Healthy relationships and sexual health in FNP

Nicki Jeffries, FNP Supervisor from Buckinghamshire Healthcare NHS Trust, writes about how the Family Nurse Partnership helps to support young parents' sexual health and healthy relationships.

 

There are a number of sensitive issues that family nurses discuss throughout the delivery of the Family Nurse Partnership programme to young mothers and families. Domestic violence, substance use and family history for example, are all talked about. Another subject nurses frequently discuss is sexual health and healthy relationships.

Initial visits and discoveries

Positive sexual health and relationships are discussed very early during the first visits in pregnancy while building the therapeutic relationship between nurse and client.

When discussing sexual health, nurses not only focus on the health and wellbeing of the mum, but that of their unborn baby too, helping to support a client’s understanding  about what this can mean. During visits, nurses use specific communication skills rooted in the field of motivational interviewing (MI) to explore:

  • What a client already thinks constitutes a healthy relationship, and

  • What the term ‘safe sex’ encompasses for the client.

From these conversations, nurses introduce relevant materials and interactive resources using specific techniques and a guiding communication style, together with agenda-matching programme delivery with the client.  The aim of this is to explore and build knowledge which, alongside the client’s own intrinsic motivation to be the best mum and have the healthiest pregnancy possible, can help to trigger behaviour change where needed.

This approach enables nurses to have conversations in a very open and respectful way, covering the subject of their client’s own personal health to guard against sexually transmitted infections (STIs) and future unplanned pregnancy etc, in addition to protecting their emotional wellbeing.  

Positive sexual health

Within Buckinghamshire, our close working relationship with sexual health services helps us to focus on this aspect of a young mum’s, and sometimes a dad’s, personal health. When we begin to discuss positive intimate relationships and sexual health, family nurses skilfully weave in the offer of chlamydia screening both to mums and dads. By bringing kits in to the home environment, we often find that young people are happy to be tested and potentially treated confidentially by sexual health services.

Condoms are a form of contraception that nurses help young mums access in Buckinghamshire, especially during pregnancy. Using the local C-card Scheme allows nurses to register young people to access free condoms in certain places within the area, including via FNP,  which helps to promote safe sex and protect against STIs and the potential impact these could have to the young person and the pregnancy. Later, nurses continue to promote condoms alongside other forms of long-acting reversible contraception (LARC) methods as well, as part of a healthy sexual relationship message.

A healthy, intimate relationship

Another important aspect that family nurses aim to cover with young mums is the topic of what makes a healthy intimate relationship. This can of course be around physical aspects of sexual health, but also the emotional aspects, looking into the potential power and control or equality in a relationship.  This helps to build a client’s awareness and knowledge alongside their own self-efficacy in what is ok for them and what this can mean for them and their baby.

Family nurse example from practice
 
“Recently while working with a client we looked at a facilitator called ‘Match don’t catch’ together. This programme tool is intended to support conversations around healthy relationships, safe sex and contraception. A conversation was generated, with the client becoming open and sharing concerns around a possible STI. Prior to this we had been looking together at the balance of power and control and trust within her intimate partner relationship.
 
“This conversation led to some practical guidance and support around access to immediate treatment for an STI in the short term, however, my role in this area will be on-going. The longer term implications for this client’s own health and wellbeing, both physical and emotional, alongside the nature of her current or future intimate relationships, are important apects to plan into our visits.
 
“At the heart of this piece of work is the Family Nurse Partnership psycho-educational model and the nature of the therapeutic relationship, which enables the client to engage in the relationship with me, engage in the programme itself and engage with change.”

 

Family nurse learning and development

As a supervisor, I have regular contact with all my family nurses and during our supervision sessions, nurses may identify any difficult conversations they have had with clients relating to healthy relationships and sexual health.

By far the most powerful way for nurses to learn the communication skills needed to have difficult conversations is experiential learning.  Talking things through and practicingas a team is a big feature of the time we spend together. Also, as the baby is a great teacher for our young parents, our parents are great teachers for us and we often seek their advice and opinions on how we are doing in our delivery of the programme including these sometimes sensitive conversations.

The therapeutic relationship

The best tool a family nurse can utilise to help young mums and dads build positive sexual health behaviours and healthy relationships is their therapeutic relationship with their clients. The nurse’s expert communication skills and the belief that clients are the experts in their own life supports respectful, positive, open and motivating conversations.

 

You can find out more about the therapeutic relationship in Family Nurse Partnership and how nurses engage with clients by reading this blog by Ruth Rothman, Head of Clinical Implementation and Learning at the FNP National Unit.