THE QUINACRINE METHOD PROCEDURE MANUAL
CHAPTER 2 Counseling
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 Learning ObjectivesAt the end of this lesson, you will be able to:
Reasons for Contraceptive CounselingBecause one of the prerequisites for using this manual is a basic knowledge of counseling, we will only briefly review the importance and rules of good counseling.Counseling provides information about the choices a couple has to regulate their fertility. With this information, they can choose a method which best meets their needs. If they make this choice, research has shown that they will be much more likely to continue to use the method correctly and consistently and be satisfied with their choice. In addition, counseling addresses misinformation. Prior to counseling, many clients receive inaccurate information or have heard false rumors about contraceptive methods. Counseling provides an opportunity to dispel these myths. Minimum Resources for Effective CounselingThe following resources must be available to provide effective counseling:
Client ScreeningIn determining if a client is an appropriate candidate for QS, the following broad categories should be considered.
Because the importance and relevance of these factors vary from country to country, each program should decide whether or how these factors should affect the provision of QS. Warning Signs That a Client May Not Be Making a Free Choice
If any of these are observed, the counselor should offer the client a reversible method of contraception and advise her to return at a later time. Quinacrine Sterilization CounselingThere are many reasons for doing specific counseling about QS. Most important is to be certain your client understands that QS is a nonreversible method of contraception. Also, while QS is highly effective, it is not 100 percent effective. Both intrauterine and tubal pregnancies can occur after the procedure.General Facts to Share with Clients About Sterilization
QS counseling provides the opportunity to explain the following:
In QS counseling, you should explain each of these. The most essential topics are symptoms and actions to take in case of severe side effects and the importance of returning for a second insertion. The most severe complication of failure of QS or any contraceptive method is an ectopic or tubal pregnancy. (This is addressed in greater detail in Chapter 4). Describe the symptoms by showing where on her body she will feel pain and how the pain will feel. Most importantly, you should explain what steps she should take if she suspects pregnancy. The other important counseling issue specific to QS is the timing of the first and second insertions. It must be very clear to your client that she must have no blood in her uterus when the QS is done. Help her calculate the correct date in her cycle to have the first insertion. You should also stress the necessity of returning for her second insertion. Doing so will reduce the chance of a method failure. Please turn to Appendix B for an educational brochure prototype on QS. This is for the client to read and take home with her. It includes information on how the method works, advantages and disadvantages, efficacy, side effects and complications. Ways to Establish a Good Counseling Rapport with your ClientA good counseling environment is established by creating a private space where there is confidentiality and attentiveness, without a sense of being rushed. A client and her husband, if present, must feel that they can freely ask questions and express concerns without sensing pressure or judgment to make a particular decision.A bad example of this would be: Mrs. X asks a question about whether QS can be reversed. Provider Z responds, "I told you that it is a permanent method. You have too many children already, so you need a permanent method." A good example of this would be: Mrs. X asks a question about whether QS can be reversed. Provider Z responds, "A surgical procedure is needed to reverse quinacrine sterilization. Success is limited. If you have any doubts about whether you want a permanent method, perhaps we should spend some more time discussing your needs. We have several temporary methods available which I would be glad to discuss with you." Making Sure a Client Understands the Information You ProvideIn order to help ensure that your client understands the information you provide, you must pay attention to the following:
This can be accomplished by listening and watching for any discomfort she shows as you begin the counseling session. If you use a term that you think she might not understand, be certain to ask her if she is familiar with the term and perhaps, ask her to tell you, in her own words, what you meant. The technique of asking your client to explain things back to you is a very effective way to both determine if she understands what you have said and also to reinforce important information for her. There are several other techniques to provide information in a way that your client is most likely to understand and remember. These include:
Ensuring Informed Choice and Informed ConsentOnce your client has been given all the information she needs about QS, without biases or incentives, and has had ample opportunity to ask questions and receive responses, she will make a choice about whether this method is appropriate for her. The provider and the client have two distinct roles in this process. The provider gives the accurate and appropriate information. The client must make her own decision.Informed choice precedes informed consent. Informed consent consists of a form that is either read by the client (if she is literate) or is read to her by a female/woman witness who is capable of explaining the procedure and everything on the form. The basic form asks for the following information:
how the method worksadvantages and disadvantagesefficacyside effects and complicationsSee Appendix C for a sample quinacrine sterilization informed consent form. Guidelines to Safeguard Against Coercion For or Against QSEncouraging an individual to undergo nonsurgical sterilization is coercive in the following situations:
Allowing a period of time to pass in between the client's making a decision to undergo quinacrine sterilization and having the procedure is optional. A waiting period between making the decision and having the procedure done can be helpful in making sure a client will not change her mind, but mandatory waiting periods can decrease the accessibility of the service. That is, if a woman has traveled a long distance to have the procedure done and she is unlikely to be able to return, a mandatory waiting period can be a real obstacle to service delivery. Also a woman is at risk for an unwanted pregnancy during a waiting period. Waiting periods should be flexible, so that exceptions can be made. Other measures, such as complete counseling, should be used to assure a woman is making a considered, informed and voluntary choice. Case Study IIIClient X comes to your clinic wanting to be sterilized. You sit with her and discuss her options. She seems very anxious and is not paying attention to your explanation. You continue your explanation while your client seems to be nodding in agreement. She is very eager to know about reversibility of QS. You present her with an informed consent form which she signs, then you proceed with a quinacrine sterilization.Identify the problem: How would you solve it/how would you improve this interaction? Check you answer against that provided on page 49.Return to the chapter text for any information you did not understand. |
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