Case Manager Communication Skills
Resolution of Ethical Problems: Teenage Pregnancy
Zawdie Rockcliffe
New York City College Of Technology
NUR 4030
Introduction
Over the years our society has been struggling to deal with the problem of teenage pregnancy which has severely impacted our young and their families. The Center for Disease Control and prevention (CDC) report a declined in teenage pregnancy however there are still a significant number of teenage pregnancy in the US. The CDC report’s “In 2017, a total of 194,377 babies were born to women aged 15–19 years, for a birth rate of 18.8 per 1,000 women in this age group. This is another record low for U.S. teens and a drop of 7% from 2016.1 Birth rates fell 10% for women aged 15–17 years and 6% for women aged 18–19 years”. Teenage pregnancy has far reaching consequences beyond just a young girl giving birth to a baby. Education is disrupted for most teenagers during pregnancy, with most teenagers dropping out of school due to being embarrassed or for other reasons. The relationship between the teenager and their parents also takes a hit during the pregnancy. Some parents are disappointed, upset and ashamed of the pregnant teens and sometimes asked them to leave the home which creates another problem for the teen. Being homeless is a very difficult situation for anyone and can be devastating and emotionally overwhelming for the teenager.
There is also the financial aspect to teen pregnancy, which includes the cost of prenatal care and hospital visits. Besides dealing with these many issues, the pregnant teenager must also deal with being stigmatized by members of the society for being pregnant. Dr. Lee SmithBattle (2013) study “Reducing the STIGMATIZATION of teen Mothers” talks about the difficulty teen mother face trying to fit in while being pregnant. Dr. SmithBattle believes teen mothers are misrepresented and therefore stigmatized “Teen mother are especially vulnerable to bring stigmatized due to their age, class, and racial/ethnic background” SmithBattle, L (2013). The case manager must be skilled, knowledgeable and equipped to deal with the many issues faced by teen mothers.
Resolution of Ethical Problems by Case Manager
They are many issues that arise from teenage pregnancy; however, the ethical issues are much more difficult to overcome. Ethical issues can be problematic for the health care team, sometimes conflicting with their own beliefs and values. However, the case manager’s role in dealing with ethical issues is very important and he or she must possess the skills needed to communicate effectively with the teenager, their parents, and other team members. The case manager must be knowledgeable, a good communicator, and cultural competent in order to resolve the ethical issues that can arise during teenage pregnancy.
Some of the ethical issues related to teenage pregnancy are medical consent, abortion, adoption decision, and confidential medical care. They is also controversy about discouraging sexual activity, contraception accessibility, and cessation of smoking, drugs and alcohol during pregnancy. In Redwood, Pyer & Armstrong (2012) study title “Exploring attitudes and behavior towards teenage pregnancy” the authors discussed the role of alcohol and drugs and its effect on teen pregnancy. The study showed that the use of alcohol and drugs by teenagers contribute to risk taking and loss of inhibition. Teenagers that engaged in sex while intoxicated with alcohol and high on drugs become pregnant because they take no precaution during sex.The success of the case manager in resolving these issues can go a long was in the transition for the pregnant teen mother into a confident and capable care giver for the newborn. However, they are necessary communication skills needed to be effective in communicating with teenagers when dealing with teenage pregnancy. The case managers need to be cultural competent, neutral, Knowledgeable, a good communicator, a good listener and good at research.
Communication Skills
Cultural competency
Over the past three decades or so, our society has become much more diverse with many different cultures, beliefs and practices coinciding together. There is no longer a one size fit all approach and public servants such as health care workers and others must achieve cultural competency in other to provide the best care to the public. The case managers are no exception, and he or she must strive to become cultural competent by learning as much as possible about the culture and practices of the different community groups. However, the first step is for the case manager to examine his or her belief and values in relation to the issues in order to eliminate unintentional biases. While teenage pregnancies are seen by many as disruption to the teen’s life and a shameful occurrence, some groups are not so critical of teen pregnancy. Other cultural and ethical issues such as abortion, contraception use, medical consent, cessation of smoking, and abstinence of drugs and alcohol should all be delta with on a case by case basis. The knowledge gained from learning about the cultural practices of the different groups can go a long way in helping the case manager be more effective at his or her job.
Excellent Communicator
A great communicator must first be a good listener and also be able to communicate none verbally. “The ability to listen sends a message that the case manager places the needs of the patient before his or her own needs or those of the organization” (Powell & Tahan 2010). A good listener must give attention to the speaker which includes make eye contact, facing the speaker and give clues to convey understanding. The case manager must be an excellent communicator when dealing with teenage pregnancy and other teenage ethical issues. Teenager are sometimes rebellious to authorities and seldom wants to listen to anyone that don’t see things there way. They believe that grownups just don’t understand their point of view and never will, so they shut down and don’t want to communicate. Motsomi, K., Makanjee, C., Basera, T., Nysaulu, (2016) study discuss the teens communication “Numerous statements from adolescents revealed that they do not openly communicate with their parents because their parents are strict and they fear that they will be embarrassed and misunderstood”. The case manager must be able to reach the teenager, build a working relationship by winning the teen’s confidence and then convey sensitive information in a way the teenager sees as none bias and with no hidden agenda. Some information that must be conveyed to the pregnant teenager is health practices like alcohol abstinence and smoking cessation which are important to the unborn health. The case manager must also be able to convey the wishes and feelings of the teenager to their parent in a way that the parent doesn’t feel he or she is being blamed for the situation or did anything wrong. This can be very difficult especially conveying information that goes against the parent cultural belief such as abortion, contraceptive use and sexual education. The case manager must be sensitive to these issues and must communicate in a therapeutic way to show empathy to all involved.
Neutrality
One very important quality of the case manager is his or her ability to remain neutral in all situations. This can be very difficult when dealing with ethical issues like teenage pregnancy, teen abortion and sex education in relation to teen contraceptive use. Once again, the case manager must first examine his or her own view on these issues and his or her ability to render non bias representation on behalf of the client. If the case manager feels like the issues at hand might be an ethical dilemma and he or she may not be able to render no bias services, they should excuse themselves from the case. The case manager must not show favor to any one side or be judgmental because of his or her view or belief. He or she should be respectful to the views of all involved while giving the best representation on behalf of the client. Neutrality is very important for all aspect of public services and health care, especially when dealing with ethical dilemmas.
Knowledgeable
The case manager must be knowledgeable about the state or city guidelines in relation to any ethical issues and the legal perimeters. The case manager should be knowledgeable about teen emancipation, the age and circumstances in which a teen can be emancipated and the confidentiality that follows. He or she should also be well verse in their job procedure and protocol, rules and guidelines, and available resources in order to provide the best services to the client. In relation to teenage pregnancy, the case manager should be knowledgeable about the different support groups and programs that help pregnant teen to deal with emotional issues related to pregnancy. He or she should be knowledgeable about city or govermantial funds or other finances and housing that are available to the pregnant teen. Being knowledgeable about the legal guidelines, job procedures and protocol and available resources can make the case manager a valuable member of the care team.
Skilled At Research
Research is very important in any profession; and being skilled at research is a valuable tool for a case manager. They will be times when a case manager may encounter a difficult case where the law or rules are not clearly establish and may need to do research in order to become educated on the topic. The case manager can also research for resources such as educational programs that the pregnant teen can attend, emotional support programs, and financial support, not provided by the facility but can be beneficial to their client. One such example is housing for homeless pregnant teen where housing or temporary shelter may be available through non-for –profit organizations such as Coalition for the Homeless and Hour Children. The case manager can also research the culture, beliefs and practices of any new and unfamiliar clients. I believe in order to provide the best service the case manager must be skilled at research and willing to go the extra mile to be more informed about resources available to the client.
Conclusion
The case manager is a very important member of the health care team and his or her communication skills are valuable tools of the trade. “The case manager as the hub of the wheel must channel information to and from all other parties” (Powell & Tahan). In addressing the ethical problems of teenage pregnancy, the case manager must be even more tactful. He or she must be a great listener, cultural competent, neutral, good at research, knowledgeable and an excellent communicator. More importantly, when dealing with cultural dilemma and ethical issues the case manager must be mindful of his or her none verbal cues and body energy that may be an impediment to effective communication. If case managers are able to master all of the above tasks, he or she will be a skilled communicator and be of great value to the health care team.
References
Motsomi, K., Makanjee, C., Basera, T., Nysaulu, P.(2016). Factors affecting effective communication about sexual and reproductive health issues between parents and adolescents in Zandspruit informal settlement, Johannesburg, South Africa. Pan African Medical Journal, 25: 120.doi: 10.11604/pamj.2016.25.120.9208.
Neiterman, E. (2012). Constructing and deconstructing teen pregnancy as a social problem. Qualitative Sociology Review, 8(3):24-4.
Powell, S.K., & Tahan, H.A.(2010). Case Management: A Guide for Education and Practice. (3rd ed.). New York: Lippincott: Williams and Wilkins.
Redwood,T., Pyer, M., Armstrong- Hallam, S. (2012).Exploring attitudes and behavior towards teenage pregnancy. Community Practitioner, 85(3): 20-23.
SmithBattle, L.(2013).Reducing the Stigmatization of Teen Mothers. The American Journal of Maternal/Child Nursing, 34(4):235-241. doi: 10.1097/NMC.0b013e3182836bd4.
