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The Process Of Destigmatisation:  The Work Of Sexual Health Nurses   

Annette Mortensen, RCpN, M.Phil (Hons), Dip Ed.  Refugee Health Coordinator, Public Health, Auckland District Health Board   

Gillian White: MA (Hons), PhD. Associate Professor,  School of Health Sciences, Massey University, Auckland 

Mortensen, A., & White, G. (2003). The process of destigmatisation: The work of sexual health nurses. Nursing  Praxis in New Zealand, 19(1), 32-39. 

Abstract   

In 2001 the Ministry of Health undertook to develop a Sexual and Reproductive Health  Strategy in recognition that there are gaps in service provision and that the sector  lacks the strategic direction needed to improve. The intention of this plan is to provide  the Ministry of Health, District Health Boards and other organisations across the health  sector with the basis from which to develop service specific plans and make funding  decisions. The process for development of a Sexual and Reproductive Health Strategy  has two phases, the first being the release of the overarching direction. This is to be  followed by development of a series of action plans to address key issues, such as  reducing sexually transmitted infections (including HIV/AIDS), sexual abuse and  unwanted/unintended pregnancies, and at the same time maximising the health of  at-risk groups such as youth, Maori and Pacific peoples.   The focus of this article is on the findings of a grounded theory study of sexual health  nursing in New Zealand. Nurses' experiences of providing sexual health care are  described and theoretical explanations generated. The emphasis in this article is on  countering stigma which emerged as a recurrent problem for nurses in the study. A  comparative analysis of the nurses' counter reactions with Gilmore and Somerville's  (1994) model of stigmatised reactions towards people with sexually transmitted diseases  was done. The model describes the processes of disidentification, depersonalisation,  scapegoating, and discrimination, which characterise stigmatised reactions.  Destigmatising in the context of this study means that the nurse is engaged in the  process of counteracting the prejudice and negative social attitudes towards people  who attend sexual health clinics and who have sexually transmitted infections. The  process occurs in the interactions between the nurse, the client and the community.  This process is dynamic and reflects changes in patterns of social sexual relations in  society and community attitudes towards these.   Essentially this study shows that for nurses the basic social processes of  destigmatisation are based on complex factors including gender, culture, and sexuality  of both the practitioner and client, not all of which can be explored fully in the space of  this article. Nurses’ understandings of the impact of socioeconomic conditions and  gender/power relations in society have an important role to play in how nurses manage  care. As a consequence of their work nurses in this study encountered professional  stigma. The practice of sexual health care results in being professionally marginalised.   

Key Words: Sexual health nursing, destigmatisation, cultural safety      

Introduction   

For many years providers in the  sexual and reproductive health sector  have been concerned that services are  fragmented and underfunded. It is  now recognised (Ministry of Health,  2001) that young people in New  Zealand have poor sexual and  reproductive health. There is a  continuing trend towards earlier onset  of sexual activity and a correlated  increase in teenage pregnancy,  abortion and sexually transmitted  infections (STI). The Ministry of  Health is currently working to  complete a New Zealand strategy for  sexual and reproductive health. continued   

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