The Nurse and Sexual Decisions
Providing assistance to people who wish to make decisions is a primary nursing task. Nurses in public schools, higher education, physicians’ offices, public health agencies, and hospitals have nearly limitless opportunities to help people make decisions. Nurses can (1) point out options, reviewing the risks and benefits (“pros and cons”); (2) provide accurate information about each choice; and (3) help the person accomplish the decided upon goal.
The intercourse decision is affected by fear of pregnancy, conflict with religious or moral values, age, cultural or peer group influence, respect and concern for oneself and others, individual sexual needs, availability and suitability of a partner, and access to an appropriate place for intercourse. Many teenagers struggle with all these factors and solicit help from adults whom they trust in order to clarify values.
The decision regarding the number of children to bear affects not only the sexually active woman but also her children, her partner, her parents, and society as a whole. For the family, economic, psychological, and social effects occur. The woman’s own life is dramatically affected in terms of education, career, and marriage. If her partner participates in the decision regarding children, his influence can be enormous.
The child and potential siblings are affected by the age of the mother, the spacing of the children, and the ability of the mother to provide care. Very young adolescents tend to bear low birth weight babies, who in turn have greater incidences of neurological and intellectual impairments. Having children very close together is physically difficult for the mother and frequently means she is unable to spend sufficient time or energy in caring for her children.
The world population seems little affected by whether or not one particular woman has one particular child. But if she has two or three, and each of them has two or three, and so on, very large numbers soon are reached. Few people die these days before they are truly elderly. It is not uncommon to see photographs of four or even five generations of daughters seated together. Having one child has far-reaching results.
Nurses must assist people at each “trigger point” in the chain of sexual and reproductive decision making. Education programs we provide for high schools should emphasize that no one should ever have a sexual relationship if it causes emotional discomfort. Everyone also has the right to be a virgin without harassment from others. Many teenagers need to be reminded that abstinence—i.e., not having sex—is normal, and healthy, and perfectly OK. They need to know there is no perfect form of contraception except abstinence. As a matter of fact, the majority of teens are not sexually active in high school. They also need to know that contraceptive methods are available to teens and that most unwanted pregnancies can be prevented.
Nurses instruct couples and individuals about the many effective methods of birth control and then help them to choose the method best for them. Many people equate birth control with birth control pills and are truly surprised to learn that there are lots of different ways to keep from getting pregnant. A yearly pelvic examination, breast examination, Pap smear, and VD test help women protect their reproduction health.
A woman or a couple facing an unplanned pregnancy must make many additional choices: How to tell the partner/parents? Have the baby? Have an abortion? Keep the baby? Get married? Stay single? Adoption? Foster care? Most married women continue the pregnancy and keep the child. If they make no active decision to have an abortion, they will have a baby. For some, the decision to terminate or to continue the pregnancy and keep the child. If they make no active decision to have an abortion, they will have a baby. For some, the decision to terminate or to continue a pregnancy may be the first important decision they ever made. Problem-pregnancy counseling with an emphasis on informed decision making is provided by nurses.
About half the unmarried teens choose abortion, the other half mainly keep the baby whether or not they marry. Very few women choose adoption despite common knowledge that infants are very quickly adopted by carefully screened people who desperately desire a child. There is considerable pressure, especially among teen peers and partners, in favor of keeping the baby.
Many unwanted children are born because the parents avoided decisions or because the decisions made were based on false information. Every child has a right to be welcomed and wanted. Every parent has a responsibility to provide the best possible care for each potential child. There are many choices if only we learn to make honest, informed, and rational decisions.
Finally, nurses must filter out their own opinions and judgments from the counsel they give. Nurses must listen to themselves and to each other as they talk with clients in order to identify those subtle points where objectivity ends and persuasion begins. Nurses are responsible only to delineate options, to provided accurate information about risks, benefits, and procedures, and to assist in implementation of goals. Nurses do not make the decisions and are not responsible for the decisions clients make.
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