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Good Practice GuidelinesSHASTD’s primary objective is “to improve and maintain
standards and encourage professional development of Health Advisers in sexually
transmitted diseases” (SHASTD constitution). These guidelines aim to support this
statement by focusing on good practice in the core areas of health advising. They
work in context with SHASTD’s Code of Ethics and Code of Conduct. As a positive step towards standards for good practice it is
important that all Health Advisers have a clear understanding of the issues outlined in
this document. CONTENTS
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| Ensuring that the well being
of the client is considered at all times. |
| Work within SHASTD Partner
Notification guidelines. |
| Having accurate knowledge of
clinic protocols and procedures relating to each sexual infection. |
| Ensuring accurate
documentation in medical notes of any discussion and action regarding partner
notification. |
| Maintaining regular
evaluation of partner notification activities and outcome. |
| Adhering to the “Key
Points for Good Practice” covered under Section 1.3 Counselling and Counselling
Skills in this document. |
Pre and Post HIV test discussion/counselling are fundamental aspects
of health advising. Policies vary between different clinics about who should offered
counselling prior to having an HIV test.
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| Having accurate knowledge of
clinic and hospital procedures and protocols relating to HIV testing. This
should include protocols for referral to the Health Adviser e.g. those perceived to be
high risk/anxious. |
| Discussing other issues of
sexual health and promoting sexually transmitted infection screening. |
| Ensuring accurate
documentation in medical notes of any discussion and action regarding HIV testing. |
| Maintaining regular
evaluation of HIV testing activities and outcome. |
| Adhering to the “Key
Points for Good Practice” covered under Counselling Skills (1.3) in this document. |
As health advisers have a counselling role the ability to use
counselling skills is a fundamental aspect of health advising in the support of patients,
partners and families[3]. It is appropriate for health advisers to use these skills in a
variety of different situations. These include:-
| Crisis Management sessions
e.g. At the time of diagnosis of an STI, sexual assault. |
| Negotiating partner
notification. |
| Developing individual sexual
health strategies. |
| Exploring and challenging
high risk behaviour. |
| Giving information to
individuals e.g. HIV transmission, contraception. |
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| Ensuring a non-judgmental
professional approach. |
| Providing a safe and suitable
environment that is free from interruption. |
| Working within SHASTD’s
Code of Conduct and Code of Ethics. |
| Having appropriate and
regular clinical supervision. |
| Appropriate referral to other
agencies. |
It may be appropriate for some Health Advisers to undertake time
limited or even long term counselling work. Health Advisers undertaking this work
should have some form of recognised counselling training and should work to the “BAC
Code of Ethics and Practice for Counsellors”.[4]
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| Working within the BAC Code
of Ethics and Practice for Counsellors. |
The aim of health promotion and education in the GUM setting is
to reduce the incidence of STI’s and HIV by improving awareness of the risks
associated with transmission. The Health Advisers role in health education and
promotion is usually carried out in a one to one interview with the client. This
provides time for the client and the Health Adviser to assess individual concerns and
issues. Health Advisers are also involved in telephone advice and participation in
teaching and groupwork. SHASTD recommend that health advisers work to empower
clients to make choices regarding their sexual health.[5]
The Society for the Advancement of Sexual Health defines sexual
health as the “The enjoyment of sexual activity of one’s choice without causing
or suffering physical or mental harm.”
SHASTD believe that an individual should have:
1. The capacity to make informed decisions, free of coercion,
about who they have consensual sex with and what kind of sex they have.
2. The capacity to control and make decisions about fertility.
3. Freedom from disorders which compromise health and sexual or
reproductive function.
| Have appropriate teaching and
facilitating skills. |
| Having a good knowledge of
sexual infections including symptoms, incubation period and modes of transmission. |
| Having a good knowledge of
the mechanisms of safer sex within the full range of sexual practices. |
| Having a good knowledge of
the mechanisms of safer injecting drug use. |
| Being able to demonstrate
condom and femidom use. |
| Having a good knowledge of
the range of condoms available. |
| Having a good up to date
knowledge of other contraceptives. |
| Having a good knowledge of
factors which lessen peoples ability to practice safer sex and safer injecting drug use
e.g. self esteem, peer pressure. |
| Having a good knowledge of
the behavioural, psychological and physiological aspects of sexuality. |
| Having a good knowledge of
issues related to sexual identity. |
| Having a good knowledge of
current government policies with regard to sexual health targets and local “target
populations”. |
| Ensuring that one to one
interviews are backed up with health education literature which is relevant and up
to date. |
| Having a good knowledge of
general health issues, e.g. healthy diet, alcohol, smoking. |
Receiving regular clinical supervision is intrinsic to the work of
the health adviser. Clinical supervision involves both managerial and counselling
supervision. As individual activities managerial and counselling supervision contribute to
the quality and effectiveness of the health advisers work. As health advisers have a
counselling role they should use counselling skills when dealing with clients who
have issues with HIV/AIDS, sexual assault, sexual abuse, relationship problems and
sexuality. SHASTD believe that all aspects of clinical supervision are an essential
part of the support and education of health advisers.
As distinct from the broader clinical supervision (in which both
managers and colleagues may have a role), counselling supervision offers benefits to the
health adviser, client, and agency as a whole. Counselling supervision aims to
improve skills, communication, reduce stress and maximise the therapeutic quality of
the health adviser’s interactions with clients. In addition counselling
supervision aims to decrease staff turnover, levels of staff sickness and burnout. [6]
SHASTD support the BAC Code of Ethics and Practice for Counsellors
which states that it is a “breach of the ethical requirement for counsellors to
practice without regular counselling supervision”[7]
Counselling supervision should not be undertaken by the line manager
although managerial support and agreement are essential when establishing a system of
counselling supervision. Counselling supervision should be inclusive within a health
adviser post and be undertaken in the Health Advisers work time.
A counselling supervisor ideally should not be an immediate clinical
colleague (i.e. should not be involved with the same clients as the supervisee)
However, if counselling supervisor works within the same agency as the supervisee,
boundaries, ground rules and expectations must be made clear and adhered to by both
parties in the same way as if the counselling supervisor is external to the agency.
It is also important for the individual health adviser should have an input into the
selection of their supervisor.
| Having one to one or group
supervision not less than monthly. |
| Having a counselling
supervisor who has supervisory experience and is a qualified counsellor, psychotherapist
or clinical psychologist. |
| Having a supervisor who has
BAC supervisor accreditation. |
Personal and professional development is important to ensure that
health advisers continue to improve their practice. Management supervision is the key
forum where these issues e.g. workload, service development, professional development and
case work can be discussed. Management supervision should be undertaken by the
health adviser’s line manager.
| Having regular fortnightly or
minimum monthly management supervision. |
| Health Advisers should have
an annual IPR appraisal setting learning objectives to benefit the clinic team, patients
and the individual Health Adviser. Within management and counselling supervision
Health Advisers should be able to develop practice and identify learning needs. |
| Having relevant time and
funding commitments from the NHS trust so that the health adviser can carry out their
objectives. |
| Attending SHASTD annual
conference/ regional meetings. |
| Attending relevant seminars,
courses and keeping up to date with relevant literature. |
| Visiting other GUM/ HIV
clinics to review/update practice. |
| Keeping an up to date record
of courses attended and documentation of management discussion regarding professional
development. |
SHASTD recommends the involvement of health advisers in research and
audit so as to improve and maintain professional standards of practice.[8]
The results of research and audit may be used to gain an overview and
recognition of some of the aspects of health advising. The findings of research and
audit may be used to develop the role or to inform policy.
Health advisers should be aware of the requirements of the KC60
and should ensure that within their clinic that their work is adequately represented.
| Co-ordinating and sharing
research and audit activities with members of the clinical team. |
| Taking research and audit
findings forward to appropriate policy and management forums within the
organisation. |
| Acknowledging those
individuals who were involved in the work in subsequent presentations and publications. |
| Ensuring consultation and
approval from clinicians, managers and local research ethics committee. |
| Producing one piece of audit
work per year[9]. |
The purpose of this code is to establish and maintain standards for
Health Advisers working within a GUM setting.
All healthcare workers are in a position of trust. These
guidelines outline the accountability of the individual carrying out the health adviser
role. The Code of Conduct is a framework for managing responsibilities to patients,
colleagues and the public. Where a health adviser cannot work within this Code of
Conduct then they will need to discuss this conflict with their manager and/ or clinical
supervisor. Where there is a conflict around medical management of a client, this should
be discussed with the relevant consultant/senior doctor within the clinic setting.
Each health adviser should:-
| Work in such a way as to
promote and protect the interests and well being of patients, their partners/
contacts and relatives. |
| Work to those
responsibilities outlined in their job description and for which they have had training. |
| Be aware of their own
professional limitations. They should recognise and acknowledge any limitations in
their competence and have a responsibility to refer appropriately. |
| Be responsible for actively
maintaining and improving their own theoretical knowledge and practical competencies and
should use this knowledge and experience to enhance the professional competence of others. |
| Respect confidential
information obtained from patients or their partners in the course of professional
practice, and work within the NHS (VD) regulations 1974 and the NHS Trust (VD) Directive
1991. They will ensure that information is not disclosed inappropriately or without
consent of the patient, unless it is required by criminal law, high court subpoena, or is
necessary in the public interest. |
| Respect an individuals’
customs, beliefs and values. |
| Report to the relevant line
manager/ healthcare worker any concerns about a patient’s physical, psychological or
social conditions. |
| Report to the relevant line
manager any concerns about another healthcare workers actions that are detrimental to the
patient or patient’s partner(s). |
| As an individual decline any
offers of gifts, favour or hospitality. |
| Be responsible for the
setting and monitoring of professional boundaries between themselves and the
patient. These boundaries should be made explicit to the patient. Where there
is a professional relationship with a health adviser in a GUM setting then this precludes
a relationship outside of work (and vice versa) |
| Act in such a manner as to
uphold and enhance the good standing and role of the health adviser. |
| If working as counsellors
should work to the “BAC code of Ethics and Practice for Counsellors” |
| If involved in the
administration of medicines work to the “Administration of Medicines - A UKCC
Advisory Paper. A framework to assist individual professional judgement and the
development of local policies and guidelines. |
The purpose of this Code is to define general principles and set out
standards for Health Advisers in Sexually Transmitted Diseases. members of this
Society, in assenting to this Code, accept their responsibility to patients/ clients,
colleagues and this Society. Health Advisers will act always in such a way to
promote and safeguard the well-being and interests of their patients/ clients. The
patient’s/ client’s interest is paramount and this Code should be used as a
framework within which to work.
The Health Adviser forms part of a professional and multidisciplinary
team whose responsibility it is for promoting treatment and the educative prevention of
sexually transmitted diseases. The Health Adviser will act as a source of
information for the patient/ client regarding his or her current and future sexual health.
The Health Adviser will seek to promote treatment, containment and
prevention of the spread of sexually transmitted disease by working with the patient to
agree on the appropriate information to be given to sexual partners.
The Health Adviser will provide and maintain high standards of care
by applying his or her professional knowledge and skills. Updating of these is the
responsibility of the Health Adviser.
Information given by patients/ clients to Health Advisers is
confidential within the terms of the 1974 NHS VD regulations. Health Advisers have a
duty to clarify with patients/ clients which information can be properly shared with other
professionals concerned in the are of the patient/ client.
The Health Adviser will always recognise and promote the right of a
client to self-determination. Thus the Health Adviser will not impose a particular
set of standards, values, morals or ideals upon their patients/ clients.
Health Advisers will take account of the specific needs of
individuals including customs, values, spiritual beliefs, sexual orientation, cultural
backgrounds and disabilities.
Health Advisers should identify their boundaries within which they
work and be aware of their professional limitations in offering services to their
patients/ clients. Support and supervision are a vital part of the health advisers
professional framework if they are to fulfil their responsibility to themselves and their
patients/ clients.
The Health Adviser will behave in accordance with professional
scientific integrity when carrying out research and will not encourage or condone courses
of action detrimental or damaging to patients/ clients, their partners or to society as a
whole.
SHASTD wish to thank and acknowledge the Health Advisers who helped
to produce this document.[10]
[1] Partner Notification Guidelines a working document produced by SHASTD
[2] This list represents those infections for which SHASTD recommend partner notification is always carried out. Many HA’s offer partner notification for other infections.
[3] For the purposes of these guidelines SHASTD adheres to the definition of counselling skills as set out by The British Association of Counselling. “The term ‘counselling skills’ does not have a single definition which is universally accepted. For the purpose of this code, ‘counselling skills’ re distinguished from ‘listening skills’ and from ‘counselling’. Although the distinction is not always a clear one, because the term ‘counselling skills’ contains elements of these other two activities, it has its own place in the continuum between. What distinguishes the use of counselling skills from these other two other activities are the intentions of the user, which is to enhance the performance of their functional role, as a line manager, nurse, tutor, social worker etc., The recipient will in turn, perceive them in that role.” Code of Ethics and Practice for Counselling Skills, The British Association for Counselling, Rugby, 1984
[4] As described by the BAC “Counselling is concerned with addressing and resolving specific problems, making decisions, coping with crisis, working through feelings and improving relationships with others” The Code of Ethics and Practice for Counsellors, 1984.
[5] SHASTD support the World Health Organisations statement that “health promotion is about raising the health status of individuals and communities. It is the process of enabling people to increase control over, and to improve their health”, 1994
[6] SHASTD support the definition of
counselling supervision as a necessary process for “People involved in work which
contains a significant element of counselling. It is a term given to
consultation (often ongoing)......to help one think about the issues connected with client
work, including the impact this has on the practitioner.....Many people see
supervision as supporting the kind of reflective learning that underpins the continual
improvement of practice” Making use of supervision: practical and ethical
issues ,George Leach (1995)
[7] The Code
of Ethics and Practice for Counsellors, British Association for Counselling (1996)
[8] “Research is a scientific process
of enquiry and/or experimentation that involves purposeful systematic and rigorous
collection of data. Analysis and interpretation of the data are then made in order
to gain new knowledge or add to existing knowledge”, Dempsey, PA, The Research
Process in Nursing, 1986, Jones and Bartlett
“Clinical
audit involves systematically looking at the procedures used for diagnosis, care and
treatment, examining how associated resources are used and investigating the effect care
has on outcome and quality of life for the patient” Department of Health,
Clinical Audit: Meeting and improving standards in Healthcare, 1993
[9] Help can be obtained by contacting the trusts clinical audit department or the regional audit chairman.
[10]SHASTD Honorary Secretary, MSF Centre, 33- 37 Moreland Street London EC1V 8BB
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