WORK/LIFE BALANCE FROM A MOM AND NURSE PRACTITIONER

My thoughts on Faith-based Healthcare education

6/23/16
Recently someone ask me a question about how I discuss abortion with patients, and I realized I had really not had any preparation in my education about discussing abortion with patients. I did my graduate education at a private Evangelical Christian university, which may explain why I did not receive training to talk about this subject. Prior to this program I had only attended public secular schools, and thus when I applied to this program I didn't have any idea what to expect in terms of the religious aspect. I grew up going to a Christian church, but my parents were very loose in terms of their religious beliefs. I chose to apply to this institution for the particular entry-level FNP program, not taking into account the fact that it was a religious-based school. Roughly half of the cohort in the program also chose this program without regard to religion. Incorporating prayer and faith into the curriculum and classroom felt foreign to me at first. As I spent more time at this institution, I came to appreciate the prayer and re-connection with a spiritual side I had long neglected. We prayed in most classes daily, and each course required a faith integration assignment. I had two courses required regarding spiritual care, one requiring a lengthy paper dissecting a theme from biblical passages and theologians throughout the centuries. My theme was grief, and the assignment has been very meaningful to my practice in the past and currently. I ended up loving that class, and the class discussions were so engaging, and at times emotional. At the end of the semester each student presented their papers, and one presentation in particular had the whole room in tears and hugging one another. I felt the religious aspect of the program added to the humanity of medicine, which is often neglected in most curriculums.  The flip side of a faith-based  institution was that the topics in medicine that did not align with Evangelical Christian doctrine, such as care of LBGT patients or abortion, were simply not taught. The problem with the omission of such topics were that sites for clinical rotations were not faith-based, and thus students were still required to see LBGT patients and patients who sought abortions. During our mental health rotation my fellow classmates and I did hours at a mental health hospital with a wing dedicated to LBGT patients. This was my favorite unit, and I would always enjoy the group therapy sessions more than anything else during these clinical hours. One student however, refused to sit in during these sessions on the LBGT unit, because she didn't agree with these "lifestyles." During our lecture discussion in class that week, my good friend and classmate who is always outspoken, brought this to the attention of the professor asking "Since this is a Christian University are we going to talk about interacting with gay people in clinical settings?" The professor just left it as an open-ended question, and the discussion did not move any further. This academic program very much emphasized "vulnerable populations" in healthcare, but somehow LBGT community who are an extremely vulnerable population in healthcare, were not at all discussed. The reality is if a patient walks into my clinic who is transgender, I cannot just refuse to talk about this or treat the patient. I also need to understand the medical treatment behind gender- transitioning, which was never taught. In the graduate-level women's health course, abortion was never discussed, even though some students in this course were at clinical sites where abortions were performed. The curriculum for the women's health course never discussed counseling a patient requesting abortion, or even when an abortion may be a medical necessity for the patient. We had a guest-speaker who worked as a SART (sexual assault response team) nurse talk about care of patients who were victims of rape and incest, but in this discussion there was no mention about how to counsel patients in these cases on abortion as an option. In California a provider has the right to refuse to perform abortions for moral reasons, however the provider should still be able to counsel the patient and make a referral.
 Although I only have my own personal experience at Christian university to draw from, it seems that the avoidance of education on abortion and LBGT-specific care is not only a problem in religious-based medical training institutions.  I recently heard this segment on NPR about the limited sites offering training on abortions for OB/GYN residents in Texas. Furthermore, I also recently read this article, about how LBGT healthcare is also rarely taught in most medical programs. With this in mind, it seems that this is not simply an issue at religious-based institutions, but in general topics that are still taboo in our society. I also cannot speak for all Christian healthcare education, and I would be interested to hear thoughts from anyone else who attended a religious-based institution, or from those educated at a secular medical program how these issues were addressed. I felt overall a religion was valuable in my education, but I would have appreciated at the least a brief education on the topics of LBGT healthcare and abortion.
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