Running Head: COMMUNITY NURSING LEARN REFLECTION

Reflection on Observing in Sexual Health Clinic as Part of Community Nursing Placement Melissa Jenkins Trent University

COMMUNITY NURSING LEARN REFLECTION Reflection on Observing in Sexual Health Clinic as Part of Community Nursing Placement As part of my placement at the Peterborough County-City Health Unit (PCCHU) I was given the opportunity to observe the work of two Public Health Nurses (PHNs) in the sexual health clinic during an MD clinic. This experience greatly broadened my understanding of the role of community nurses, especially public health nurses. During my shift, I was able to observe the PHNs take patient histories, perform pregnancy tests, and collect urine samples for testing regarding gonorrhea. I was also able to speak with them about their roles in the MD clinic as well as their other duties at PCCHU and the PHN run clinics. Through these interactions I was able to garner a better appreciation to their roles and scope of practice and became quiet interested in the role they play in educating patients about safe sex practices and sexually transmitted infections (STIs). Observing several patient histories increased my awareness of the cliental of the sexual health clinic in Peterborough. Prior to this experience, I believed that most clients of sexual health clinic would fall under two categories, teenagers and sex workers. I was pleasantly shocked to find that this was not necessarily the case. Many of the patients seen the night of my shift were young to middle aged adults. Many were there for suspected STIs and pregnancies but a few were there for preventative measures. Specifically one couple had come in in order to speak to the physician about their relationship in terms of the one partner having herpes. PHNs play an integral role in educating patients about STIs, their risk, and how to protect themselves. Two cases were particularly good examples of this. One case involved a young adult male that came in suspecting he had gotten HPV (human papilloma virus) as evidenced by a wart on his penis. HPV is one of the most common

COMMUNITY NURSING LEARN REFLECTION STIs in North America, with approximately 50% of sexually active adults contracting HPV at some point in their lives (Jordan 2008). Risk for HPV is related to age of onset of sexual activity, number of sexual partners, smoking, and oral contraceptive use (Jordan 2008). During his patient history it became evident that he had had many sexual partners in the last year that were too numerous for him to remember. Recognizing his risk the PHN addressed his concern by stating that even though he always used a condom it could be HPV and that the physician would be able to diagnosis and treat him that evening. He did not take this news well and found it very hard to cope given that he had always protected himself. I felt the nurse handled this situation as well as was able by trying to console the patient using statistics and information about the disease. The second case involved a young woman who rarely used protection and had been seen before for suspected pregnancy and STIs. She had come back under the same concerns again, especially about a recurrence of HPV wart outbreak. I found this case fascinating because the patient had expressed that she did not want to become pregnant and did not want to contract any more STIs yet was failing to use protection. She also turned down the PHNs attempts to address safe sex practices. The PHN respected the patients wishes and continued taking her history and conducted a pregnancy test. Through conversations with the PHNs after each of the cases I learned that dealing with patients like these can often be frustrating. PHN have a unique opportunity to affect the behaviours and practices of their patients in order to reduce the transmission of STIs. With the rate of STIs increasing in adolescents and young adults it is important to identify and practice strategies that are effective at educating these individuals which is a primary goal of PHNs (Royer & Zahner, 2009). Discussion during class indicated that there are several reasons why this group holds misconceptions and why rates may be increasing. The common belief that it

COMMUNITY NURSING LEARN REFLECTION wont happen to me is out there as well as general misunderstandings of the different STIs, how they are transmitted, what the symptoms are, how they are treated, what puts them at risk, and what the risks of contracting one are. In addition STIs are still highly stigmatized. As part of the Common Sense Model (CSM) individuals generate representations of health threats such as STIs (Royer & Zahner, 2009). Interactions with health care providers such as PHNs are part of the process of building these representations (Royer & Zahner, 2009). In order to help adolescents and young adults build medically sound representations regarding STIs it is important to identify that misconceptions often exist within this group (Royer & Zahner, 2009). This can be evidenced by the upset experienced by the young man who could not be consoled about his possible HPV by being told that most sexually active individuals contract HPV and though not curable it responds well to treatment due to his belief that all STIs are the same and the worst case scenario type situations. Royer and Zahner (2009) provide several ways that the CSM can help PHN address misconceptions. They suggest identifying individual representations and understanding that emotions also play a part in the development of these representations. By being sensitive to these emotions and representations PHNs may have increased efficacy when it comes to education and reduction of STIs. The PHNs at the PCCHU are effective at creating an environment that is welcoming and does not stigmatize individuals. They maintain an air of confidentiality and professionalism. If they make judgements regarding individuals it does not show. The PHNs were also able to identify some representations regarding STIs in the patients seen, and were able to address these

COMMUNITY NURSING LEARN REFLECTION in hopes of encouraging a change in behaviour. I think these are valuable skills that have developed through years of experience and practice and for which I greatly admire them. Moving into the future I think it is important to find new strategies for prevention of STIs and health promotion for individuals at high risk for STIs and unwanted pregnancies, who are often the clients of sexual health clinics held at health units. Though the PHNs at the PCCHU provide competent nursing care and strive to educate patients in order to prevent STIs and unwanted pregnancies, I feel there is always room for improvement. The article by Royer and Zahner (2009) introduced new ways to think about educating adolescents and young adults which can be easily applied to my future practice. The amount of welcoming and professionalism I felt at the clinic is an aspect that I hope to introduce into my practice to ensure that I am offering safe, competent, and effective care to patients in these situations. Everyone makes judgements but the PHNs of the PCCHU were effectively able to mask these judgements when dealing with patients, something that I hope that I am equally able to do when I enter into practice. This experience broadened my understanding of the role community nurses participate in at the PCCHU as well as the role of PHNs. I have come to understand a great deal more about the role of PHNs and STIs prevention, assessment, and health promotion. My perceptions of the sexual health clinic have changed. This experience has also increased my knowledge regarding STIs and contraceptive methods. I view it more as a positive space both for patients and nurses. I have a greater understanding of the clientele. I am thankful for this experience and look forward to applying this knowledge in my future practice.

COMMUNITY NURSING LEARN REFLECTION References Jordan, K. S. (2008). Sexually transmitted infections: A major public healthy challenge for advance practice nurses. Advanced Emergency Nursing Journal, 39(1), 63-74. Retrieved from http://journals.lww.com/aenjournal/pages/default.aspx Royer, H. R., & Zahner, S. J. (2009). Providers experience with young peoples cognitive representations and emotions related to the prevention and treatment of sexually transmitted infections. Public Health Nursing, 26(2), 161-172. doi:10.1111/j.1525.1446.2009.00767.x