Intervención de enfermería en la sexualidad de los pacientes ostomizados / Nurse intervention in the sexuality of ostomy patients

En España viven más de 70.000 personas con una ostomía, situación que lleva a los pacientes a modificar sus hábitos de vida. En la mayoría de casos y según numerosos estudios, los pacientes ostomizados tienen afectada su vida sexual. La baja autoestima situacional comporta miedo y ansiedad y esto produce evitación de las relaciones sexuales. También algunas técnicas quirúrgicas pueden provocar disfunciones sexuales. La intervención enfermera en el abordaje de la sexualidad es fundamental en los pacientes ostomizados porque detecta con presteza cualquier trastorno sexual. En el presente artículo se ofrece información a las enfermeras acerca de cómo abordar la sexualidad y las disfunciones sexuales para que a su vez puedan dar recomen-daciones a los pacientes ostomizados y detectar cuándo derivar el paciente a otro profesional competente, dado que los cambios físicos y/o psicológicos que experimental conllevan, en ocasiones y considerando que la sexualidad es multidimensional, la necesidad de cuidados específicos por parte de profesionales expertos (psicólogo, sexólogo, fisioterapeuta de suelo pélvico...) en un tratamiento de tipo multidisciplinar

In Spain, more than 70,000 people live with an ostomy, a situation that leads patients to modify their life habits. In most cases and according to numerous studies, the sex life of ostomy patients is affected. The situational low self-esteem involves fear and anxiety and this leads to avoidance of sexual relations. Some surgical techniques may also cause sexual dysfunctions. Nurse intervention in the approach to sexuality is essential in ostomized patients because it is the professional that detects any sexual disorder early. This article tries to inform nurses of how to approach sexuality and sexual dysfunctions in order to re-commend ostomized patients and also detect when to refer them to another competent professional, given the physical and / or psychological changes they experience. In some cases, the need for specific care by expert professionals (psychologist, sexologist, pelvic floor physiotherapist...) may be needed by carrying out a multidisciplinary treatment since sexuality is multidimensional

Sexual dysfunctions and related variables with sexual function in patients who undergo dialysis for chronic renal failure.

AIMS AND OBJECTIVES: To evaluate personality characteristics and psychological symptoms believed to have an effect on the sexual functions and performances of patients undergoing dialysis treatment. BACKGROUND: Chronic renal failure is a life-threatening condition which can often have a poor prognosis. The loss of vital kidney function and other complications can affect almost all age groups. DESIGN: A quantitative descriptive study. METHODS: The study sample included 225 patients selected randomly from patients who have undergone dialysis treatment for at least 3 months at a dialysis centre in a university hospital. In this study, the Golombok Rust Inventory of Sexual Satisfaction (GRISS), the Eysenck Personality Inventory (EPI) and the Brief Symptom Inventory (BSI) were used. RESULTS: In the correlation test, made to investigate the relation between the patients' sexual satisfaction and their personalities, a significant positive relation was found between the communication subscale of the GRISS and the Lie dimension of the EPI, and a significant negative relation was found between the Communication subscale of the GRISS and the Lie dimension of the EPI, and between the Vaginismus and Orgasm subscales of the GRISS and the Extroversion dimension of the EPI. CONCLUSION: Results showed that sexual problems, in the areas of nonsensuality, anorgasmia, avoidance and communication, are associated with extroversion and psychological symptoms. RELEVANCE TO CLINICAL PRACTICE: Sexual health and the psychological well-being of patients with renal failure is an important issue that should be considered in nursing practice. Nurses should take the psychological problems of patients and their relations with partners into account and consider these problems in a holistic manner within the framework of nursing practice. They would then be able to play an effective role in intervening at an early stage and would be better equipped to help and control the psychological and sexual problems that some patients may experience.

Nurses' perceptions of providing psychosexual care for women experiencing gynaecological cancer.

PURPOSE: To gain insight into how Western Australian nurses conceptualise the provision of psychosexual care for women undergoing gynaecological cancer treatment and how this aligns with nurses globally. METHODS: A qualitative descriptive design was chosen to facilitate insight into nurses' perspectives of their reality. Seventeen nurses working at a tertiary women's hospital in Western Australia participated in one-on-one interviews and were asked to describe their perceptions and identify factors that facilitate or challenge psychosexual care provision. RESULTS: Data analysis revealed five themes affecting the provision of psychosexual care: (1) Nurses use strategies to aid the conversation (subthemes: supporting the woman, facilitating engagement); (2) Women have unique psychosexual needs (subthemes: diversity, receptiveness); (3) Nurses are influenced by personal and professional experience and values (subthemes: confidence, values, making assumptions); (4) Systems within the health service affect care (subthemes: being supported by the system, working as a team); and (5) Society influences attitudes around sexuality. Nurses' views differed around whether these factors had a positive or negative impact on the conversation required to provide this care. CONCLUSIONS: Factors influencing nurses' provision of psychosexual care are multifaceted and differ amongst nurses. Recommended strategies to improve service provision include guidelines and documentation to integrate assessment of psychosexual issues as standard care, encouraging shared responsibility of psychosexual care amongst the multidisciplinary team and implementing education programs focussed on improving nurses' confidence and communication skills.

Obesity and Sexual Dysfunction: Making the Connection.

Understanding the relationship between the two may motivate patients to discuss weight loss.

Intimacy for patients with a stoma.

Jennie Burch, Enhanced Recovery Nurse Facilitator, St Marks Hospital, Middlesex, looks at what nurses can do to support patients after stoma formation in relation to body image and intimacy.

[Nursing consultation for sexual problems in multiple sclerosis]. / Vers une consultation infirmière en neurosexologie.

Patients with multiple sclerosis often complain of sexual problems. Nurses in a neurology department have decided to explore the sexual health of these patients. They also intend to assess the need for a neurosexuality nurse consultation.

A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol.

INTRODUCTION: Prostate cancer is common and the incidence is increasing, but more men are living longer after diagnosis, and die with their disease rather than of it. Nonetheless, specific and substantial physical, sexual, emotional and mental health problems often lead to a poor quality of life. Urology services increasingly struggle to cope with the demands of follow-up care, and primary care is likely to play the central role in long-term follow-up. The present phase II trial will evaluate the feasibility and acceptability of a nurse-led, person-centred psychoeducational intervention, delivered in community or primary care settings. METHODS AND ANALYSIS: Prostate cancer survivors diagnosed in the past 9-48 months and currently biochemically stable will be identified from hospital records by their treating clinician. Eligible men would have either completed radical treatment, or would be followed up with prostate specific antigen monitoring and symptom reporting. We will recruit 120 patients who will be randomised to receive either an augmented form of usual care, or an additional nurse-led intervention for a period of 36 weeks. Following the health policy in Wales, the intervention is offered by a key worker, is promoting prudent healthcare and is using a holistic needs assessment. Outcome measures will assess physical symptoms, psychological well-being, confidence in managing own health and quality of life. Healthcare service use will be measured over 36 weeks. Feedback interviews with patients and clinicians will further inform the acceptability of the intervention. Recruitment, attrition, questionnaire completion rates and outcome measures variability will be assessed, and results will inform the design of a future phase III trial and accompanying economic evaluation. ETHICS AND DISSEMINATION: Ethics approval was granted by Bangor University and North Wales REC (13/WA/0291). Results will be reported in peer-reviewed publications, at scientific conferences, and directly through national cancer and primary care networks. TRIAL REGISTRATION NUMBER: ISRCTN 34516019.

A workshop for educating nurses to address sexual health in patients with breast cancer.

Breast cancer is associated with significant sexual side effects. However, nurses and other healthcare providers are often reluctant to initiate a discussion about sexual health with their patients because of numerous barriers, including knowledge, time, and confidence. This article describes the development and implementation of a sexual health workshop for oncology nurses intended to increase their knowledge about common sexual side effects in patients with breast cancer, strengthen their confidence in addressing sexual health, and provide them with tools and resources to educate their patients.

Cardiac comorbidities and sexual activity predict sexual self-perception and adjustment.

BACKGROUND: Changes in sexual satisfaction and sexual activity are often reported by cardiac patients, although factors influencing sexual adjustment are not well established. Knowledge of risk and protective factors can guide nurses in addressing physical and psychological needs of patients. OBJECTIVES: We examined predictors of sexual self-perception and adjustment in a cross section of cardiac patients. METHODS: A nonexperimental, descriptive survey design was used to examine overall sexual self-perception and adjustment, sexual anxiety, sexual depression, sexual satisfaction, sexual self-efficacy, sexual activity, selected demographic factors, and 20 cardiac and noncardiac comorbidities using a mailed survey with a broad sampling of cardiac patients (n = 128). Data were analyzed with descriptive statistics, t tests, and regression analysis. RESULTS: Fewer cardiac conditions and being sexually active were significant predictors of sexual self-perception and adjustment. Participants with hypertension reported more sexual depression; those with myocardial infarction had higher scores for both sexual anxiety and depression, and greater sexual anxiety occurred for those with peripheral artery leg bypass. DISCUSSION: Positive sexual self-perception and adjustment are linked to sexual activity and fewer cardiac problems. This finding can be used to inform decisions about initiating sexual counseling.

Evaluation of a rural nurse-led clinic for female sexual dysfunction.

OBJECTIVE: The objective of this study was to explore changes in the sexual function of women who attended a rural nurse-led female sexual dysfunction clinic. DESIGN: This exploratory study was designed as a one-group pre-test/post-test design from a convenience sample of women attending the clinic. SETTING: The setting was a women's health centre located in regional Western Australia. PARTICIPANTS: One hundred eleven women aged between 18 and 65 years were recruited from clinic attendees. MAIN OUTCOME MEASURE(S): The Australian version of the validated McCoy Female Sexuality Questionnaire was completed before the first appointment (T0), and 1 (T1) and 6 months (T2) after the last appointment. RESULTS: Women attending the clinic reported significant increases in sexual desire, satisfaction and orgasm quality and achievement at 1 and 6 months after their last appointment. There was also a significant increase in satisfaction with their main sexual partner at 6 months. CONCLUSIONS: This study confirmed the value of an innovative approach to managing female sexual dysfunction in a rural area with workforce shortages and limited health services. It is recommended that care by a nurse-led multidisciplinary team be used in the management of sexual dysfunction. Further research is needed to see if this model of care would be effective in other settings.

Pharmacologic therapy for female sexual dysfunction.

Female sexual dysfunction (FSD) is a common health issue that can have significant negative effects on overall well-being and quality of life. The primary purpose of this article is to review commonly noted pharmacologic therapies for FSD. The pathophysiology, clinical evaluation, and selected nonpharmacologic therapies are also briefly addressed as well as recommendations for practice.

[Ineffective sexuality pattern in an adolescent: nursing approach in primary health care]. / Patrón sexual ineficaz en un adolescente: abordaje enfermero en atención primaria.

Adolescent is a phase of continual physiological, psychological and social adaptation. It is during this time that young people tend to have their first sexual experiences. Sexual dysfunctions are characterized by important clinical changes in sexual desire and/or by psycho-physiological changes in the sexual response cycle. Premature ejaculation is one of the most frequent sexual dysfunction amongst men, with a higher prevalence in the younger population compared to other populations. The clinical case is presented of a 17 year-old male who experienced difficulties during his sexual relations. It is discussed whether his condition was a sexual dysfunction or ineffective sexual pattern. The care plan which was developed in nursing consultation was described for ineffective sexual pattern; the pending nursing treatment incorporated activities recommended by scientific evidence. Finally, the role of primary health care nursing professionals is pointed out in the detection and approach of sexual problems in adolescents.

Acknowledging female sexual dysfunction in women with cancer.

Female sexual dysfunction (FSD) is a common side effect of cancer and cancer treatments. Assessing for sexual dysfunctions in women with cancer is a vital component of helping women to have better, more satisfying sexual experiences. FSD is not widely addressed in most healthcare facilities or by healthcare providers, but it is a topic that all providers should be discussing with their female patients.

Sexual concerns and practices after ICD implantation: findings of the COPE-ICD rehabilitation trial.

BACKGROUND: Studies show that patients with implantable cardioverter defibrillators (ICD) frequently experience sexual dysfunction. These experiences are often linked to exercise intolerance, side-effects of medication, and psychological problems. OBJECTIVE: To describe (a) the level of information given about sexual activity, (b) the areas of patient concerns related to sexual function and the ICD, and (c) changes in sexual behavior. METHODS: A randomized controlled trial including 196 patients (1:1) was designed, including 12 weeks of exercise training and 1 year of psycho-educational follow-up focusing on modifiable factors associated with poor outcomes, including sexual functioning. The Sex After ICD Survey was administered 6 months after the randomization as part of the planned explorative outcomes. 141 patients responded. RESULTS: The analyses showed that 37 of the 69 (55.2%) patients of the intervention group and 16 of the 72 (24.6%) patients of the control group received information (p<0.001). The areas of greatest concern reported by many patients were: lack of interest in sex, erectile dysfunction, and an over-protective partner. Fewer patients were sexually active 6 months after the ICD implantation than before the ICD implant: 51.8% versus 66.7%. In the intervention group, patients had sexual intercourse a mean of 4.9 times during the previous 2 months versus 4.0 in the control group (p=0.4). CONCLUSION: Despite having received more information, no interventional effect was found between groups in terms of sexual concerns or activity.

The 5-As framework for including sexual concerns in mental health nursing practice.

Available evidence informs us that sexual health concerns of consumers are commonly avoided within mental health services. This paper describes the findings of a qualitative exploratory research project. This research was conducted in three stages, all involving in-depth interviews with 14 nurses working in a mental health setting. Stage 1 involved an exploration of participants' views about including sexual concerns in their practice and included an educational intervention designed to encourage sexual inclusivity in practice. Stage 2 involved follow up interviews 4-6 weeks later to discuss the effectiveness of the intervention and whether practice change had resulted. Stage 3 was conducted two years later with the aim of determining the extent to which practice changes had been sustained. The themes emerging throughout the research emphasised five main stages in the nurses' experience: avoidance; awareness; applying; approval; and acknowledgement. Avoidance of the topic was commonly noted in the early stages of the research. The education program led to awareness raising of sexual concerns and approval towards the importance of this area to which lead to applying it to practice. This ultimately resulted in acknowledgement of the need for sexual concerns to become part of mental health nursing practice. These five stages are represented in the Five A's for including sexual concerns in mental health nursing practice, the framework developed by the first author.

Talking about sexuality with consumers of mental health services.

PURPOSE: To explore nurses' perceptions of how consumers of mental health services have responded to mental health nurses discussing sexuality with them. DESIGN AND METHODS: Qualitative exploratory design including in-depth individual interviews with 14 mental health nurses in Australia on two occasions. Nurse participants were taught the BETTER model in the first interview and were asked to use this in their practice. FINDINGS: In the second interview nurse participants described the model as useful and consumer responses as very positive. PRACTICE IMPLICATIONS: The findings suggest the BETTER model is a simple and effective intervention that can assist mental health nurses to include sexuality as part of nursing care.

Getting BETTER: breaking the ice and warming to the inclusion of sexuality in mental health nursing care.

Discussing sexual issues with consumers is considered a nursing role, yet it is commonly avoided. Research suggests that sexual issues and difficulties are particularly evident in mental health settings, and failure to address these issues represents a significant gap in care and treatment. Specific models for raising sexual issues have been used in oncology and cardiac care settings to assist clinicians. A descriptive, exploratory study was conducted with mental health nurses from Queensland, Australia. The aim of this research was to explore whether a specific model, the BETTER model (bring up, explain, tell, time, educate, record) was useful in assisting mental health nurses in raising the topic of sexuality with consumers. In-depth interviews explored participants' attitudes and experiences of discussing sexuality. Participants were introduced to the BETTER model, and were asked to trial the approach with consumers. They were then interviewed a second time. Two main themes emerged: greater awareness and becoming part of practice. Participants described a transformation of their practice from one of avoiding issues of sexuality with consumers, to a position of inclusion, which became embedded within practice. Participants did not tend to use the model in a structured way, and it appears that knowledge and awareness were more useful than the model itself.