their health. There are staff training and development programmes in all services that address sexual health issues as appropriate to the needs of the client group. This includes services for which sexual health is not a main priority. Staff should be expected to be knowledgeable, supportive and non-judgmental in their approach to clients. Using evidence-based knowledge which is available through a varied means of learning, gives the sexual health nurse up to date insights on changes and recommendations of daily practices within the sexual health area of healthcare.
With Scotland having the highest rate of unwanted pregnancies in Europe. Many sexual health statistics show the higher amounts of recorded STI’s are in areas of the poorest population. Sexual health services in Scotland treat large numbers of young female adults with low cost interventions, but this has proved to be poorly developed due to under-investment, lack of strategic leadership and low prioritisation. These factors have resulted in a variance in accessibility and quality of services available to this clientele. With sexual health being a personal and sensitive area of health. There is still a stigma attached to the use of these services, that can result in the lack of public involvement and proves difficult to obtain a public voice.
Scotland issued a national sexual health and relationship strategy. This was published as the Respect and Responsibility: strategy and action plan for improving sexual health in Scotland. This strategy was launched in January 2005, with the aim to enhance sexual health promotion, education and services provisions, which is now in its second phase (2008-2011). This is to address the wider societal issues related to sexual health with shifting cultural and behavioural change. The strategy has nine standards, that set out the initiative. The developments of the second stage includes a publication of an HIV Action Plan, that has prevention as its main core and commitment in providing treatment and care for all those who need it.
All sexual health services performance will be monitored in each of the NHS Boards areas by the NHS Quality Improvement Scotland (NHS QIS).
The government standards are not a set of rules but a guidelines for all NHS Boards to develop and improve sexual health services. The standards are set out as follows: Standard One – A comprehensive range of specialist sexual health services is provided locally and that individuals with the greater need are treated as a priority. This means that each NHS board must provide a full range of sexual health services that will identify the needs of the local population and to prevent inequality within the area. These services must ensure a high quality of care within these services to reduce individual morbidity and maintain public health.
Standard Two – The public has access to accurate and consistent information about sexual health relevant to the client’s needs. Access to accurate and unbiased information, this can only assist if the client attends the service facility or if information is made available within all doctor’s waiting rooms.
Standard Three – NHS boards ensure the development and delivery of integrated approaches to sexual health improvement, particularly in relation to young people. This standard is in relation to the role of the parent or carer and the positive influence that they assume there is between parent and child, but this is not always the case in most families and certainly not in the case of young adults over the age of twenty-five.
Standard Four – Individuals who are diagnosed with a STI, see an appropriately trained member of staff to organise partner notification (contact tracing). This would be an ideal strategy in the prevention of increased rates of STI’s but we do not live in a society that is so open and understanding with each other.
Standard Five – Individuals attending for ongoing HIV care are offered high quality sexual and reproductive healthcare to improve personal wellbeing and to minimise the risk of transmitting infection to others. This will raise the quality of sexual and reproductive healthcare provided for this clientele.
Standard Six – Women receive safe termination of pregnancy with minimal delay, followed by contraceptive advice and psychological support. The Sexual health nurses role in this situation is to provide information on all contraceptive interventions and arrange for counselling if the client needs it.
Standard Seven – Men who have sex with men who are at risk of sexually transmitted hepatitis B are offered vaccination. Statistics show that homosexual men are 54% more likely to seek sexual health advice than a heterosexual male.
Standard Eight – All individuals have access to intrauterine and implantable contraception. These are more effective and the individual is not required to have continuous routine follow-ups until the expiry of the contraception. This can reduce the rate of unwanted pregnancies but eludes the need for education of the individual’s sexual behaviour.
Standard Nine – All staff who deliver sexual health are adequately and appropriately trained. Sexual Health care like any other area of healthcare requires a high standard of competency, with a non-judgemental and sensitive approach towards the individual. The staff must also be aware of legal and local policies to protect the individual and their care.
Sexual health is not just about clinical services. These services must make a contribution to the vast effort of promoting sexual health rather than just that of sexual behaviour. This may result in, these services only being beneficial to this client group, if they attend. But for those that are not fully aware of these confidential services, the only other means of finding out about these services is through the power of literature provided within doctors surgery waiting rooms or through advice and instruction from relationships with peers and family. This has a follow on effect to the quality and amount of sexual health and relationship education reaching Scotland’s young female adults.
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Sexual health services such as Specialist Family Planning Clinics, Genito-Urinary Clinics, GP’s, Chemists and Nurse Practitioners can provide sexual health services that the individual can use to access advice, information, contraception such as condoms, morning after pill to longer lasting contraception such as implant (Implanon), Contraception Injection or the IUD (Coil). These are measures to stop unwanted pregnancies but these services also provide screening for STI’s with follow up assistance and guidance.
Within these services, the sexual health nurse will provide the instruments for avoiding STI’s, unwanted pregnancies and all screening and testing but they must also provide the individual with holistic health education. An individual’s emotional, social and spiritual aspects of their health are just as important as the physical aspects. People learn best when they feel secure, the relevant and appropriate needs are met, they are actively involved and know and understand what has to be done to reach their goals set but most importantly they are respected as individuals in their own right. (Daines et al 1992)
For the sexual health nurse, there are several models of nursing that can be used with the nursing practice of sexual health and behaviour. Beattie’s Model of health promotion offers a structural analysis of Health Promotion. Beattie suggests that there are four strategies of health promotion which are 1. Health persuasion. This is aimed at the individuals and is co-ordinated by the sexual health nurse and other members of the multidisciplinary team, to be persuaded and encouraged the individual to change to a healthier lifestyle. The sexual health nurses role is to be the expert or ‘prescriber’. Activities include advice and information. 2.Legislative action. This strategy protects the population by making healthier choices available. The sexual health nurse is the role of ‘Custodian’ knowing what will aid the improvement of the individuals health. Activities could include policy work and lobbying. 3.Personal Counselling. The Sexual health nurse use their skills to empower the individual to have the confidence to take more control of their health. This intervention is client led with a focus on personal development. 4.Community Development. This strategy is similar to personal counselling, with the aim of seeking to empower or enhance the skills of the community with their sexual health with further education.
Beattie’s model is a useful tool for the sexual health nurse because it can identify a clear framework for deciding a strategy but remind them that the choice of interventions can be influence by social and political aspects. (Beattie, 1991)
Tannahill’s model of health promotion is extensively accepted by health care workers. Tannahill’s model takes a holistic view, showing that all three spheres of activities are entwined. The three spheres of Tannahill’s model are Health education, which emphasises on communication to enhance well-being and prevention of ill health through knowledge and attitudes. Prevention, by reducing or avoiding risk of disease or ill health through medical interventions. Health Protection, using legislative, fiscal or social measures in the bid to safeguard the populations health. This model suggests that all aspects are interrelated but they also reflect distinctive ways of looking at health issues and is descriptive of what goes on in practice but does not show why the sexual health nurse may chose one approach over another. (Downie et al 1996)
There is also the Empowerment model by Tones, which its main principle is to enable individuals take and gain control over their own sexual health. Healthy Public policy + Health Education = Health Promotion, health promotion involves improving a population’s health through improvement of their lifestyle (or behaviour), environment, and health policy. It prioritises empowerment as the core value and strategy underpinning and defining the practice of health promotion. The support of the individuals is also vital for implementing change. Tone’s model of empowerment enhances individual autonomy and enables individuals, groups and communities to take control of their sexual health. (Tones & Tilford 2001)
All the above models aid the sexual health nurse to think through the aims, implications of different strategies and their own role as the practitioner with a successful outcome.
Health promotion has a full range of modifiable determinants of health which are not just concerned with only individual behaviours and lifestyles but other societal factors such as income, social status, education, employment, work conditions and also factors such as access to health services and their physical environment. These effect everyone throughout their lives and health. This is a ongoing challenge within health promotion for sexual health nurses.
Using data collected from GUM clinic setting, between 2004-2008, it was observed that diagnosis of STI’s, as an example Gonorrhoea infection had raised 77% within young adult females group. Even though this seems to be a large percentage of reported cases, Scotland is ranked ninth (for Gonorrhoea infection) in comparison to thirteen areas of the United Kingdom.
Within Scotland, the Scottish Government are diligent in obtaining the national statistics in regards to sexual health as this give them a clearer insight on how to update and promote better health services available to the population.
Scotland’s statistics for STI’s with young adult females (25-45). In the past five years (2004-2008) of data collection, there has been on average 3,388 reported cases and this covers eleven NHS Boards covering Scotland.
Although data show that STIs, unintended pregnancy and abortion are more prevalent in those aged less than 25, these issues also affect older age groups. In 2008, individuals aged 25-44 comprised 40% of the workload in GUM clinics. While one third of all acute STI diagnoses made in the GUM clinic setting are attributed to this age group, over half of acute STIs among those aged over 25 are being diagnosed in the 25-29 year age group. (ISD 2009)
There are many people in Scotland that experience positive sexual relationships and good sexual health but looking at the statistics, they show that there is a growing concern within the promotion of sexual health. The media has an impact on society and their choices. Sexual imagery is used in today’s society as a tool to entice the consumer to spend money. It uses sex and relationships to emphasise stereotypes about different beliefs in activities and behaviours, usually in a way that ignores the risks associated with sexual behaviours, and has contributed to the casual attitudes to sexual issues are risk free and acceptable.
But, the media can be a powerful tool in regards to getting the important messages of sexual health out to the public and can also be an incentive tool in recruiting individuals to help with government campaigns to change the attitudes of the younger generations view of sexual health.
In conclusion, the sexual health nurse is a varied role in society, with the ongoing challenge of assisting the younger female adult obtain a good sexual health attitude and showing them how to promote good sexual health as peers.
The government is working hard to raise Scotland’s standards of sexual health for the individual and communities, which can aid the struggle of reducing the numbers of STI’s reported across Scotland.
All individuals have their own views of sexual health and healthcare services are there to give them more information, support and guidance on their sexual health needs. This, if nurtured can reduce statistics and for the next generation of Scotland be sexually healthier.
Scotland’s sexual health issues cannot be remedy overnight but with continuous improvement and availability of sexual health nurses and services, Scotland can look forward to a positive sexually healthier Scotland.
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