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How to broach sensitive subjects

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Understanding staff and patient attitudes can help nurses raise awkward issues.

Even the most experienced nurses encounter issues that they don’t find easy to raise with patients. Simply being uncomfortable talking to patients about the issue in question can lead to unresolved patient problems, missed targets and a knock to staff morale. But with the right training, nurses can tackle sensitive issues head on.

In 2008, the National Social Marketing Centre (NSMC) worked with NHS Norfolk and NHS Great Yarmouth and Waveney on a pilot project to increase chlamydia screening rates. The screening programme was delivered at mixed settings, including pharmacies, schools and surgeries.

Research had revealed that the health professionals who were supposed to carry out the screens didn’t feel comfortable raising the issue with young people. As one nurse put it: “If I went into the surgery for a holiday vaccine and somebody asked me about my sex life, I would think ‘what are they on about?’”

Using insights like these, we developed a training workshop to give screening providers strategies and the confidence to raise sexual health with young people.

Crucially, the Talking Chlamydia workshops focused on developing an understanding of young people’s attitudes to sexual health - for example, their concept of risk (“six feet tall and bulletproof”) and susceptibility to peer pressure. They gave the staff skills to initiate and maintain an effective conversation (trying to use youth slang is a big no-no; being brief and inviting questions helps). As staff time is precious, they also showed staff how to keep the conversation brief. Through role play, it helped providers to develop responses to a range of scenarios.

Tips on awkward issues

● Engage with staff about the issue - they’ll tell you where they need help

● Talk to patients’ groups and charities working on the issue to build your understanding and get advice on how to brief your staff

● Pre-test training with a small group of staff before you roll it out

● Make yourself available to hear your team’s concerns

● Don’t assume a one-off intervention will be adequate - feed in staff and patient insight as it develops

The training was well received and effective, contributing to a threefold increase in chlamydia screens.

Key to its success was that it was rooted in an understanding of both health professionals’ and young people’s attitudes to the issue - how they really felt about it. This enabled the training to give practical tips that health professionals were able to put into practice immediately and share with colleagues.

Another important lesson is that, although this case was successful, it doesn’t mean the answer to every awkward issue lies in staff training. Don’t put the cart before the horse - understand how the issue is perceived by both patients and staff before you develop a solution.

This example does show that dealing with these issues is not insurmountable. Great progress can be made through relatively simple changes.

John Bromley is director of the NSMC ( He has 20 years’ experience of managing complex behaviour change programmes. He has worked at the Department of Health, setting up the Social Marketing Development Unit and developing a number of national clinical strategies.

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