Transcript Chapter 34 Sexuality

Chapter 34
Sexuality
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Sexual Health
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According to WHO, sexual health is “a state of
physical, emotional, mental and social well-being in
relation to sexuality; it is not merely the absence of
disease, dysfunction or infirmity.”
Nurses help patients achieve sexual health by having
a sound scientific knowledge base regarding
sexuality.
Sexual health contributes to an individual’s sense of
self-worth and to positive interpersonal relationships.
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Scientific Knowledge: Sexual
Development and Sexual Orientation
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Sexual development
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Sexuality changes with each stage of
development.
Sexual orientation
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Describes the predominant pattern of a person’s
sexual attraction over time
Heterosexual, homosexual, lesbian, gay, bisexual,
transgender
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Developmental Stages
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Infancy and early childhood: gender identity
School-aged years: questions
Puberty/adolescence: emotional and physical
changes
Young adulthood: emotional maturation
Middle adulthood: concerns re attractiveness
Older adulthood: physiological sexual
response changes with aging, but aging does
not lead to diminished sexuality
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Adolescence
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Case Study
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Nikki is a nursing student who volunteers at a
free health clinic in a medium-sized college
town. Nikki enjoys volunteering at the clinic
because the nurses allow her to provide
health care education to the young women
who frequent the clinic. Much of Nikki’s
teaching involves education about sexually
transmitted infections (STIs) and reliable birth
control methods.
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Scientific Knowledge: Contraception
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Nonprescription contraceptive methods:
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Abstinence, barrier methods, spermicide, rhythm
Methods that require health care provider
interventions:
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Hormonal contraception, intrauterine device (IUD),
diaphragm, cervical cap, sterilization (tubal ligation
or vasectomy)
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Case Study (cont’d)
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Nikki is educating Ms. Tamika Jones, a 16year-old mother of three, regarding the
benefits of practicing safe sex and using
effective contraception. Nikki explains to Ms.
Jones that sterilization is the most effective
birth control measure aside from abstinence.
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In females, sterilization is referred to as
__________ __________, whereas in males, it is
referred to as __________.
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Scientific Knowledge:
Sexually Transmitted Infections
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About 19 million people in the United States are
diagnosed each year with a sexually transmitted
infection (STI); almost half of them are 15 to 24 years
of age.
STIs are transmitted from infected individuals to
partners during intimate sexual contact.
Usually curable STIs: syphilis, gonorrhea, chlamydia,
trichomoniasis
Viral STIs: human papillomavirus (HPV) (genital
warts) and herpes simplex virus (HSV) type II (genital
herpes), human immunodeficiency virus
(HIV)/acquired immunodeficiency syndrome (AIDS)
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Treatment Barriers
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Locating and treating people with STIs
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Some people do not know that they are infected because
symptoms may be absent or may go unnoticed.
Common symptoms include discharge from the vagina,
penis, or anus; pain during sex or when urinating; blisters or
sores in the genital area; and fever.
Any contact with another person’s body fluids around the
head or an open lesion on the skin, anus, or genitalia can
transmit an STI.
Embarrassment
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Scientific Knowledge:
Sexually Transmitted Diseases
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Human immunodeficiency virus (HIV):
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Human papillomavirus infection (HPV):
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Primary routes of transmission include contaminated IV
needles, anal intercourse, vaginal intercourse, oral-genital
sex, and transfusion of blood and blood products.
Most common STI in United States; aka genital warts;
spread through direct contact with warts, semen, or other
fluids
Chlamydia (bacterial)
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Causes infertility, pelvic inflammatory disease (PID), and
neonatal complications
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Nursing Knowledge Base: Factors
Influencing Sexuality
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Sociocultural dimension of sexuality
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Impact of pregnancy and menstruation on
sexuality
Discussing sexual issues
• Sexual assessment and interventions need to be
included in health care.
• Nurses who have difficulty discussing topics related to
sexuality need to explore their discomfort and develop a
plan to address it.
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Nursing Knowledge Base: Decisional
Issues
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Contraception
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Factors that influence effectiveness: method of
contraception, couple’s understanding of the
method, consistency of use, compliance with
method’s requirements.
Abortion
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It is essential to choose specialties or places of
employment where personal values are not
compromised and the care of a patient in need of
health care is not jeopardized.
STI prevention: only abstinence is 100% effective
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Case Study (cont’d)
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Ms. Jones tells Nikki that she doesn’t think
she’s at risk for STI.
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Which of the following populations have the
highest incidence of STI?
(Select all that apply.)
A. Hispanic women aged 15 to 24
B. African American men aged 15 to 24
C. Caucasian men aged 50 to 58
D. Caucasian women aged 42 to 53
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Nursing Knowledge Base Alterations
in Sexual Health
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Infertility = Inability to conceive after 1 year of
unprotected intercourse
Sexual abuse
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Nurses must report suspected abuse to the proper
authorities.
Conflicts
Sexual dysfunction = Absence of complete
sexual functioning
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Affected by illnesses and medications
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Quick Quiz!
1. Upon admission, when gathering a patient’s
sexual history, nurses should
A. Focus only on physical factors that affect
sexual functioning.
B. Discuss sexual concerns only if the patient
raises questions or concerns.
C. Use emotionally laden terms when
discussing sexual concepts.
D. Include questions related to sexual function.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Nikki informs Ms. Jones that she has tested
positive for Chlamydia.
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True or False: Chlamydia is the most common STI
in the United States.
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Nursing Process: Assessment
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Factors affecting sexuality
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Developmental stage
Physical and functional factors
Lifestyle
Relationship and psychological factors
Self-esteem factors that influence sexual functioning
By including sexuality in the nursing history, the nurse
acknowledges that sexuality is an important
component of health and creates an opportunity for
the person to discuss sexual concerns.
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Nursing Process: Assessment (cont’d)
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PLISSIT Assessment of Sexuality:
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Permission to discuss sexuality issues
 Limited Information related to sexual health
problems being experienced
 Specific Suggestions—only when the nurse is
clear about the problem
 Intensive Therapy—referral to professional with
advanced training if necessary
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Assessment
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Sexual health history
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Sexual dysfunction
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Most patients want to know how medications,
treatments, and surgical procedures influence
their sexual relationship even though they often do
not ask questions.
Many illnesses, injuries, medications, and aging
changes have a negative effect on sexual health.
Physical assessment
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Teach breast and testicular self-examination.
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Nursing Diagnosis
Anxiety
Ineffective coping
Social isolation
Interrupted
family
processes
Ineffective
sexuality
pattern
Deficient knowledge
(contraception/ STIs)
Sexual
dysfunction
Risk for other-directed
violence
Risk for selfdirected
violence
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Planning
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Nursing interventions for patients with sexual
concerns focus on supporting patients’ need
for intimacy and sexual activity.
Patients often feel overwhelmed and
hopeless about returning to the previous level
of sexual functioning.
They usually need time to adapt to physical
and psychosocial changes that affect their
sexuality and sexual health.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Implementation
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Health promotion
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Acute care
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Annual health examinations provide an opportunity to
discuss contraception and safe sex practices.
Illness and surgery create situational stressors that often
affect a person’s sexuality.
Restorative and continuing care
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In the home environment, it is important to provide
information on how an illness limits sexual activity and to
give ideas for adapting or facilitating sexual activity.
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Evaluation
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What other questions do you have about your
sexual health?
Did you experience less pain during sexual
intercourse after taking your pain medication?
What barriers are preventing you from
discussing your feelings and fears with your
partner?
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