Over the last twenty years, two events have occurred which have shaped sexual health promotion and education, specifically, the emergence of the HIV epidemic and the change in social attitudes towards sexuality and sexual behavior (Irwin, 1997). These events are in turn reflected in an increasing emphasis on primary prevention (DOH, 1992). Health promotion and health education within this clinical area is a legitimate role for the health professional and is an essential nursing function (Ingram-Fogel, 1990).
In 1987 The World Health Organisation (WHO) discussed the issues of sexual health promotion and concluded that due to a wide range of individuals, cultures, social differences, sexuality and gender roles, there is no single definition of a sexually healthy individual. However, Curtis et al (1995) cites the WHO’s (1986) description of sexual health state that, “He or she needs a capacity to enjoy and control sexual and reproductive behaviour in accordance with a social and personal ethic. Freedom from fear, shame, guilt, false beliefs and other physiological factors inhibiting sexual response and impairing sexual relationships.
Freedom from organic disorders, disease and deficiencies that interfere with sexual and reproductive functions “. This definition appears to focus on the positive elements of a sexual being with an element of negativity surround “disorders and disease”. The author has recently completed a placement a Watford general hospital and was given the opportunity to visit the Genito-urinary medicine clinic and observe the nurses giving advice and treatments to patients and was able to gain a better understanding into the specific role that they perform.
The department its self was well organised and very welcoming, the staff are approachable within a relaxed environment, it appeared to the author that the main reasons for attendance to the clinic was that the patients had exposed themselves to sexually transmitted infection (STI’s) for example Chlamydia, Herpes simplex and the human immunodeficiency virus (HIV), or concerns about exposure to organisms.
When clients attended the clinic they were fully assessed by the staff and the appropriate clinical tests carried out, the clients health education and health promotional needs were also assessed, the primary task is to establish the clients current knowledge and understanding of the ways that STI’s are acquired. This situation demands an equal and non-judgmental relationship between the Nurse and client, and is referred to as “androgogy” or the art and science of teaching adults (Knowles, 1973 cited. n Nicklin and Kenworthy, 1995). Knowles (1973, cited in Nicklin and Kenworthy, 1995) suggests that this allows the client to learn through experience and accomplishment, and build on existing experience and knowledge. This can be achieved through a basic verbal question and answer scenario. This encourages the thought processes of the client and identifies key factors inherent to the problem of unsafe sexual practices (Walkin, 1990).
Therefore a full evaluation is made on the specific areas where the nurse believes they need information or advice, there are two main characteristic dimensions of health education, which can guide the nurse, both of which are supported by Gott and O’Brien (1990) and state, “The transmission of information to individuals perceived to live in ignorance of it, and The creation of trusting relationships with clients, so that they will be more likely to adopt the advice given to them” (Gott and O’Brien 1990). ”
During a consultation with the nurse the patient is able to ask any questions or discuss any concerns they may have, in return the nurse is able to assess what safer sex means to the patient and whether they have the knowledge about the correct way to use protection, it might be that the patient is embarrassed to say what the problem is and the nurse has to cover all specific areas in turn, thus giving the client information on all types of protection and the ability to understand the consequences of not protecting themselves , this empowers the client with the vital information that they need and makes them more aware of the preventative measures they need to take and where the protection is available. The author noted that on two occasions during a consultation with the Nurse that the clients were unwilling to discuss the reasons as to why they failed to use the correct protection or discuss the implications they believed it might have on them, they just wanted to be free from the STI and forget about what had happened.
In these particular cases there was a need to attempt to change the client’s attitude towards a healthier lifestyle, which would allow them to have a better understanding of safer sex issues. The aim of changing a persons behavioral approach is to encourage the client to take up healthier behavior for example to discuss and demonstrate the correct use of a condom, enabling the client to make informed decisions therefore a behavioral change maybe achieved, the nurse explained to the author that although the client is agreeable to the change it may well be short lived, so the need for health education is vitally important. Sexual Health Education can be defined as ” efforts aimed at producing positive changes in attitudes and in health seeking behaviors in sexually transmitted diseases and their prevention ” (WHO, 1991)
Sutton and Payne (1997) suggest that education and learning in sexual health can be considered under four basic principles, these are, “Adults learn from one another as well as the educator, they learn from asking questions and getting answers. Within a group setting, they learn from other people’s questions and answers, especially the shy or inhibited. This may not be practical within the client/professional relationship in the GUM clinic, but can be applied, where the aim is the promotion of sexual health. They learn from talking. By listening to the client talk and encouraging them to disclose their fears, misinformation can be corrected and worries allayed. ” (Sutton and Payne, 1997).
The author observed the nurse on numerous occasions where she spoke to both male and female clients, assessing, treating and advising clients, they appeared to listen and take on board the advice that they were given, it is important that the nurse does not dwell on the negativity of the STI or disease as this may have the opposite effect and the client may well switch off and ignore any information that is given to them, although during the consultations that the author observed there was a good nurse/client relationship, the clients appeared relieved and happy to talk to someone who was not judgmental as to why they were there. This essay has briefly considered an approach to sexual health promotion and education.
In order to evaluate the impact of health promotion and its educational outcomes, it would be of benefit to have further discussions about safer sex with the client at subsequent follow-up appointments. However, most behavioral changes take time, and constant reinforcement can have the opposite effect when discussing issues surrounding sexual health. Due to the client’s having a tendency to distance themselves from the situation being discussed (Miller and Bor, 1991) It is clear to the author that health promotion and education are an ongoing processes and that as professionals it is important that we have a clear understanding of the role of the nurse in this activity. It is also a fundamental requirement for the nurse, to have an ongoing process of positive strategies to meet the needs of the client, now and in the future.