Transcript Document
SEXUALITY CONCEPT IN NURSING By Purwaningsih Organs have dual functions: • Produce reproductive cells • Produce hormones responsible for sex characteristics Females - estrogen and progesterone Males - testosterone REPRODUCTIVE SYSTEM 2 • Expressed by individuals of all ages • A way to show feminine or masculine qualities: Clothing styles and colors Hairstyles Hobbies and interests Sexual habits (continue into old age) Gestures 2.03 Nursing Fundamentals 7243 3 • May be expressed by: Sexual intercourse Caressing, touching, holding hands Masturbation • Is a right of all residents to experience 2.03 Nursing Fundamentals 7243 4 Factors affecting sexuality • Culture • Religion • Ethics • Lifestyle • Health state • Age • Stereotypes –Fathers more than mothers 5 External genitals of the female Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Female Reproductive System oviduct oviduct ovary uterus urinary bladder pubic symphysis fimbriae ovary cervix rectum urethra vagina anus uterus vagina Function of Female Reproductive System • Ovulation – ova begins to mature & enlarge until discharged – Migrates toward & enters oviduct where possible fertilization may take place • Mentrual Cycle – involves production of estrogen & progesterone • Menopausal period – end of woman’s reproductive capacity. • Early menopause – surgical removal of ovaries, chemotherapy, radiations, unknown etiology Sexual Health • Negative definitions – Avoidance of unintended pregnancy – Avoidance of sexually transmitted infections – Absence of sexual dysfunctions • Positive definitions (the above plus) – Equitable relationships – Sexual fulfilment – Sexual rights (and responsibilities) Sexual Rights – WHO, 2002 • Sexual rights include the right of all persons, free of coercion, discrimination and violence, to – the highest attainable standard of sexual health, including access to sexual and reproductive health care services – seek, receive and impart information related to sexuality – sexuality education – respect for bodily integrity – choose their partner – decide to be sexually active or not – consensual sexual relations – consensual marriage – decide whether or not, and when, to have children – pursue a satisfying, safe and pleasurable sexual life Infantile sexuality • Freud – orality • Montague – Touch • Parental reinforcement – Trust Toddlers… • Body image – Self concept – Autonomy vs. shame and doubt • Primary identification – Traditionally imitation from observation of same sex parent • Exploration of body – Masturbation – ‘anality’ Preschoolers… • Initiative vs. guilt – Conscience, superego • Self concept ~ emerging overt sexuality – Parental and peer (re)enforcements • Masturbatory substitutes – Rocking, riding Schoolagers… • Sexuality ‘sublimated’ into industry – Doesn’t mean ‘asexual’ – Cognition – Social interaction skills • More self concept and body image – Inter-relationship depends on environment – Chum-ship • Some mid- and late schoolagers are sexually active – Development of secondary sexual maturation Answering questions about sex… • Open acceptance • Answer what is asked – Know the facts! – Be honest • Don’t skip information because initial response is ‘Oh, I know that…’ – Also, don’t include too much information in one sitting Adolescence • Establishing sexual identity or self concept – Involves understanding roles, values, duties and responsibilities as well as physical responses – Sexual orientation is a continuum • A personal evaluation of one’s sexual feelings and actions – Accommodating adult erotic feelings – Experimental sexual behaviors – Dealing with behavior choices Biology vs. Psychology • Physical sexual response cycles in men and women only understood since the 1970’s – Masters and Johnson • excitement, plateau, orgasm, resolution • Most people closely tie physiology with emotions – Sex for sex’s sake vs. sex for love’s sake – Sex for procreation vs. recreation – Abstinence is not a dirty word Young adults • Developmental level and chronology often not synchronous • Making love and having sex aren’t the same • There aren’t any ‘abnormals’ in sexual relationships if the behavior is acceptable to both parties • Overtly or covertly, everybody cares about and is interested in sex, whether or not they act on it Adulthood • Developmental stages of partners impacts quality of relationship • Stresses of everyday life can negatively impact sexual expression – ‘Being all things to all people’ – What to do with the kids… • Fatigue and poor communication greatest impediments to positive sexual behavior – Creativity and time management • Loss of partner from divorce or death Aging and sexuality • Age should not be a barrier to sexual expression • Social circumstances might be – but can be changed • Attitudes and expectations may be problematic – Those who are aging – Relatives and friends Sexuality and Aging • Human drive – Diminishes with aging • Other bodily changes – Mechanically less responsive • Opportunity – Partner passes away or is ill • Cultural bias – Images of beauty, sexuality Sexuality and Dementia • Partners must adapt to change – Degree of intimacy • May be less interested – Patience • May be clumsy, poorly coordinated – See as appropriate • Be supportive of their desire for intimacy – May alter what regarded as intimacy • Normal sexual activity may be unrealistic – May be uncomfortable, frustrating • Persons views, attitudes on sexuality may change Sexuality in the Nursing Home • Most still want to be sexually active – Over 60% of elderly residents endorsed a desire for intimacy – 52% of men 60-69 report intercourse in the previous 4 weeks • Barriers to intimacy exist – – – – Lack of privacy Staff, family attitudes Informed consent issues Lack of a partner Hypersexuality • Definition – Exposure – Obscene sexual language – Inappropriate masturbation – Propositioning of others – Touching breasts and genitalia Infections can be transferred through the exchange of bodily fluids like: • • • • • Blood Semen Vaginal secretions Saliva Breast milk Nursing Role in Women’s Health • • • • Health promotion Illness prevention Provide support & counseling Encourage women in their health goals and behaviors – personal hygiene, detecting & preventing diseases (STDs), diet & exercises, sexuality issues- menopause, contraception, preconception, pre-/postnatal care, stress management & well-being, healthy lifestyles, & avoiding risky behaviors Nursing Role in Women’s Health • Nurses need to model that lifestyle for patients • Recommend & promote regular examinations • Non-judgmental, understanding & sensitive • Screen for/and recognize s/sx. abuse • Recognize cultural differences & beliefs • Respect sexual orientation Nursing Dx r/t sexuality • Sexual dysfunction • Sexuality patterns, ineffective • Body image, disturbed 28 Guidelines For The Nurse Aide In Dealing With Resident Sexuality • Assist to maintain sexual identity by dressing residents in clothing appropriate for men or women • Assist with personal hygiene 2.03 Nursing Fundamentals 7243 29 Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued) • Assist to prepare for special activities by “dressing up” –selecting attractive clothing –fixing hair in a special way –applying cosmetics –wearing a special perfume or aftershave 2.03 Nursing Fundamentals 7243 30 Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued) • Help to develop a positive self-image • Show acceptance and understanding for resident’s expression of love or sexuality –provide privacy –always knock prior to entering a room at any time –assure privacy when requested 2.03 Nursing Fundamentals 7243 31 Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued) • Never expose the resident • Accept the resident’s sexual relationships 2.03 Nursing Fundamentals 7243 32 Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued) • Provide protection for the nonconsenting resident • Be firm but gentle in your rejection of a resident’s sexual advances 2.03 Nursing Fundamentals 7243 33 Possible Effects Of Injury Or Illness On Sexuality • Disfiguring surgery may cause a person to feel: –unattractive and ugly to others –mutilated and deformed –unworthy of love or affection 2.03 Nursing Fundamentals 7243 34 Possible Effects Of Injury Or Illness On Sexuality (continued) • Chronic illness and certain medications can affect sexual functioning 2.03 Nursing Fundamentals 7243 35 Possible Effects Of Injury Or Illness On Sexuality (continued) • Disorders that cause impotence –diabetes mellitus –spinal cord injuries –multiple sclerosis –alcoholism 2.03 Nursing Fundamentals 7243 36 Possible Effects Of Injury Or Illness On Sexuality (continued) • Surgery can have both physical and/or psychological effects –removal of prostate or testes –amputation of a limb –removal of uterus –removal of ovaries –removal of a breast –colostomy –ileostomy 2.03 Nursing Fundamentals 7243 37 Possible Effects Of Injury Or Illness On Sexuality (continued) • Disorders affecting the ability to have sex: – stroke – nervous system disorders – heart disease 2.03 Nursing Fundamentals 7243 38 Possible Effects Of Injury Or Illness On Sexuality (continued) • Disorders affecting the ability to have sex: –chronic obstructive pulmonary disease –circulatory disorders –arthritis or conditions affecting mobility/ flexibility 2.03 Nursing Fundamentals 7243 39 Sexuality and the Nursing Home, Thomas Magnuson, M.D. Assistant Professor Division of Geriatric Psychiatry UNMC Peter Aggleton University of Sussex