Unit 5: Special Issues

Relevant to Family Nursing

Sexuality and Sexual Health Assessment and Intervention
N 304.3 Fall 2013 Dr. Kelly
Penz

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Class Outline
Guest Speaker
Break
Lecture/ Activities
Part 1: Background Information
Part 2: Review of Selected Readings
Part 3: Improving Practice

Review for Final Examination

Class Objectives
Identify why sexuality is an important
aspect of family nursing
Identify unique health challenges faced
by the LGBQITT community
Describe ways to integrate sexual health
into nursing practice

IN THE NEWS
It Gets Better Project
http://www.youtube.com/watch?v=5p-AT18d9lU
Rick Mercers Rant
http://www.youtube.com/watch?v=Wh1jNAZHKIw
From Make it Better
http://www.makeitbetterproject.org/about
Bullying is a widespread problem
The Federal government estimates that 2 out of 10 high
school students experience bullying each year (typically
worse for middle school students).
For lesbian, gay, bisexual, intersexed, and
transgender students,

10.

this rate is 9 out of

Part 1: Background Information

Definitions
Sexuality:
a central aspect of being human throughout life
encompasses sex, gender identities and roles, sexual orientation,
eroticism, pleasure, intimacy and reproduction
Sexuality is experienced and expressed in thoughts, fantasies, desires,
beliefs, attitudes, values, behaviours, practices, roles and relationships
(not all of these dimensions are always experienced or expressed)
Influences on sexuality include: biological, psychological, social,
economic, political, cultural, ethical, legal, historical, religious and
spiritual factors (and their interactions)

Sexual health:
The experience of ongoing physical, psychological, and socio-cultural
well being related to sexuality
Not merely the absence of dysfunction or disease

Part 1: Background Information

Definitions
Sexual orientation:
Terminology related to romantic/physical relationships (i.e. Gay, lesbian,
bisexual, transgendered, two-spirited, queer, asexual, etc.)

Two-spirited a term used by some Aboriginal communities,

mostly in North America, to describe Western notions of gay,
lesbian, bisexual, transgender individuals
Two-spirit people were considered visionaries, blessed and were
regarded as spiritual advisors, often they were seen as mediators within
the community, people felt they could understand both sides of a
dispute between women and men
Unfortunately, many aboriginal communities have lost this part of their
cultural history, which may result in the discrimination of, and violence
towards two-spirited people within their own communities
LGTB Health Matters (2006). Retrieved from:
http://www.sexualhealthcentresaskatoon.ca/pdfs/p_lgbt.pdf

Part 1: Background Information

Definitions
Heterosexism
the assumption that everyone is, or should be, heterosexual
The assumption that heterosexuality is superior/preferable to
homosexuality/bisexuality
also refers to organizational discrimination (When the norms
implied by an institution are discriminatory either overtly or
covertly ( organisation discrimation), it base on our races,
sexuality, ethnicity.

Homophobia (also biphobia, transphobia)

the irrational fear, hatred, aversion to, and discrimination
against homosexuals/bisexuals/trans
Many levels and forms of homophobia

Part 1: Background Information

Definitions
As early as 1974 the American Nurses Association
recognized the importance of sexual health as a
component of nursing practice
In 1992, the Canadian Nurses Association issued
The Role of the Nurse in Reproductive and
Sexual Health (in 2002 this was replaced by the
The Role of the Nurse in Reproductive and
Genetic Technologies.
Nurses have a role in sexual health
Nurses are advocates for informed decision making
around reproductive and sexual health matters and
practices.

Part 1: Background Information

Nursing & Sexual Health
Where do we encounter sexual health
and sexuality?
Sexual health clinics
Fertility clinics
Palliative care
Acute care
Home Care
Long Term Care Settings
EVERYWHERE when we really think about it

Part 1: Background Information

Nursing & Sexual Health
Nursing Practice
Sexual health and sexuality are both components of the human
experience, and thus, a component of holistic nursing care,
regardless of age/ability (Dattilo & Brewer, 2005; Treacy &
Randle, 2004; Webb, 1987)
The therapeutic relationship provides an ideal relationship
within which to raise sexuality, and sexual health issues, and
integrate therapeutic interventions when planning patient care
(Katz, 2003)

The responses and actions of nurses, relating to

sexuality, are a reflection of broader societal views
and beliefs (Guthrie, 1999)

Part 1: Background Information:

Nursing & Sexual Health
What do we know about nursing practice and sexual health?
Dattilo & Brewer (2005) interviewed senior nursing students about the inclusion
of sexual health assessments in their practice

Do nurses regularly include sexual health as a component of care?

Students cited a lack of inclusion based on : personal discomfort with the topic, lack of
educational preparation, and that similar practice was mirrored by their colleagues

Literature demonstrates that nurses acknowledge it as an aspect of care (Ekland, 1997; Guthrie,
1999; Higgins et al., 2006; Shell, 2007,)
Studies continue to show that nurses are consistently hesitant to integrate sexual health into their
practice (Jolley 2001; Lewis & Bor, 1994; Magnan et al., 2005; Treacy & Randle, 2004)

Why Not? (Magnan, Reynolds & Galvin, 2005)

nurses may not believe that patients expect nurses to ask about
sexual concerns
Discomfort, lack of confidence (despite knowing how
disease/treatment affected sexual health)

Part 1: Background Information

Nursing & Sexual Health
Why is sexuality/sexual health important?
Sexuality is an important part of being human, but an area
of practice mostly ignored by practitioners who are lacking
in comfort and skills about how to approach or handle the
topic (Katz, 2005)
Hughes (2000) defines sexuality as an important aspect of
health and quality of life, human fulfillment, which is not
defined by age or through the genitals
Sexuality is the giving and receiving of affection between
people (Shell, 2002).
The human need for touch and intimacy is a dynamic
process, but it remains and may even increase through a
difficult illness

Part 1: Background Information:

Nursing & Sexual Health
In palliative care
Palliative care services seek to improve
quality of life for patients and families with
a life-threatening illness by addressing
their physical, psychological, and spiritual
needs (World Health Organization, 2005).
Sexuality was found to be an important
concern for most patients at the end of
life, but was rarely addressed (Lemieux et
al., 2004)

Part 1: Background Information

Nursing & Sexual Health
In relation to individuals with disabilities:
Nurses have a pivotal role to play not only in the promotion of sexual
health amongst people with disabilities, but also in challenging
prevailing attitudes about sex and sexuality in regards to this
population
(Earle, 2001; Phillips & Phillips, 2006; Wheeler, 2001).

Positive and negative messages, communicated through

the attitudes and actions of caregivers, about the sexual
health and conduct of people with disabilities, affect how
individuals interpret their own sexuality and behaviours
(Szollos & McCabe, 1995)

Part 1: Background Information

Nursing & Sexual Health
Individuals with disabilities
cont
Tend to demonstrate more negative attitudes towards
sexuality and have lower sexual self esteem than
those without a disability
(Hellemans, Colson, Verbraeken, Vermeiren, & Deboutte, 2007;
Taleporos & McCabe, 2003; Vansteenwegan et al, 2003)

Are at a greater risk for sexual abuse

(Cheng & Urdy,

2002, 2005; Murphy & Young, 2005, Suris et al, 1996)

Adolescents with disabilities may engage in sexual

experiences without adequate information or skills to
keep them healthy, safe, and satisfied (Murphy &
Young, 2005, p. 641)

Part 2: Reviewing Selected

Readings
Shell
What(2007)
are the key points in this article?
Need for discussion
Nurses are trusted for their advice
- BETTER
PLISSIT

P = Permission
LI = Limited Information
SS = Specific Suggestions
IT = Intensive Therapy

Be prepared!

B = Bring up the
topic
E = Explain
T = Tell
T = Timing
E = Educate
R = Record

Part 2: Reviewing the Readings

Rndahl, Innala, & Carlsson (2006)
Heteronormativity
A powerful heterosexual structure,
heterosexuality is a universal norm, resulting in
homosexuals being treated like heterosexuals,
resulting in invisible lifestyles, discrimination,
and social exclusion.

Part 2: Reviewing the Readings

Rndahl, Innala, & Carlsson (2006)
What contributes to heteronormativity?
Lack of education about different types of
lifestyles
Assuming heterosexuality
Fear of opening a discussion
Becoming invisible

Part 2: Reviewing the Readings

Weber (2009)
Clinical challenges in providing
nursing care to children and
adolescents:
Sexual orientation unknown
Fears of latent homophobia
Creating an environment of trust
Reconciling personal beliefs and
professional obligations

Part 3: Improving Practice

Challenge our assumptions

Use gender neutral, non-judgmental terms
Encourage open communication and recognize communication issues
Provide help and support
Ensure that specific literature is available that addresses the needs of the GLBTQ community
GUEST SPEAKERS
Accept people for who they say they are in practice LBGTQ. THE QUEER INVOLVE ALL THE SEXUALITY
Transgender is acting in the opposite societal expectation of your sex
Spectrum (people other than heterosexulas)are in between male and female. What pronoun will you like for me
to address you, use of partner is safe
Intersex : to easily classified as male or female in terms of the hormone. There should be no medical
interventions for intersex children. Let the child grows up before deciding which sex he or she wants to belong.
Institutions are built on homonegativity and transnegativity policies.
Homonegativity and trans negativity is more frowned out in church and colonial roots, Canadian blood services
Medical issues on transgender : both can get pregnant and intake/medical forms should include homosexuals.
Ensure to give a sexually safe care
Public institutions and transgender
Family group and structure
There is no medical coverage for same sex pregnancy thus making clinic services inaccessible to gay partners.
Respect people for who they are in terms of sexuality in practice