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