Abstract: Overcoming the Emotional and Informational Barriers to Patient Disclosure in Pregnancy: Perspectives and Strategies of Nurses

◆ Elizabeth D. Dalton, Middle Tennessee State University
◆ Scott Eldredge, Western Carolina University
◆ Laura Miller, University of Tennessee, Knoxville
◆ Ivanka Pjesivac, University of Georgia

Nurses who care for pregnant and laboring women must elicit a range of psychosocial and medical information from their patients in order to provide optimal care. In maternity care, critical sources of information include both the prenatal record and the patient herself, while the types of information nurses need include patients’ health behaviors, mental health and emotional wellbeing, social support systems, physical symptoms, and health history (Murray & Huelsmann, 2009). But pregnant women in these situations may be reticent when it comes to revealing sensitive health or psychosocial information about themselves to nurses who are caring for them (e.g., Keeling & Mason, 2011; Phillips, et al. 2007). Obtaining accurate information from patients is important in the context of pregnancy for a number of reasons, among them the ability to anticipate potential complications that may affect the mother or the fetus (Littleton-Gibbs & Engebretson, 2012). Our goal is to better understand nurses’ perspectives on the barriers to and strategies for eliciting patient disclosures in pregnancy, and to produce recommendations for encountering difficult topics of disclosure using an interdisciplinary approach that can extend across fields of nursing practice.

Disclosure has been theorized and modeled in ways that largely focus on processes associated with the decision to disclose in personal relationships (e.g. Greene, 2009), and as a reciprocal process that moves parties toward greater intimacy in initial interactions (Altman & Taylor, 1973). In healthcare, although reciprocal disclosure has been examined in mental health nursing (e.g. Unhjem, Vatne, & Hem, 2018), little research has examined the processes of eliciting disclosure as a one-sided aspect of interpersonal information-seeking. Our data come from interviews conducted with 22 nurses, nurse practitioners, and certified nurse midwives from across the Southeastern United States. Using framework analysis (Ritchie & Spencer, 1994) to approach our qualitative data with an eye toward applied policy outcomes, this study identifies the topics of disclosure that can be difficult to elicit from pregnant women, analyzes nurses’ constructions of the deeper barriers preventing those disclosures, and elucidates the communicative strategies nurses use to overcome those barriers. Nurse participants confirm that there are specific topics, including drug use, STIs, pregnancy history, sexual and physical abuse, social support, medications, and general health history that pregnant and laboring patients are often reticent or unable to disclose. The identified barriers behind these topics are broadly categorized as emotional or informational. Nurses attribute women’s emotional barriers to fear, shame, anxiety, dislike, and suspicion. Informational barriers are attributed to patients not being informed of their own medical history, forgetting events or details, or not believing certain information is salient. Nurses’ beliefs about the emotional and informational barriers to disclosure drive the strategic approaches they use to obtain information from patients, including education, creating a positive communication climate, using creative questioning techniques, and circumventing the patient by seeking out medical/prenatal records or biomedical indicators.

In addition to practical recommendations, this study adds interdisciplinary depth to our understanding of how nurses can elevate straightforward information-gathering to a therapeutic enactment of social support.