The knowledge on counselling of rape and HIV/AIDS victims is the same as in a family planning client. You will now explore counselling patients seeking reproductive health services in a health facility. As a community health nurse, you may have come across several patients seeking family planning services in the clinic.
As a nurse in practice you should be familiar with all the methods used to provide reproductive health services. The GATHER methodology of counselling will be used for this section. However, before you start this section you should revise the following:
• The anatomy and physiology of the male and female reproductive organs
• The methods used in Family Planning and their relative merits.
Receiving a Family Planning Patient.
Here is a guide to using the GATHER methodology with a family planning (FP) patient.
Greet the patient as they enter clinic/FP room and offer them a seat. Close the door and (if appropriate) open the windows for fresh air. Introduce yourself to the patient and explain the type of reproductive health services offered in the clinic.
Assure the patient about the confidentiality of everything discussed. Ensure there is privacy in the room and nobody else can hear the discussion. The room should have no distracting diagrams, except those of family planning. After establishing rapport with the patient and feeling that the patient has gained confidence, ask them what they need from you.
Ask the patient about themselves and their family. Ask them to tell you what they know about family planning. Ask them to describe any of the specific methods they are aware of. Ask them if they have discussed reproductive health with anyone else before coming to the clinic. Ask them to tell you if their partner is supportive of the idea of practising family planning. Ask them if there is any specific method that their partner prefers.
You must listen very attentively to what the patient is telling you. Show a lot of concern and understanding. Observe any non-verbal communication through the patient’s facial expression and gestures. Try to identify the type of methods they are interested in, or are putting a lot of emphasis on.
Tell the patient about all the methods of family planning you can offer. Tell the patient about the other reproductive health services/choices available elsewhere other than in your clinic. Tell the patient about the advantages and disadvantages of each of the methods discussed. Demonstrate how each of the methods discussed is used and how it functions. Encourage them to ask questions during the demonstrations. Tell them to discuss the methods both partners may be interested in. Ensure they understand all available methods of family planning.
Help the patient to make an informed choice; one which would suit both themselves and their partner. Ensure the patient has adequate knowledge of the method of family planning they are interested in.
If possible, discuss the selected method with both partners. Allow both partners to express their opinions and concerns about the selected method. Help them to understand the suitability of the method as not all methods are suitable to all people. Help both partners to understand the effectiveness of the selected method and that the selected method does not affect sexual activity in any way. Help both partners to understand that fertility returns when the method used in family planning is stopped. For example, if the patient stops taking the pills regularly, they may become pregnant.
Explain and demonstrate to the patient fully how to use the selected method and ensure the patient is able to use the selected method. For example, if the patient has selected the natural method, ask them to describe it. If it is a male patient who has selected vasectomy, explain to both partners how the procedure will be carried out. Let the couple understand they will not get any more children.
Continue encouraging the patient to ask questions to alleviate any doubts they have about the selected method. It is important to give the patient a chance to demonstrate how to use the selected method. Ensure you provide the moral support to patient all the time.
Return to the clinic. Discuss with the patient when they should return for a follow up and to collect any new supplies. Tell the patient to feel free to return any time for assistance if the need arises. Tell the patient to consult a doctor if they notice anything abnormal.