This article focuses on the need for mental health nurses to promote sexual health. As a mental health nurse I have observed that during practice, nurses are encountering problems dealing with sexual health issues in mental health. Clients have experienced sexual health needs that nurses failed to meet and many nurses have experienced that they are out of depth.
Lomas (2009) carried out a survey with at least 283 mental health professionals of which half of them were nurses. Evidence from the research showed that even though 80% of the participants were in support of the idea that sexual health promotion was a vital part of their role, only 30%, representing less than half the participants regularly discussed sexual health with mental health patients, (Lomas 2009). A revelation also made by Lomas (2009), survey suggested that 92% of respondents had no clue that people with schizophrenia were at an increased risk of contracting HIV than the general population, 72% were not even convinced that they were more likely to engage in high-risk sexual behaviour. From the participants, 14% felt uncomfortable discussing sexual health issues with mental health patients, gay and lesbian issues was a very uncomfortable topic for 13% of them. This queries whether mental health nurses are well equipped to promote sexual health, (Lomas 2009),
Through this, mental health nurses must learn to appreciate the clause from the National Midwifery Council (2004) stating that health care professionals are expected to continuously update knowledge and skills throughout our working life and regularly take part in learning activities that develop our competence and performance. In support to this, Higgins et al (2006)suggested that individuals with `severe’ mental health problems will most likely end up engaging in high-risk sexual activities creating the susceptibility to sexually transmitted infections. In Higgins et al (2006)literature review from 1980 to 2005 focusing on sexual health education and sexual dysfunction emanating from prescribed medication, it was confirmed that sexual health education programmes were beneficial. Education proved to produce a reduction in sexual risk activities compared to complete cessation. This undoubtedly highlights the issue that mental health professionals should make an effort to deliver holistic care that includes sexual health promotion (Higgins et al 2006)
In a similar study conducted but this time it included Glove-wearing Hughes and Gray (2009) states that only 61% of the participants reported wearing gloves whilst administering an injection. Hughes and Gray (2009) continue to say that the nurses are also risking infection by not wearing gloves.
Bahrick and Harris (2009) emphasises that antidepressants are a popular cause for sexual dysfunction. This suggests that reassurance and advice from nurses becomes a necessity. Having an understanding of sexual health would make it easier for nurses to offer appropriate advice because sometimes this becomes debilitating for the mental health clients and therefore requires intervention Bahrick and Harris (2009). Hughes and Gray (2009) mentioned that the lack of awareness and knowledge of sexual health does not only leave the clients disadvantaged by not having reasonable access to sexual health services or relevant information on sexual health. Hughes and Gray (2009) goes on to say that by this level of lack of knowledge, the mental health nurses continue to place themselves at risk.
In a study conducted by Cochran and Mays (2000), evidence was transparent that there was an escalated risk of suicide symptoms among homosexually experienced men. Cochran and Mays (2000), further explains that some gay men also reported the risk of recurrent depression as slightly increased. This again makes it a necessity for mental health nurses to be aware and well equipped w ith sexual health knowledge in order to be able to holistically assist their clients in a non judgmental manner. (Cochran and Mays 2000)
Interestingly MIND (2008) highlighted another good reason for mental health nurses to be aware of sexual health issues. MIND (2008) explained that the distress experienced by some lesbians, gay men as well as bisexual’s mental distress is not due to their sexuality instead it is seen as the impact of heterosexism and homophobia, MIND (2008). As a result of this, many lesbians, gay men as well as bisexual’s find it a daunting task for fear of being seen as abnormal as well as not being understood. MIND (2008) confirms that there is evidence that these concerns or worries are not baseless as homosexuality used to be seen as a psychiatric diagnosis in 1993. Although nowadays there is an improvement in the awareness in the mental health field, it would be more beneficial for mental health nurses to be well equipped to deliver sexual health to clients with serious mental health problems (Mind 2008)
Implications for practice
This exercise has made it possible to identify gaps in service provision. From my own experience, I have witnessed situations were mental health clients bring contraceptive pills on the ward and the nurses role is to administer them. This questions whether these clients suffering from severe mental illness are aware of other sexual health issues other than pregnancy. In support to this, The Royal College of Nursing (2001) has highlighted that contraception alongside teenage pregnancies and sexual infections are some of the significant issues that have a great impact on health care practice. The Royal College of Nursing (2001) has highlighted that “sexual health is about the holistic care of patients and clients”, it was also brought to attention that Clinical practice, Clinical education practice and Clinical policy development are essential in ensuring holistic care in sexual health. This has proved that evidence based practice is essential in delivering successful holistic care. This includes sexual health for mental health patients facilitated by mental health nurses. In support to this, Dawes et al (2005) emphasises that evidence based-practice ensures that individual health professionals practice based on sound research and successful outcome. Every registered nurse needs to consider the evidence-based for practice in a multitude of areas as this is a requirement of Nursing and Midwifery Council (NMC 2004).
Having a good knowledge base on sexual health promotion will not only help to educate mental health clients on sexual health but when health promotion is carried out by mental health nurses, it could become cost effective. This will also be supporting the Government in fulfilling its pledge in the NHS Plan to make progress in the amelioration of ill health. The Royal College of Nursing (2001).
Through undertaking a literature review, this has also provided guidance that will enable us as mental health nurses to be keen on development and evaluation of sexual health education programmes that will be beneficial for our service users. However, this also enlightens us to the fact that mental health nurses need to prioritise sexual health training and practice development or make an effort to make it part of their personal development plan in order to bridge the theory and practice gap. It should also be noted that they are also some hindrances. It is obviously a rather daunting task after considering the financial issues faced by the government as a result of the recession. The Royal College of Nursing (2001) has highlighted that a lack of interest to develop knowledge in sexual health has been one of the hindrances. On the other hand, another advantage brought about by continuing professional development is that resources are utilised more effectively. This is confirmed by the Chartered Institute of Professional Development (CIPD 2010), continuing professional development makes staff become more productive and work with efficiency by focusing on their own learning through reflection, (CIPD 2010).
The health care delivery system is plagued by lack of resources. Updating knowledge and skills ensures that the best use of these resources is put into practice. A continuing professional development allows the individual to work out what area of practice requires development in this case sexual health promotion by mental health nurses, This will be made possible through highlighting gaps in their knowledge and experience.therefore giving the individual a chance to compare what knowledge and skills they possess, and what is expected at their level of professional practice, (CIPD 2010).
Sexual health skills are required or desirable to meet the demands of the promotion of sexual health. It also serves as a way of improving one’s competences to ensure satisfactory performance during sexual health promotion. Enhancing knowledge and skills for mental health nurses allows the individual to engage in evidence based practice. Simpson and Dodds (2004). This promotes conventionality minimising ambiguity and rendering information shared between health professionals and clients. Improving teamwork this way reflects a climate that best supports a therapeutic environment (Simpson and Dodds, 2004). Another vital point to make is that this form of practice could be useful to bridge the theory – practice gap as research evidence have proved that mental health nurses certainly need to be better equipped to promote sexual health. Hughes and Gray (2009) argue that it is essential for policies to improve in order to extend on the achievements of the National Service Framework for Mental Health. The New Horizons programme is a programme that was launched by the Department of Health in 2009; this is a 10-year strategy to continue to improve the mental health services offered by 2020. However, this does not mention sexual health, (NHS Choices 2010)
The Royal College of Nurses (2001), states that health promotion policies that dispel inequalities in sexual health should be put in place and utilised. In addition to this, Gray et al (2002) pointed out that the sexual health policies of several mental health NHS Trusts are completely out dated, Gray et al (2002) further says that most of these policies simply states that patients are not permitted to have sex whilst on the ward. Gray et al (2002) gave as an example a policy from a mental health Trust that simply states that ‘Sexual activity involving patients on hospital premises is not an acceptable form of behaviour’.
Developments and improvements in practice need to be made. In order to achieve safe effective nursing practice, it is paramount to be able to enhance knowledge, skills, values and attitudes towards professional practice. This could be done through staff training and adopting a learning culture. However, time and duties need to be well managed in order to make this a success. In addition to this, Nurse Week (2005), points out that nurses tend to spend most of their time in administrative and managerial duties which prevent them from spending time engaging in more therapeutic work with patients. A learning culture is a practice of a ‘no blame’ approach to management which according to Collier (2005) generally translate theory and directives into practice in a meaningful way.
Conclusion
In conclusion, this article has demonstrated the relevance of mental health nurses having a good knowledge base of sexual health and the benefits of it and substantiated it with evidence The literature used during this exercise highlights the need for mental health nurses to have sexual health knowledge and how much the mental health patients will benefit from sexual health education. It has also proved that with sexual health education, evidence shows that they can be a reduction in sexually transmitted infections. It is important to state finally that this exercise has given me a clear understanding of the importance of mental health nurses being able to promote sexual health. It is clear that clients with mental health problems are more likely to experience problems with their sexual health.
The experience I had made me realise that knowledge is power and when faced with situations were mental health clients have sexual health needs they do not have enough knowledge on. Health promotion is also identified among the seven pillars of clinical governance initiative (DOH, 1998), in which I will be expected to engage in my professional practice as a registered nurse. In order to practice ethically and to empower clients to live an independent life, mental health nurses need to have knowledge about how to respond to the needs of people with mental illness in an ethical, honest, and non judgemental manner and this includes sexual health.
By Beatrice Kungwengwe