- Hina Mirza
As a part of Reproductive Health Course year III BScN, for community clinical we went to karimabad colony to assess family needs related to health. There I visit one family that I choose as my secondary client. After assessing different dimension of health when it comes to Reproductive health assessment, I took initiative by asking about normal menstrual cycle of the mother and her daughter as both were alone in the room. The mother told me that she has reached to menopause and the girl who is 22 year old was having normal Menstrual cycle. Further I proceed to another concern that has been came into noticed is leucorrhea; Studies shows that the prevalence of leucorrhea in Pakistan is very high which is 12%. (Chris Kenyon, 2013). The girl nod the head into yes while responding to me but her facial expression seems to be anxious towards me. I tried to dig on to this query which I had in mind that whether the girl has any concern related to reproductive issue which she thinks needs to treated. After completing my question I made an efforts to ask more questions but it seems difficult for me when it comes to reproductive health because I was not confident and familiar with the vocabulary that is used in reproductive health and on the other hand it was my first interaction with that family so I don’t want to invade their privacy or make them feel uncomfortable. As soon as I finished my part the mother stated that “Yes, she complaint sometimes about discharge that is irritating and smelly and in addition to it some burning sensation in perineal area, might be she is having infection”. Afterwards I wanted to ask to the girl about characteristics of discharge and sexual behaviors that lead to infection as stated by her mother but suddenly, her Father came into the room and I stopped myself from asking more about it because I feel that it will bother her to talk about it in front of her father as well as I lost my confidence level in this particular component of health, in terms of privacy. Moreover, she also felt uncomfortable and tried to change the topic.
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When I reflect back the situation, I feel I should not discontinue the topic because the girl might have some serious issue related to the discharge and there might be some reproductive health concerns that were in her mind. That is why when I asked her about the discharge, she respond to it so anxiously and promptly and it seems like that she wanted to share something with me.
When I analyze at my part, that why this incident happened to me was firstly, due to lack of confidence in dealing with reproductive concerns of the client. According to Literature, “More general predisposition, such as comfort and confidence, that might influences nurses openness to dealing with patient sexuality” (Cort et al., 2001) Secondly, my own sociocultural barriers that how should I invade someone else privacy and also client’s perception that they might have while discussing such stuff. This made me overprotective for the conversation supported by the literature that “The first line of inquiry culminates in the classification of nurses as liberal or conservative in their views about specific sex-related behaviors” moreover according to literature, Reproductive health is not openly discussed in many cultures of the world and that is why client hesitate to raise questions and concern related to these issues with their health care provider (Tsai.Y, 2004). Thirdly, the communication problem contributes major part to this incident, it seems difficult for me to decide what best vocabulary and way of communication enable health care provider to make client understand about the main focus of the discussion evident by literature that “Communication about health and sexuality often differs by ethnicity, age, socioeconomic status, geographic location, and sexual orientation. Communication patterns can form serious obstacles to care”( Moss.T, 2004) Lastly, if I look at the surrounding one more barrier in discussion was privacy factor because of her father came into the room and that made me hold back the discussion.
Few of the things that I could have done so that I can help out the patient at that time related to their reproductive health issues by maintaining my confidence level by increasing competency in reproductive health nursing before visiting the client. According to the article, Nurses’ state that they do not initiate to assess reproductive health of client due to insufficient knowledge regarding problem that patient might raise during conversation (Magnan.M et al., 2005). In addition to it I could have kept my sociocultural barriers aside and making client needs as priority because reproductive concerns are majorly remain unaddressed and it has been observed that client wait and expect health care provider to initiate these topics. “Although patient have said that discussion with nurses is appropriate and that they would prefer having nurses initiate the discussion” (Magnan.M et al., 2005). Last but not the least if her father came into the room I could have been stop for a while but after seeing appropriate time I should have made the first move to ask her about her reproductive concern or if still she is uncomfortable I could tell her to talk to me in privacy, may be in other room or as she prefer. As evident by literature “Lack of confidentiality is often a barrier to the delivery of health care services, especially reproductive health care, for adolescents” (Committee on Adolescent Health Care, 2010)
To conclude if this kind of scenario ever happens again the experience will facilitate me to boost up my confident by making me realize my mistake of neglecting one patient’s health. Besides this by gaining more competencies in vocabulary, knowledge and communication pattern in reproductive health will help me to address the client needs and initiate the concerns in which client face difficulty to elaborate.
Kenyon, C., Colebunders, R., &Crucitti, T. (2013). The global epidemiology of bacterial vaginosis: a systematic review. American Journal of obstetrics and gynecology, 209(6), 505-523.
Tsai, Y. (2004). Nurses’ facilitators and barriers for taking a sexual history in Taiwan. Applied Nursing Research, 17(4), 257-264. doi: 10.1016/j.apnr.2004.09.011
M,T. (2004). Barriers to Health Care for Youth of Color.
Committee Opinion(460). (2010). Retrieved from The American College of obstetricians and Gynecologists womens health care physicians website: http://www.acog.org/~/media/Committee Opinions/Committee on Adolescent Health Care/co598.pdf?dmc=1&ts=20140501T1128433150
Magnan,M.A., Reynolds,K.E., & Galvin,E.A. (2005). Barriers to Addressing Patient Sexuality in Nursing Practice.MEDSURG NURSING,14(5). Retrieved from http://www.kc-courses.com/fundamentals/week15diversitygrief/barriers.pdf
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