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Assisting individuals to express sexuality in nursing

Assisting individuals to express sexuality in nursing
As previously established, assisting individuals to express their sexuality is essential for the preservation of health and the promotion of well-being, including assisting them to maximize their abilities within the parameters of their perceived physical and/or psychological constraints. There is increasing evidence which suggests that how a child is encouraged and permitted to express their sexuality as a child influences their future sexual behaviour and subsequent expressions of sexuality. For example, exploring genitalia is quite normal for young children; if they are not permitted to do this and are given the impression that it is ‘dirty’ it may impact on their behaviour as an adult.

In assisting clients to express their sexuality the type and level of assistance will obviously be dependent on the individual’s expressed needs and preferences following a comprehensive assessment, and may well include support, education, or referral to more specialist services. Other factors that might impact on the type of assistance prescribed, as with any other activity of living, will include the knowledge and skills of the assessor, those of the care giver, and the resources and facilities available. Given the particularly sensitive nature of this activity for all concerned, the individual client’s wishes must be balanced against the needs, values and beliefs of others without contravening individual rights.

For example, a male client admitted to an acute-care setting for a gender reassignment might ask to be situated in a female bay or ward. Whilst it can be argued that we now live in a much more liberated society than our forefathers, this clearly has the potential to compromise other clients and therefore it may be impossible to grant the request. The most ethically sound solution in this instance would be to offer this client a single room with en-suite facilities. The ways in which we can assist clients express their sexuality are given below.

Clearly the management of abuse is a specialized field of practice, our role being to refer clients to the most appropriate resource. It is important therefore that clients do not swear us to secrecy, as it may be necessary to share information with other members of the health care team to ensure the best possible outcome. You should make this fact known to clients at the outset of any interaction, to avoid being faced with an ethical dilemma

• Be approachable
• Try not to appear embarrassed or uncomfortable when dealing with issues surroundin sexuality
• Adopt a professional approach
• If you feel unable to address these issues with the client, seek appropriate help.
Explain to them that you do not consider that you are skilled enough to help but that you can refer them to someone who is
• Seek opportunities to develop your skills in this area of care delivery
• Do not ignore the client’s expressed need, as they may never pick up the courage to broach the subject again

Birthmarks, malformations
These can have a profound psychological impact on an individual, and clients may look to the health care professional for reassurance and support. We can assist by always being prepared for the unexpected and not showing abhorrence. Have awareness that clients often watch our faces for non-verbal indicators of disgust or acceptance. If the perceived defect is clearly causing great anxiety for the individual, it is often possible to refer the client for surgery or counselling

Chemotherapy / radiotherapy
Clients prescribed chemotherapy and/or radiotherapy are often very worried about the actual and potential side effects of the treatment and whether or not it is likely to make their hair fall out, affect their ability to have sexual intercourse or indeed whether it will affect their ability to have children in the future. Obviously these are very real concerns for clients and, if not addressed, can lead to feelings of panic and even clinical depression. We can assist clients by listening to their fears and anxieties, by correcting any misconceptions, and referring them to more specialized help if the foundations of their concerns are real. For example, arrangements can be made for some individuals to store their eggs or sperm if appropriate

Continence (promoting)
Incontinence of urine and/or faeces can impact significantly on a person’s ability to express themselves sexually. Clearly if a resolution to the incontinence can be found then this should be a priority and many an incontinence advisor has either directly or inadvertently restored or promoted clients’ sexual relationships. One question frequently asked by clients with a long-term indwelling urinary catheter, and one sometimes disregarded by health care professionals if clients do pluck up the courage to ask, is whether they can still have normal sexual relations with their partner. The answer is a resounding ‘yes’, but care must be taken to ensure that, in males, an appropriate sized catheter has been inserted to allow for penile erection. We also recommend that the client wear a condom over the penis and the catheter to reduce the potential for infection and trauma. In females the catheter can be fitted with a spigot and discretely secured to the groin

Provide education and offer guidance regarding the variety of methods available, in keeping with clients’ cultural and religious beliefs as appropriate

Cultural and religious needs
Develop a sound understanding of differing cultural and religious beliefs, values and expectations in relation to expressing sexuality. For example, Hindu women prefer to be treated by female staff; Islam requires that followers keep the whole of the body covered; Jewish men do not usually like women to touch them or be in attendance when sick; Roman Catholics do not support termination of pregnancy or in-vitro fertilization, and only support certain methods of contraception

Disfigurement following a burn injury
Assistance is largely the same as below, though it may be useful to know that remedial beauticians can often be of great value to some clients, particularly those with facial injuries, in guiding and teaching them how to apply make-up to improve their overall aesthetic appearance

Disfigurement Following surgery (perceived)
For some clients, surgery, such as mastectomy, stoma formation, removal of a testicle or hysterectomy, can have a profound impact on their body image. We can assist clients in adapting to these significant bodily changes by ensuring good preparation prior to surgery: by involving them in the decision processes; by giving them time to come to terms with their situation; by introducing them to other clients who have already undergone and adapted to similar sets of circumstances; and by giving them time to voice their concerns, fears and anxieties. We can also help by putting them in touch with local self-help groups and associations. The relevant clinical nurse specialist is usually an excellent resource for such contacts and can also be invaluable in helping clients to readjust

Dress in Appropriate attire
Assist clients to select appropriate attire, paying due regard to individual preferences and contexts of care. Parents often express the sexuality of their child through their choice of clothing, for example dressing their baby boy in blue, and this should be respected

Health professionals often make assumptions that clients can urinate or defecate in the presence of others or with a very thin partition such as a curtain for privacy. They also frequently expect clients to balance precariously on bedpans on occasions. Clearly this is not normal behaviour. Nor is it normal for most adults to require that a stranger wipe their peri-anal area, let alone one of the opposite sex. It is essential, therefore, that we allow clients choice in the how, when, where and with whom of care, without taking offence or foisting ourselves on them merely because we are ‘professionals’, thus promoting privacy and dignity

Similar to puberty, the menopause signals a number of physiological and psychological changes in both males and females that can impact on an individual in varying degrees. Assisting individuals through this natural time may take the form of educating them about the process and the variety of interventions available that might help with some of the common problems experienced, such as hot flushes, osteoporosis and forgetfulness. For others, empathy, a listening ear, and reassurance that the individual is not going mad, but that this is a very normal process, may be all that is required

Ensure adequate provision of sanitary wear and provide the means for discreet disposal. If possible, anticipate needs to reduce embarrassment

Personal hygiene
Assist clients to maintain their personal hygiene (see Chapter 3), paying particular attention to hair, nails, desire to wear make-up, use of perfume or aftershave, etc. in keeping with client preferences

Personal space
Do not invade a client’s personal space except with their express permission unless failure to do so would result in client harm

Physical contact
Encourage and, if necessary, facilitate clients’ pursuance of normal physical contact with their loved ones and significant others. Almost all close relationships involve handholding, touching, kissing, cuddling and other shows of affection. In some instances this may necessitate the provision of an environment of privacy, depending on the nature of the act, the circumstances and the individuals involved

During puberty individuals experience a whole host of emotions, for example anger, resentment and frustration, as well as having to contend with changes in bodily function such as the ‘breaking of the voice’ in young males or the onset of the menstrual cycle in young women. The most common form of assistance we can offer at this difficult time is education and support, not just for the client but also for family members who may be finding it very difficult to understand some of the behaviour exhibited, particularly if the individual is becoming aggressive or self-harming. Often it can help the young person to talk to a health care professional rather than those closest to them, and doing so can sometimes help to avert aggressive outbursts by providing what they perceive as a more objective outlet for their feelings and frustrations. It is important, however, that we acknowledge our limitations and refer the client to more specialist help as appropriate, particularly if the client is manifesting a clear disorder such as anorexia nervosa or bulimia. It is useful therefore to develop a basic level of knowledge and understanding of such disorders. This can then help us to recognize those clients in need of more specialist help

Reviewing and evaluating care
Ensure that care needs are reviewed and evaluated regularly, particularly if the client’s condition or circumstances change or if the prescribed care does not appear to be effective

An area of significant concern to many individuals is the likelihood of developing cancer of the breast or the genitalia. We can empower clients by informing them of the importance of self-examination and teaching them how to undertake this effectively. A variety of education leaflets can generally be accessed at your local Health-Promotion Unit

Sexual Intercourse
Whilst this may not appear pertinent or a necessary consideration for the majority of clients in our care it would be inappropriate to make assumptions without adequate assessment. For some clients, particularly those in long-term care facilities, the need to sustain sexual relationships can prove particularly problematic. It is therefore essential that staff address the issue with clients in a diplomatic and caring manner and assist in facilitating the maintenance of such relationships by, for example, providing a private and secure space free from likely disturbances. For other clients, it may simply be a need for information or education, such as the 42-year-old gentleman admitted following a myocardial infarction (heart attack) who is desperately worried that he will not be able to resume a normal sexual relationship with his wife. Some individuals may need more specialized assistance and to this end it is helpful to build up your resources by becoming familiar with the specialists in your locality such as the sex therapist, clinical nurse specialists, clinical psychologists, etc. so that you can make appropriate referrals

Sexual orientation
Be accepting of alternative lifestyles in keeping with the laws of the land and code of professional conduct

Children often express sexuality in their play, for example guns, cars, prams, dolls and association with male or female role models such as ‘Barbie Dolls’ or ‘Action Man’. Sometimes this notion can be exploited to teach children about issues surrounding sex and sexuality

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