trends Family Planning Technician

Training and Role of a New Professional

K A T E COX, Program Developer, and W I L M A SCHINER, RN, Family Planning Coordinator

Family Planning Technicians were added to the hospital staff to Mcpplement multimedia family planning education in an impatient setting. Staff believed that family planning information could be offered the patient on the ward as a routine hospital service, ordered by the physician, and provided at a convenient time during the hospital stay. Women with wbom the patients could easily identify were chosen and trained for their new roles. Th,e service was designed to meet the needs of patients and hospital staff. T b e new service has become an integral part of the hospital. This report summarizes the first year’s experience.

Kapiolani Hospital, where approximately half of the babies born in the State of Hawaii are de- livered and where additional obstetric and gyne- cologic services are provided, is well suited to serving patients and their families in an educa- tional and outreach capacity. Patients who come to the hospital for specific medical services can be given information on, and referral for, other needed services.l Individuals, families, and the com- munity benefit as the hospital assumes an increas- ingly important role in preventive health efforts.

For the past two years, with the aid of a grant from The American College of Obstetricians and Gynecologists, staff at Kapiolani Hospital have been developing a comprehensive famiIy planning service for patients. A variety of educational tech- niques are currently used to provide information to both in- and out-patients-among them, written materials and closed-circuit television programming that is available in all rooms. The hospital’s Family Planning Technicians visit with patients a t the bedside, meet with small groups of postpartum patients on the obstetric floors, and counsel pa- tients in the Out-Patient Department.

Before hiring the Family Planning Technicians, hospital staff had begun to develop a Family Plan- ning Department. The Hospital had purchased and

installed a closed-circuit television system for pa- tients2 The repeal of the State’s 100-year-old antiabortion law which brought nearly 200 abor- tion patients each month to Kapiolani Hospital, dramatically emphasized the need for expanded efforts in family planning education and service. The Family Planning Technician was described by the hospital as a well-trained professional whose role was to make the family planning program visible, provide specific information, and assist the patient in utilizing available services. In this way, the hospital’s capacity for informing and serving its patients could be supplemented without putting additional strain on busy hospital personnel.

In the Spring and Summer of 197 1, after nearly 10 months of preliminary program planning, four women were hired and trained to offer family planning services to in-hospital patients. After a year of experience, a new professional has emerged -the Family Planning Technician. The tech- nicians, chosen from the various ethnic groups in Hawaii, were Japanese, Filipino, Polynesian, and Caucasian. They came from a variety of socio- economic backgrounds. The oldest technician was 45 and married; the youngest, 20 and unmarried. One had a college degree, and another had com- pleted only grammar school. One had had 16 pregnancies, and another had never been preg- nant. All were comfortable conversing in the lo- cally spoken “pidgin” as well as English, and some could speak an additional local language. Hiring staff with a variety of experiences provided a capacity within the program for an understanding of the complex needs of the consumers. These employees were carefully chosen and trained for their new role by the Project Nurse and a family planning specialist, both hospital employees.

Hiring

Advertisements placed in local newspapers at- tracted numerous applicants from which only four could be selected. The Project Nurse interviewed all applicants. The interview was designed to re- veal attitudes toward contraception, abortion, and human sexuality. It was necessary to determine

July/August 1973 JOGN Nursing

whether the applicant was receptive to and able to learn new information, accept new ideas, work in an often demanding situation, and communi- cate well. Prior to hiring, applicants met with other members of the family planning staff for additional evaluation. Individuals were hired not on the basis of specific skills, but because showed promise of meeting the description Family Planning Technician.

they of a

Orientation

Before the new staff arrived for orientation, the Project Nurse met with the Director of Nursing

instruct their patients in birth control methods. Nearly all physicians are participating a t present. Many have left standing orders expressing their conviction that the service is a valuable one for all patients.

The technicians were instructed to bring white smocks to wear in the hospital, and name tags were supplied, identifying them to all hospital personnel.

The Director of Nursing began the technician’s orientation to the hospital by reviewing basic policies and protocol. Staff then began an intensive two-week training period, most of which was spent in the classroom, where sufficient time was set aside

for rap sessions among themselves and with project staff and for independent reading. During this time, the techni- cians learned reproductive anatomy and physiology and methods of con- traception. They discussed pertinent medical procedures and were given a general knowledge of program phi- losophy and goals. Particularly impor- tant in the training program was the time allowed the technicians for study and discussion to explore and evaluate feelings about such matters as abortion and sexual behavior, to become accus- tomed to new situations, and to ac- quire the necessary knowledge for offering learning opportunities to pa- tients. The last part of the training program involved intensive training in birth control instruction techniques,

primarily through the use of role-playing sessions. Because project funds permitted only part-time employment, the training was accompIished in four- hour sessions each day.

A Family Planning Technician at Kapiolani Hospital visits with a postpartum patient at the bedside.

to design procedures for integrating the new service into the hospital routine. Together, they carefully analyzed the already busy daily schedule of both maternity patients and nursing personnel to determine the best times for offering the new service. They also planned orientation sessions to acquaint staff nurses with the program prior to its implementation.

The Chief of Staff gave the program consider- able impetus by talking with his colleagues, ex- plaining the new service, and inviting them to utilize it by leaving orders for the technicians to

The Role of the Nurse

The technicians were directly responsible to the Project Nurse, who provided them with in- formation, supervision, and moral support. The nurse offered advice on dress, approach to the

July/August 1973 JOGN Nursing 53

The technicians examine a new pelvic model used for their training. They observe the local custom of wearing colorful muumuus to work on Fridays.

patient, completion of paper work, and specific suggestions for approaching and winning the re- spect of nursing staff. They were carefully in- structed as to what they could tell the patient and when they should refer questions to the pa- tient’s doctor. She discussed with them exactly what they could and could not do and in which situations they should come to her for assistance. It was necessary for her to be readily available for the many anticipated and unanticipated prob- lems that might arise.

After the training period, the technicians were sent to see patients. The nurse recalls that on some occasions she held her breath, crossed her fingers, and hoped that everything would turn out alright. Letting the technicians work on their own early ‘in the program, with frequent checks

on their performance, proved beneficial. They were able to function independently and deal with new and demanding situations but were always careful to call for assistance in those few situations that required it.

More Training

Early in the program, when the technicians were confident in their knowledge of contracep- tion and were already providing this information service to patients, the technicians began in-service education in additional areas of information fre- quently requested by hospital patients. Profes- sionals from the community with expertise in clinical psychology, genetics, and sexual counsel- ing participated on a consultant basis in periodic meetings with program staff. In this way, the staff were able to share experiences, discuss methods of counseling and ways of responding to particular patient problems and then apply new methods learned. They began discussing problems of sexual dysfunction, talking to parents of defective babies, approaching depressed patients, and talking about marital difficulties.

Single training sessions were held on topics, such as breastfeeding, shown by surveys to be of particular interest to Kapiolani’s patients. The training sessions gave the technicians, already knowledgeable about anatomy and birth control, the information and confidence necessary to deal with more situations, to provide assistance in many instances, and to know when to seek the help of a professional. By the end of the sessions, all technicians were comfortable counseling and were able to help patients identify needs for services and make the appropriate referrals to physicians, clinics, or other agencies. The training prepared the technicians to be confident in approaching a patient whether she is elated over the birth of her baby or upset following a stillbirth.

Additional sessions will be held to help the tech- nicians develop expertise in other areas. Short in- service training sessions are held weekly for all project staff. These treat community agencies, medical procedures, new educational methods, re-

54 July/August 1973 JOGN Nursing

search projects, and other topics of current in- terest.

What They Do

At the time of admission each patient receives a pamphlet which describes the family planning services available to her. Each day a technician visits those patients who have delivered or who are scheduled for a surgical procedure. She checks first with the nurse on the floor to determine the patient’s condition and receive any other pertinent information. She carries a brightly colored bag containing all contraceptives and literature on a variety of topics, including breast self-examination, nutrition, and care of the newborn. Her approach varies with the response of the patient, which may be an enthusiastic “I am so glad to see YOU!” or a flat refusal. If the patient seems embarrassed talk- ing about birth control, the technician may first offer her some information on baby care or post- partum exercises to establish rapport. The content of the discussion is determined by the patient’s individual needs and interests. The technician may offer to return later to include the husband in the discussion, to bring additional information the pa- tient requests, or to continue the discussion. She is careful not to make the patient feel rushed. The technician provides each patient with general in- formation on all contraceptive methods available, answers her questions, and instructs her in the use of the method she prefers.

The Results

The Family Planning Technician is now well integrated into daily hospital routine. She visits with both obstetric and gynecologic patients each day at the bedside and in small groups, counsels patients coming to the hospital for postpartum care, pregnancy tests, and other services and gives supportive reassurance to patients prior to surgery. The technician offers the patient an opportunity for referral for other services.

Nurses report that since family planning staff have been seeing abortion patients prior to surgery,

fewer patients cry in the Recovery Room. Phy- sicians call on technicians for assistance with “prob- lem” patients such as those who have had multiple abortions or who are experiencing difficulties fol- lowing hospitalization. Doctors have noted that patients coming in for post-pregnancy visits often introduce the subject of contraception and have definite ideas about what method they prefer. Said one doctor, “I used to ask my patients about birth control. Now they ask me.”

As the program has developed, the technicians have become more than birth control instructors. They can assist the doctors in the clinic, complete follow-up data on patients, provide information for patients over the telephone, and conduct pa- tient surveys. The technicians also assist in the development of educational materials and provide valuable input for program planning. Last De- cember, the technicians participated in a workshop designed to train nurses and para-professionals in family planning skills. They designed and con- ducted role-playing sessions which were enthusi- astically received by program participants. They continue to train new “family planners” such as student nurses and other community agency per- sonnel who participate in training sessions at Ka- piolani Hospital.

The technicians are competent, motivated, and effective professionals who assume a variety of roles as situations demand. They are a key to the success of a hospital-based family planning pro- gram.

Acknowledgments

The authors acknowledge the assistance and di- rection of Louise B. Tyrer, MD, Director of the ACOG Interconceptional Care Program, and the following hospital personnel, who have contributed so greatly to the success of this program: Mr. Richard Davi, Hospital Administrator; Stanley M. Saiki, MD, Chief of Staff; Mrs. Margaret Klein- kopf, RN, Director of Nursing; Dr. Ronald J. Pion, Director of Family Planning Services; the Family Planning Technicians; and the Kapiolani Hospital Staff.

July/August 1973 JOGN Nursing 55

References

1. Pion, R. J.: “Preventing Unwanted Pregnancies- Role of the Hospital.” Postgrad Med Jan 1972, pp 172-175

2. ‘LFirst Family Planning Tune-In-’Kapiolani Test Pattern.” T h e Family Planner Nov 1971.

From the ACOG Family Planning Program, Kapiolani

Address reprint requests to Mrs. Kate Cox, Family Hospital, Honolulu, Hawaii.

Planning Program, Kapiolani Hospital, 1319 Punahou Street, Honolulu. HI 96814.

Both authors are involved in the F m ’ l y Planning Program sponsored by The American College of Obstetricians and Gynecologists at Kapiolani Maternity Hospital in Honolulu-Kate Cox us Program Developer and Wi lma Schiner, RN, as Family Planning Coordinator and, previously, Patient Services Developer.

Mrs. Cox holds a B A from.Stanford University. She did graduate work in cultural anthropology at the University of N e w Mexico and studied Spanish at Mexico City College. She has directed a preschool day care center at a migrant workers camp under the California compensatory education program and has served as a Comiun i t y Organizer for Planned Parenthood of Alameda County. She was also an area director in East Harlem, N e w York City, for an OEO “Study of Social Services to the Poor,” and served with the Peace Corps in Peru.

1

Wikiia Schiner was graduated front Mount Sinai Hospital School of Nursing in N e w Ymk. She was previously the Director of Nurses and Building Supervisor at H d e Nani Hospital in Honolulu. She worked at the Medical Center of the University of California a t Los Angeles as Assistant Nursing Supervisor of In-Service Education and as Head Nurse in the Medical Out-Patient Depurmient.

FAMILY PLANNING WORKSHOP IN HAWAII A workshop entitled “A Beginning in Family Planning” will discuss techniques of counseling in the areas of human sexuality and abortion as well as up-to-date information on contraception and the anatomy and physiology of reproduction. Experts in the field of family planning and human sexuality will present the topics at a workshop sponsored by Kapiolani Hospital located in Honolulu, where ACOG sponsors an innovative Family Planning Program. The workshop site was chosen on one of the ‘heighbor islands,” where participants will have the opportunity to experience the unique charm of rural Hawaii. If you are planning to attend the ACOG District VIII Conference, November 5-9, 1973, consider joining us the following week on Kona.

PLACE: Keauhou Beach Hotel, Kona, Hawaii (“The Big Island”)

DATE: Friday, November 16, 1973 REGISTRATION: Will be limited. Write to:

Wilma B. Schiner, RN, Coordinator Family Planning Program Kapiolani Hospital 1 3 19 Punahou Street Honolulu, H I 96814 Or call (808) 941-5881

COST: $25.00

FAMILY-CENTERED CHILDBIRTH PREPARATION AND PSY CHOPROPHYUXIS The Council of Childbirth Education Specialists is offering a professional development program on family-centered childbirth preparation and psychoprophylaxis for nurses. It will be offered twice; once October 14,1973, in New York, New York, and again October 24-27, 1973, in Kansas City, Missouri. Cost is $125 for either series. T o register or for further information write:

Patricia Hassid, Registrar, CCES 168 West 86th Street New York, NY 10024 or call (212) 362-7221.

July/August 1973 JOGN Nursing