1
|
Rabeipoor S, Khademvatani K, Barjasteh S, Ghafuri D. Investigating the impact of couple counseling based on the CHARMS model on sexual quality of life and marital satisfaction of wives of men suffering from myocardial infarction: a study protocol. Reprod Health 2024; 21:55. [PMID: 38641824 PMCID: PMC11027360 DOI: 10.1186/s12978-024-01776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/16/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Cardiovascular diseases are a common chronic illness in adults, with implications for health and psychological well-being. These implications not only affect the patients themselves but also impact family members, especially the spouses of patients. One significant issue and consequence of this disease is its impact on marital relationships and sexual satisfaction, which can also influence other dimensions of quality of life. The aim of the current study is to determine the effect of couple counseling based on the CHARMS model on sexual quality of life and marital satisfaction of wives of men suffering from myocardial infarction. METHOD This study is a clinical randomized controlled trial. Sampling will be done on a convenience basis. Participants will be randomly allocated into two groups: control (50 couples) and intervention (50 couples). Couples in 6 groups of 8 members each will attend counseling sessions based con the CHARMS model, with sessions held weekly and lasting for 60 min. Data collection tools will include Demographic information questionnaire, Women's Sexual Quality of Life Questionnaire, Enrich Marital Satisfaction Questionnaire, Sexual Compatibility Questionnaire and Perceived Quality of Relationship Dimensions Questionnaire, which will be completed by women in both groups before and after the intervention. Data will be analyzed using appropriate statistical tests and SPSS software. DISCUSSION This trial will evaluate whether a counseling intervention based on the CHARMS model can enhance sexual quality of life and marital satisfaction of wives of men with myocardial infarction in Urmia city. TRIAL REGISTRATION IRCT code: IRCT20240218061046N1.
Collapse
Affiliation(s)
- Soheila Rabeipoor
- Reproductive health, Reproductive Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Kamal Khademvatani
- Department of Cardiology, School of Medicine, Urmia University of medical sciences, Urmia, Iran
| | - Samira Barjasteh
- Reproductive Health Researcher Center, Clinical Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Delniya Ghafuri
- Nursing & Midwifery Faculty, Urmia University of Medical Sciences, Campus Nazlu, 11KM Road Sero, Urmia, West Azarbaijan, Iran.
| |
Collapse
|
2
|
Dye CA, Engelstein E, Swearingen S, Murphy J, Larsen T, Volgman AS. Sex, Rhythm & Death: The effect of sexual activity on cardiac arrhythmias and sudden cardiac death. Front Cardiovasc Med 2022; 9:987247. [PMID: 36225957 PMCID: PMC9548576 DOI: 10.3389/fcvm.2022.987247] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Arrhythmias and sudden cardiac death with sexual activity are rare. However, the demographics are changing regarding the cardiovascular patients at risk for these events. Recent studies have highlighted that the individuals having cardiac events during sexual activity are becoming younger, with a higher proportion of female decedents than previously described. There needs to be an open dialog between the cardiovascular team and the cardiac patient to provide the education and reassurance necessary for cardiovascular patients to participate in sexual intercourse safely. This paper reviews how sexual activity can lead to an increase in cardiac arrhythmias and sudden cardiac arrest in patients that are not medically optimized or are unaware of their underlying cardiac condition. The most common cardiovascular diseases associated with sexually induced arrhythmias and arrest are discussed regarding their potential risk and the psychosocial impact of this risk on these patients. Finally, cardiovascular medications and implantable cardioverter-defibrillators (ICDs) are addressed by reviewing the literature on the safety profile of these cardiac interventions in this patient population. Overall, sexual activity is safe for most cardiac patients, and providing proper education to the patient and their partner can improve the safety profile for patients with higher risk cardiovascular conditions. To give the appropriate education and reassurance necessary, cardiovascular team members need an understanding of the pathophysiology of how sexual activity can provoke arrhythmias and sudden cardiac arrest. Healthcare providers also need to build comfort in speaking to all patients and ensure that sexual partners, female patients, and those in the LGBTQIA + community receive the same access to counseling but tailored to their individual needs.
Collapse
|
3
|
Gerbild H, Areskoug Josefsson K, Marie Larsen C, Schantz Laursen B. Communication about physical activity to reduce vascular erectile dysfunction - A qualitative interview study among men in cardiac rehabilitation. Scand J Caring Sci 2021; 36:839-851. [PMID: 34288023 DOI: 10.1111/scs.13021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Physical activity, a core intervention in cardiac rehabilitation, can reduce vascular erectile dysfunction (ED). ED is a common sensitive problem for men with cardiac diseases, decreasing their quality of life. Cardiac health professionals rarely provide information about ED or its relation to physical activity. Developing health professionals' communicative component of the complex intervention 'Physical Activity to reduce Vascular Erectile Dysfunction' (PAVED) is important. Understanding the receiver needs is essential in designing a complex intervention. AIM To elucidate men's perspectives on cardiac health professionals' communication about PAVED. ETHICAL ISSUES An Institutional Data Protection Agency approved the study. METHODS An interpretive data-driven thematic analysis was applied to individual, qualitative semi-structured interviews with 20 Danish men attending cardiac rehabilitation. RESULTS The men wanted health professionals' communicating about ED, as it was perceived as a major problem diminishing masculinity and tabooed by health professionals. Men wanted help for self-help, which may be possible with the aid of competent health professionals' communication about how to prevent, reduce and cope with ED - including information about PAVED. The men wanted health professionals' communication about ED in various contexts: general information in groups, sexual counselling for individuals and couples and written material. STUDY LIMITATIONS Recruitment was done from a Danish municipality's cardiac rehabilitation, and the transferability of the results may be limited to similar contexts. CONCLUSION Erectile dysfunction was experienced as a major biopsychosocial problem for the men and their partners. The men had a need for health professionals' communication about sexuality, ED and information about PAVED as well as about prevention, reduction and management of ED. The men had a need for professional communication about sexual health.
Collapse
Affiliation(s)
- Helle Gerbild
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department for Behavioural Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kristina Areskoug Josefsson
- Department for Behavioural Sciences, Oslo Metropolitan University, Oslo, Norway.,Faculty of Health Studies, VID Specialized University, Sandnes, Norway.,School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Camilla Marie Larsen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgitte Schantz Laursen
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Nursing Research Unit & Sexological Centre, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
4
|
Firoozjaei IT, Taghadosi M, Sadat Z. Determining the sexual quality of life and related factors in patients referred to the department of cardiac rehabilitation: A cross-sectional study. Int J Reprod Biomed 2021; 19:261-270. [PMID: 33842823 PMCID: PMC8023004 DOI: 10.18502/ijrm.v19i3.8574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 06/13/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND One of the neglected issues among cardiovascular participants is sexual activity, which can affect their general quality of life. OBJECTIVE To evaluate the sexual quality of life and its related factors. MATERIALS AND METHODS This cross-sectional study was conducted on 200 cardiovascular participants, referred to the department of rehabilitation of the Shahid Beheshti Hospital of Kashan, Iran in May 2017. Individuals who met the inclusion criteria filled the demographic characteristics questionnaires, including sexual quality of life questionnaire (SQOL)-female and SQOL-male, sexual knowledge post-myocardial infarction scale (SKS-MI), sexual knowledge after coronary artery bypass grafting surgery scale (SKS-CABG), and couple communication scale (CCS). RESULTS In this research, the mean score of SQOL of the participants was 50.02 ± 22.57. According to the results, there was a significant and positive association between the scores of SQOL and CCS (r = 0.540, p ≤ 0.0001), SKS-MI (r = 0.322, p = 0.006), and SKS-CABG (r = 0.178, p = 0.046). The maximum association was observed between SQOL and CCS and the minimum association between SQOL and SKS-CABG. Moreover, there was a relationship between the SQOL and participant's age and level of education. CONCLUSION According to the results of the study, the sexual quality of life scores among participants with MI and CABG was not favorable and this participant suffered from a lack of sexual knowledge.
Collapse
Affiliation(s)
- Iman Taghizadeh Firoozjaei
- Medical Surgical Nursing Department, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Taghadosi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Zohre Sadat
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| |
Collapse
|
5
|
Farhan R, Yousuf R, Hussain SNF, Khan M, Bilal Z, Khan M, Yousuf Z, Khatri B, Siddiqua A, Khan SA. Sexual Knowledge in Post-Myocardial Infarction Patients: A Cross-Sectional Study. Cureus 2020; 12:e8480. [PMID: 32642384 PMCID: PMC7336652 DOI: 10.7759/cureus.8480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Adequate sexual knowledge is a key component of cardiac rehabilitation. Sexual knowledge in post-myocardial infarction (MI) patients is unknown. Thus, we conducted this study to investigate the sexual knowledge of post-myocardial infarction patients and their accessibility to sexual counseling. Methodology Between July and September 2018, a cross-sectional survey was carried out in 6six major hospitals in Karachi. The non-probability convenient sampling technique was used to include all patients meeting the inclusion criteria. To reduce biases, face-to-face interviews were conducted by investigators who were trained prior to the start of data collection. Knowledge was assessed using the Swedish version of the "Sex after MI Knowledge Test" questionnaire, where a higher score meant higher knowledge. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0 (IBM Corp., Armonk, NY) The t-test was applied to compare the knowledge score between males and females. Results There was a total of 278 MI patients with a mean age of 54 years, of which 60% were men. The "Sex After MI Knowledge Test" scores varied between 37 and 67 (mean score 51 ± 5). None of the participants obtained the maximum possible test score of 75. The most frequently occurring score was 49 (16%). Around half of the participants (48%) incorrectly believed that sex cannot be safely resumed within a few weeks after the heart attack. Limited knowledge was found in questions pertaining to alcohol, viagra, and late evening being the best time to have sex. Medical knowledge was provided to only 27% (n=76) of the participants, of whom 77% (n=58) received it from the hospital staff itself. A significant difference existed in scores obtained by males and females, with males having a higher score and the mean difference in scores being 1.7 (p=0.015). Conclusion Lack of sexual knowledge in MI patients due to the inadequacy of healthcare providers and the social stigma surrounding the topic causes marital strain leading to low quality of life.
Collapse
Affiliation(s)
- Rida Farhan
- Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Rabail Yousuf
- Cardiology, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | | | - Maaz Khan
- Cardiology, United Medical and Dental College, Karachi, PAK
| | - Zara Bilal
- Medicine, Bahria University Medical and Dental College, Karachi, PAK
| | - Maryam Khan
- Internal Medicine, Ziauddin University, Karachi, PAK
| | | | - Burhan Khatri
- Medicine, Bahria University Medical and Dental College, Karachi, PAK
| | - Ayesha Siddiqua
- Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Shenel A Khan
- Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| |
Collapse
|
6
|
Abstract
PURPOSE OF THE REVIEW To review the current state of literature on sexual dysfunction in adults with congenital heart disease (ACHD). RECENT FINDINGS The prevalence of sexual dysfunction in ACHD is approximately 28%. Compared to age-matched cohorts, the prevalence of sexual dysfunction among ACHD cohorts demonstrates significant variability. ACHD have a lower rate of ever having sexual intercourse and often at a later age. Regardless of complexity, ACHD with sexual dysfunction have higher level of distress, decreased quality of life, and worse New York Heart Association classification. Patients, including heart failure and ACHD, treated with dual angiotensin receptor neprilysin inhibitor have reported improved sexual relationships. The prevalence of sexual dysfunction in ACHD patients is high and sexual dysfunction research in ACHD remains limited. Therefore, the relationship between sexual dysfunction and ACHD remains ill-defined. Cardiologists that participate in the care of these patients should proactively discuss sexual health and provide counseling and therapies to provide high-quality healthcare for ACHD.
Collapse
Affiliation(s)
- Sihong Huang
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan Street NE (MC248), Grand Rapids, MI, 49503, USA
- Pediatrics and Human Development, Michigan State University College of Human Medicine, 15 Michigan NE, Grand Rapids, MI, USA
- Congenital Heart Center, MC 248, 25 Michigan Street NE, Suite 4200, Grand Rapids, MI, 49503, USA
| | - Stephen C Cook
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan Street NE (MC248), Grand Rapids, MI, 49503, USA.
- Pediatrics and Human Development, Michigan State University College of Human Medicine, 15 Michigan NE, Grand Rapids, MI, USA.
- Congenital Heart Center, MC 248, 25 Michigan Street NE, Suite 4200, Grand Rapids, MI, 49503, USA.
| |
Collapse
|
7
|
Hill W, Holy R, Traiger G. EXPRESS: Intimacy, Contraception, and Pregnancy Prevention in Patients with Pulmonary Arterial Hypertension: Are We Counseling Our Patients? Pulm Circ 2018; 10:2045894018785259. [PMID: 29893615 PMCID: PMC7645767 DOI: 10.1177/2045894018785259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a serious, life-altering condition. Patients who are diagnosed are often of childbearing potential. Given the well-documented risks associated with this condition during pregnancy, as well as risks to the fetus from medications used to treat this disorder, patients should be strongly advised against pregnancy. Despite this, patients still become pregnant, leading to the question of whether care providers are counseling patients and their partners about the risks of pregnancy, methods of contraception, and issues of intimacy on a regular basis. We have conducted a survey of pulmonary hypertension specialist physicians and allied healthcare professionals on their practice patterns related to counseling on intimacy, contraception, and pregnancy prevention. Most respondents indicated they are counseling on these issues to varying degrees, but our survey pointed to several areas where improvements can be made. The most significant barrier to counseling for all respondents was lack of time. Survey respondents reported that a large percentage of the pregnancies seen in their practices were either intentional or due to contraceptive non-compliance. We review specific practical approaches to initiate reproductive health counseling as well as ways to integrate this important aspect of PAH care into regular practice routines and documentation. Protocols regarding pregnancy avoidance and PAH should be developed and become standard procedure.
Collapse
Affiliation(s)
- Wendy Hill
- Cedars Sinai Medical Group 8536 Wilshire Blvd,
Suite 201 Beverly Hills, CA
| | - Royanne Holy
- The Houston Methodist Lung Center, Houston
Methodist Hospital 6550 Fannin, SMT 1001, Houston
| | - Glenna Traiger
- Formerly of David Geffen School of
Medicine,
University of California, Los Angeles, CA
| |
Collapse
|
8
|
Rahim L, Allana S, Steinke EE, Ali F, Khan AH. Level of knowledge among cardiac nurses regarding sexual counseling of post-MI patients in three tertiary care hospitals in Pakistan. Heart Lung 2017; 46:412-416. [PMID: 28988654 DOI: 10.1016/j.hrtlng.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/07/2017] [Accepted: 09/09/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study is to measure the level of knowledge among cardiac nurses about sexual counseling of post-myocardial infarction (MI) patients. METHOD This descriptive cross-sectional study was conducted among 153 nurses at three tertiary care hospitals of a large metropolitan city of Pakistan. RESULTS The findings revealed that the majority nurses have moderate knowledge regarding post-MI sexual counseling. Additionally, nurses have lack of knowledge regarding effects of cardiac drugs on sexual life of post-MI patients. CONCLUSION There is a need to improve nurses' knowledge in regard to sexual counseling among post-MI patients. Nurses should have knowledge to deal with such a sensitive issue as sexuality, in order to improve patients' quality of life. With respect to Pakistan, this was a baseline study and may provide insights for designing interventional or qualitative studies in the future.
Collapse
Affiliation(s)
- Layla Rahim
- National Institute of Cardiovascular Diseases, Karachi, Pakistan.
| | - Saleema Allana
- Aga Khan University, Karachi, Pakistan; University of Alberta, Canada
| | | | | | | |
Collapse
|
9
|
Merghati-Khoei E, Pirak A, Yazdkhasti M, Rezasoltani P. Sexuality and elderly with chronic diseases: A review of the existing literature. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:136. [PMID: 28331522 PMCID: PMC5348839 DOI: 10.4103/1735-1995.196618] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 07/25/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022]
Abstract
Background: Increased life expectancy and the growing phenomenon of aging can lead to increased burden of chronic diseases (CDs) which adversely affects the overall health of elderly, their sexuality in particular. Sexual life of an aged population is overlooked in many of the societies. In the present narrative review, we aim to assess the impact of CDs on sexual function of elderly people. Materials and Methods: We used internet databases including PubMed, EMBASE, ISI Web of Science, Google Scholar, SID, Iran Medex, Magiran, IPPF, and UNFPA without time limit. Ninety-eight out of 174 relevant articles were selected which met the inclusion criteria: those articles were research-based in English or Persian (original or review articles) and textbooks; specified one or more CDs and sexual function of the cases; elderly people over the age of sixty, men and women; and coordination between articles and research goals. We excluded qualitative and case studies. We reported the most related CDs with sexual function in literature review and used the biological and psychological impact of the CDs on sexual function of elderly population based on the conceptual model of Verschuren et al. (2010). Results: The results of the studies were classified into the themes including physical, psychological, and cultural and social. Diabetes, cardiovascular, cancerous, and chronic respiratory diseases and also some medications can reduce sexual capacity and desire in particular resulting in negative impact on the quality of elderly sexual life. CDs may influence sexual expressions and responses which adversely affect one's mood and energy so that can cause depression and grief, as well as loss of self-confidence, self-esteem, and self-concept in elderly adults. The factors affecting sexuality of an elderly with CDs include cultural and mythical beliefs about age and illnesses, fear, and embarrass of changed physical appearance. The research conducted among elderly population examining the adverse influence of CDs on aged people's sexual life in general, sexual function and performance, and intimate interaction. Conclusion: It is considered that programs on sexual health needs of aged population for the health-care workers can prove beneficial in improving sexual health.
Collapse
Affiliation(s)
- Effat Merghati-Khoei
- Sexologist, The Iranian National Centre for Addiction Studies (INCAS), Institution of Risk Behaviors Reduction, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Pirak
- Department of Midwifery, Instructor, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Mansoureh Yazdkhasti
- Department of Midwifery, Reproductive Health PhD, Assistant Professor, Faculty Member of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Parvaneh Rezasoltani
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Department of Midwifery, Instructor, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
10
|
Bokeriya LA, Aronov DM. Russian clinical guidelines Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. ACTA ACUST UNITED AC 2016. [DOI: 10.26442/cs45210] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
11
|
Mc Sharry J, Murphy PJ, Byrne M. Implementing international sexual counselling guidelines in hospital cardiac rehabilitation: development of the CHARMS intervention using the Behaviour Change Wheel. Implement Sci 2016; 11:134. [PMID: 27724957 PMCID: PMC5057276 DOI: 10.1186/s13012-016-0493-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 08/24/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Decreased sexual activity and sexual problems are common among people with cardiovascular disease, negatively impacting relationship satisfaction and quality of life. International guidelines recommend routine delivery of sexual counselling to cardiac patients. The Cardiac Health and Relationship Management and Sexuality (CHARMS) baseline study in Ireland found, similar to international findings, limited implementation of sexual counselling guidelines in practice. The aim of the current study was to develop the CHARMS multi-level intervention to increase delivery of sexual counselling by healthcare professionals. We describe the methods used to develop the CHARMS intervention following the three phases of the Behaviour Change Wheel approach: understand the behaviour, identify intervention options, and identify content and implementation options. Survey (n = 60) and focus group (n = 14) data from two previous studies exploring why sexual counselling is not currently being delivered were coded by two members of the research team to understand staff's capability, opportunity, and motivation to engage in the behaviour. All potentially relevant intervention functions to change behaviour were identified and the APEASE (affordability, practicability, effectiveness, acceptability, side effects and equity) criteria were used to select the most appropriate. The APEASE criteria were then used to choose between all behaviour change techniques (BCTs) potentially relevant to the identified functions, and these BCTs were translated into intervention content. The Template for Intervention Description and Replication (TIDieR) checklist was used to specify details of the intervention including the who, what, how and where of proposed intervention delivery. RESULTS Providing sexual counselling group sessions by cardiac rehabilitation staff to patients during phase III cardiac rehabilitation was identified as the target behaviour. Education, enablement, modelling, persuasion and training were selected as appropriate intervention functions. Twelve BCTs, linked to intervention functions, were identified for inclusion and translated into CHARMS intervention content. CONCLUSIONS This paper details the use of Behaviour Change Wheel approach to develop an implementation intervention in an under-researched area of healthcare provision. The systematic and transparent development of the CHARMS intervention will facilitate the evaluation of intervention effectiveness and future replication and contribute to the advancement of a cumulative science of implementation intervention design.
Collapse
Affiliation(s)
- J. Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland
| | - P. J. Murphy
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland
| | - M. Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland
| |
Collapse
|
12
|
Steinke EE, Barnason S, Mosack V, Hill TJ. Baccalaureate nursing students' application of social-cognitive sexual counseling for cardiovascular patients: A web-based educational intervention. NURSE EDUCATION TODAY 2016; 44:43-50. [PMID: 27429328 DOI: 10.1016/j.nedt.2016.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/11/2016] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND A gap in knowledge and practice exists for sexual counseling of cardiovascular patients, and innovative approaches are needed to address patients' sexual quality of life. AIM To evaluate a web-based social-cognitive intervention for evidence-based sexual counseling by baccalaureate nursing students with cardiovascular patients. METHODS A pre- post-test survey design was used: pre-test (T1), immediate post-test after intervention (T2), and at 4 to 6weeks post-intervention (T3). Data were collected using the Survey of Sexuality Related Nursing Practices -Cardiac version (SSRNP-CV). Data were analyzed using descriptive statistics and t-tests. RESULTS From T1 to T2, students (N=95) significantly increased their responsibility and confidence in sexual counseling; from T1 to T3 (N=57), students significantly improved sexual counseling for confidence and practice subscales, total SSRNP score, and cardiac-specific subscales of sexual counseling, sexual activity, and gender. CONCLUSION This study clearly demonstrated that a web-based social-cognitive sexual counseling intervention was effective in improving students' ability to provide evidence-based sexual counseling of cardiovascular patients.
Collapse
Affiliation(s)
- Elaine E Steinke
- School of Nursing, Wichita State University, 1845 Fairmount, Wichita, KS 67260-0041, United States.
| | - Susan Barnason
- College of Nursing-Lincoln Division, University of Nebraska Medical Center, Suite 131, 1230 "O" Street, PO Box 880220, Lincoln, NE 68588-0220, United States.
| | - Victoria Mosack
- School of Nursing, Wichita State University, 1845 Fairmount, Wichita, KS 67260-0041, United States.
| | - Twyla J Hill
- School of Nursing, Wichita State University, 1845 Fairmount, Wichita, KS 67260-0041, United States; Department of Sociology, Wichita State University, 1845 Fairmount, Wichita, KS 67260, United States.
| |
Collapse
|
13
|
Murphy PJ, Mc Sharry J, Casey D, Doherty S, Gillespie P, Jaarsma T, Murphy AW, Newell J, O'Donnell M, Steinke EE, Toomey E, Byrne M. Sexual counselling for patients with cardiovascular disease: protocol for a pilot study of the CHARMS sexual counselling intervention. BMJ Open 2016; 6:e011219. [PMID: 27342240 PMCID: PMC4932312 DOI: 10.1136/bmjopen-2016-011219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/04/2016] [Accepted: 04/21/2016] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Sexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet this is rarely provided. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention aims to improve the provision of sexual counselling in cardiac rehabilitation in Ireland. METHODS AND ANALYSIS This is a multicentre pilot study for the CHARMS intervention, a complex, multilevel intervention delivered within hospital-based cardiac rehabilitation programmes. The intervention includes (1) training in sexual counselling for staff, (2) a staff-led patient education and support intervention embedded within the cardiac rehabilitation programme, (3) a patient information booklet and (4) an awareness raising poster. The intervention will be delivered in two randomly selected cardiac rehabilitation centres. In each centre 30 patients will be recruited, and partners will also be invited to participate. Data will be collected from staff and patients/partners at T1 (study entry), T2 (3-month follow-up) and T3 (6-month follow-up). The primary outcome for patients/partners will be scores on the Sexual Self-Perception and Adjustment Questionnaire. Secondary outcomes for patients/partners will include relationship satisfaction; satisfaction with and barriers to sexual counselling in services; sexual activity, functioning and knowledge; physical and psychological well-being. Secondary outcomes for staff will include sexuality-related practice; barriers to sexual counselling; self-ratings of capability, opportunity and motivation; sexual attitudes and beliefs; knowledge of cardiovascular disease and sex. Fidelity of intervention delivery will be assessed using trainer self-reports, researcher-coded audio recordings and exit interviews. Longitudinal feasibility data will be gathered from patients/partners and staff via questionnaires and interviews. ETHICS AND DISSEMINATION This study is approved by the Research Ethics Committee (REC) of the National University of Ireland, Galway. Findings will be disseminated to cardiac rehabilitation staff, patients/partners and relevant policymakers via appropriate publications and presentations.
Collapse
Affiliation(s)
- Patrick J Murphy
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Ireland
| | - Dympna Casey
- School of Nursing and Midwifery, NUI Galway, Ireland
| | - Sally Doherty
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | | | - John Newell
- HRB Clinical Research Facility, NUI Galway, Ireland
| | | | | | - Elaine Toomey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Ireland
| |
Collapse
|
14
|
Steinke EE, Jaarsma T. Sexual counseling and cardiovascular disease: practical approaches. Asian J Androl 2016; 17:32-9. [PMID: 25219908 PMCID: PMC4291873 DOI: 10.4103/1008-682x.135982] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients with cardiovascular disease and their partners expect health care providers to provide sexual counseling to assist them in maintaining sexual quality of life. Evidence suggests however, that there is a gap in integrating evidence into practice and that relatively few cardiac patients receive sexual counseling. This can result in negative psychological, physical, and quality of life outcomes for couples who may needlessly decide sexual activity is too risky and cease all sexual activity. Two scientific statements now exist that provide ample guidance to health care providers in discussing this important topic. Using a team approach that includes physicians, nurses, physical therapists, rehabilitation staff, and others is important to ensure that sexual counseling occurs throughout recovery. In addition, several trials using interventional approaches for sexual counseling provide insight into successful approaches for sexual counseling in practice. This article provides practical strategies and evidence-based approaches for assessment and sexual counseling for all cardiac patients and their partners, and specific counseling for those with ischemic conditions, heart failure, and implanted devices.
Collapse
Affiliation(s)
- Elaine E Steinke
- School of Nursing, Wichita State University, 1845 Fairmount, Wichita, Kansas, USA
| | | |
Collapse
|
15
|
Byrne M, Doherty S, Fridlund BGA, Mårtensson J, Steinke EE, Jaarsma T, Devane D. Sexual counselling for sexual problems in patients with cardiovascular disease. Cochrane Database Syst Rev 2016; 2:CD010988. [PMID: 26905928 PMCID: PMC6464754 DOI: 10.1002/14651858.cd010988.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sexual problems are common among people with cardiovascular disease. Although clinical guidelines recommend sexual counselling for patients and their partners, there is little evidence on its effectiveness. OBJECTIVES To evaluate the effectiveness of sexual counselling interventions (in comparison to usual care) on sexuality-related outcomes in patients with cardiovascular disease and their partners. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, and three other databases up to 2 March 2015 and two trials registers up to 3 February 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs, including individual and cluster RCTs. We included studies that compared any intervention to counsel adult cardiac patients about sexual problems with usual care. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included three trials with 381 participants. We were unable to pool the data from the included studies due to the differences in interventions used; therefore we synthesised the trial findings narratively.Two trials were conducted in the USA and one was undertaken in Israel. All trials included participants who were admitted to hospital with myocardial infarction (MI), and one trial also included participants who had undergone coronary artery bypass grafting. All trials followed up participants for a minimum of three months post-intervention; the longest follow-up timepoint was five months.One trial (N = 92) tested an intensive (total five hours) psychotherapeutic sexual counselling intervention delivered by a sexual therapist. One trial (N = 115) used a 15-minute educational video plus written material on resuming sexual activity following a MI. One trial (N = 174) tested the addition of a component that focused on resumption of sexual activity following a MI within a hospital cardiac rehabilitation programme.The quality of the evidence for all outcomes was very low.None of the included studies reported any outcomes from partners.Two trials reported sexual function. One trial compared intervention and control groups on 12 separate sexual function subscales and used a repeated measures analysis of variance (ANOVA) test. They reported statistically significant differences in favour of the intervention. One trial compared intervention and control groups using a repeated measures analysis of covariance (ANCOVA), and concluded: "There were no significant differences between the two groups [for sexual function] at any of the time points".Two trials reported sexual satisfaction. In one trial, the authors compared sexual satisfaction between intervention and control and used a repeated measured ANOVA; they reported "differences were reported in favour of the intervention". One trial compared intervention and control with a repeated measures ANCOVA and reported: "There were no significant differences between the two groups [for sexual satisfaction] at any of the timepoints".All three included trials reported the number of patients returning to sexual activity following MI. One trial found some evidence of an effect of sexual counselling on reported rate of return to sexual activity (yes/no) at four months after completion of the intervention (relative risk (RR) 1.71, 95% confidence interval (CI) 1.26 to 2.32; one trial, 92 participants, very low quality of evidence). Two trials found no evidence of an effect of sexual counselling on rate of return to sexual activity at 12 week (RR 1.01, 95% CI 0.94 to 1.09; one trial, 127 participants, very low quality of evidence) and three month follow-up (RR 0.98, 95% CI 0.88 to 1.10; one trial, 115 participants, very low quality of evidence).Two trials reported psychological well-being. In one trial, no scores were reported, but the trial authors stated: "No treatment effects were observed on state anxiety as measured in three points in time". In the other trial no scores were reported but, based on results of a repeated measures ANCOVA to compare intervention and control groups, the trial authors stated: "The experimental group had significantly greater anxiety at one month post MI". They also reported: "There were no significant differences between the two groups [for anxiety] at any other time points".One trial reporting relationship satisfaction and one trial reporting quality of life found no differences between intervention and control.No trial reported on satisfaction in how sexual issues were addressed in cardiac rehabilitation services. AUTHORS' CONCLUSIONS We found no high quality evidence to support the effectiveness of sexual counselling for sexual problems in patients with cardiovascular disease. There is a clear need for robust, methodologically rigorous, adequately powered RCTs to test the effectiveness of sexual counselling interventions for people with cardiovascular disease and their partners.
Collapse
Affiliation(s)
- Molly Byrne
- National University of Ireland, GalwaySchool of PsychologySt. Anthony'sGalwayCounty GalwayIreland
| | - Sally Doherty
- RCSIDepartment of Population and Health Science, School of PsychologySt Stephens GreenBeaux Lane HouseDublinIreland
| | - Bengt GA Fridlund
- Jönköping UniversitySchool of Health SciencesP O Box 1026JönköpingSweden551 11
| | - Jan Mårtensson
- Jönköping UniversityDepartment of Nursing, School of Health SciencesP O Box 1026JönköpingSweden551 11
| | - Elaine E Steinke
- Wichita State UniversitySchool of Nursing1845 FairmountWichitaKansasUSA67260‐0041
| | - Tiny Jaarsma
- University of LinköpingDepartment of Social and Welfare StudiesKungsgatan 40NorrköpingSweden601074
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyUniversity RoadGalwayIreland
| | | |
Collapse
|
16
|
Abstract
Patients with cardiovascular disease and their partners frequently have concerns about sexual intimacy, and sexual counseling is needed across health care settings to ensure that patients receive information to safely resume sexual activity. The purpose of this review is to provide practical, evidence-based approaches to enable health care providers to discuss sexual counseling, illustrated by several case scenarios. Evidence shows that patients expect health care providers to initiate sexual activity discussions, although providers may be hesitant and often rely on patients to ask questions. Although some providers cite lack of knowledge or confidence in their ability to provide sexual counseling, others mention time pressures in the clinical setting. Although such barriers exist, sexual counseling can be individualized to the cardiac condition of a patient with a few select questions. The representative examples of patients with angina pectoris, myocardial infarction, coronary artery bypass surgery, heart failure, and implantable cardioverter defibrillator are used to illustrate key points and provide a model for sexual counseling in practice.
Collapse
|
17
|
Dalfó Pibernat A, Pelegrina Rodríguez FJ, Dalfó Pibernat E, Rosell Vidal J, Rosell Vidal J. Is sexual health an issue in nursing education? Eur J Cardiovasc Nurs 2015; 14:466-7. [PMID: 25952056 DOI: 10.1177/1474515115586710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Artur Dalfó Pibernat
- Primary Care Centre Horta, School of Nursing, Autonoma's University of Barcelona, Spain
| | | | | | | | | |
Collapse
|
18
|
Mosack V, Hill TJ, Steinke EE. Sexual concerns of cardiac patients: predictors and the influence of specific sexual activities. Eur J Cardiovasc Nurs 2015; 14:45-52. [PMID: 24366982 DOI: 10.1177/1474515113517782] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Addressing sexual concerns of cardiac patients is integral to comprehensive patient-centered nursing care, and instruments for use across cardiac populations are needed to promote this activity. Knowing the factors that contribute to sexual concerns provides insights that help to promote inclusion of assessment of relevant sexual activity and provide sexual counseling as a standard of care. AIM This study examined demographic factors, comorbid conditions, and sexual activities as predictive of sexual concerns. Specific sexual activities and demographic variables were also examined for their relation to sexual concerns. METHODS This study was a sub-analysis of a cross-sectional observational study testing a regression model of factors that predicted sexual concerns in a broad sample of cardiac patients in the United States, using a self-report survey method. RESULTS More comorbidities and types of sexual activities contributed to greater sexual concerns reported by respondents. Sexual activities resulting in overall sexual concerns included hugging/kissing, oral sex, and finger penetration. Non-Whites reported more sexual concerns, sexual fears, and symptoms related to sexual activity. Those who were not working/retired from employment reported significantly more sexual concerns and dysfunction, whereas, those who had a smoking/tobacco use history reported more sexual concerns, symptoms, and dysfunction. CONCLUSION This study underscores that cardiac patients across a variety of diagnoses and comorbidities often experience sexual concerns, fears, symptoms, and dysfunction. The strongest predictors of sexual concerns were the number of cardiac and noncardiac comorbidities, thus illustrating the importance of a thorough assessment of these factors when examining sexual concerns of cardiac patients.
Collapse
Affiliation(s)
| | - Twyla J Hill
- Department of Sociology, Wichita State University, USA
| | | |
Collapse
|
19
|
|
20
|
|
21
|
Mosack V, Hill TJ, Steinke EE. Sexual concerns of cardiac patients: A psychometric analysis. Int J Nurs Pract 2014; 21:756-63. [DOI: 10.1111/ijn.12291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Victoria Mosack
- School of Nursing; Wichita State University; Wichita Kansas USA
| | - Twyla J Hill
- Department of Sociology; Wichita State University; Wichita Kansas USA
| | | |
Collapse
|
22
|
Byrne M, Doherty S, Fridlund BGA, Mårtensson J, Steinke EE, Jaarsma T, Devane D. Sexual counselling for sexual problems in patients with cardiovascular disease. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd010988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
Erectile dysfunction in the cardiology practice-a patients' perspective. Am Heart J 2014; 167:178-85. [PMID: 24439978 DOI: 10.1016/j.ahj.2013.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/28/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is an independent risk factor for cardiovascular events sharing mutual risk factors with coronary artery disease. Several guidelines for the management of ED in cardiovascular disease have been proposed, recommending cardiologists to routinely inquire about erectile function. However, males' specific needs and wishes regarding sexual health care in cardiology are unknown. We sought to identify male patients' view concerning possible improvements in sexual health care and preferred forms of sexual counseling in the cardiology practice. METHODS This is a cross-sectional multicentered survey study among randomly selected males visiting a cardiologist. RESULTS Of 388 respondents, 296 questionnaires were eligible for analysis. Mean age of respondents was 62.9 years. Overall, 56% (n = 165) had ED, with up to 86% in patients with heart failure. Mean bother experienced due to ED was 5.93 (±2.57) on a 0 to 10 scale. Most respondents indicated to feel comfortable discussing sexual health with the cardiologists (88%). Of men with ED (n = 165), 46% would like to have a conversation with the cardiologist about possibilities to improve sexual function, 55% would be helped if questions could be asked during consultation with a specialized nurse, and 58% would appreciate written information. Of all respondents (n = 296), 28% ever tried a phosphodiesterase inhibitor; 4% received the prescription of the cardiologists. CONCLUSIONS Erectile dysfunction is highly prevalent in patients with a variety of cardiovascular diagnosis and care for sexual function is mandatory. Patients indicated that above consultation with the cardiologist, both consultation with a specialized nurse and written information would be helpful.
Collapse
|
24
|
|
25
|
Steinke EE. Sexuality and chronic illness. J Gerontol Nurs 2013; 39:18-27; quiz 28-9. [PMID: 24066783 DOI: 10.3928/00989134-20130916-01] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/15/2013] [Indexed: 11/20/2022]
Abstract
Sexual function is often affected in individuals living with chronic illness and their partners, and multiple comorbidities increase the likelihood of sexual dysfunction. This review focuses on the areas of cardiovascular disease, respiratory conditions, and cancer, all areas for which there are practical, evidence-based strategies to guide sexual counseling. Although nurses have been reluctant to address the topic of sexuality in practice, a growing number of studies suggest that patients want nurses to address their concerns and provide resources to them. Thus, nurses must be proactive in initiating conversations on sexual issues to fill this gap in practice.
Collapse
|
26
|
Byrne M, Doherty S, Murphy AW, McGee HM, Jaarsma T. Communicating about sexual concerns within cardiac health services: do service providers and service users agree? PATIENT EDUCATION AND COUNSELING 2013; 92:398-403. [PMID: 23582647 DOI: 10.1016/j.pec.2013.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/06/2013] [Accepted: 03/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Sexual assessment and counselling is a recommended, yet underprovided and challenging, aspect of cardiac rehabilitation. We compared the views of cardiac healthcare providers and patients in terms of their experiences of communication about sexual issues. METHODS Cardiac patients (n=382) completed telephone surveys and hospital cardiac rehabilitation staff (n=60) and general practitioners (n=61) returned postal questionnaires. RESULTS Patients reported that sex was rarely discussed, yet nearly half of patients said they would have liked this opportunity. Most general practitioners (70%) reported not addressing sex with their patients and the majority of cardiac rehabilitators (almost 61%) reported that sexual problems were poorly addressed in their service. Patients perceived fewer barriers to communication (the main barrier was lack of privacy) than health professionals (the primary barrier for general practitioners was lack of time, and for cardiac rehabilitation staff, lack of training). CONCLUSION All participants agreed that sexual assessment and counselling is currently poorly implemented. A gap exists: patients, who generally want sexual issues to be addressed, perceive fewer barriers to communication than healthcare providers, who fear causing anxiety and discomfort by raising sexual issues with their patients. PRACTICE IMPLICATIONS Developing brief interventions for healthcare providers and information materials for patients are recommended.
Collapse
Affiliation(s)
- Molly Byrne
- School of Psychology, National University of Ireland, Galway, Ireland.
| | | | | | | | | |
Collapse
|
27
|
Steinke EE, Jaarsma T, Barnason SA, Byrne M, Doherty S, Dougherty CM, Fridlund B, Kautz DD, Mårtensson J, Mosack V, Moser DK. Sexual counselling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP). Eur Heart J 2013; 34:3217-35. [PMID: 23900695 DOI: 10.1093/eurheartj/eht270] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
After a cardiovascular event, patients and their families often cope with numerous changes in their lives, including dealing with consequences of the disease or its treatment on their daily lives and functioning. Coping poorly with both physical and psychological challenges may lead to impaired quality of life. Sexuality is one aspect of quality of life that is important for many patients and partners that may be adversely affected by a cardiac event. The World Health Organization defines sexual health as '… 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. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences ….'(1(p4)) The safety and timing of return to sexual activity after a cardiac event have been well addressed in an American Heart Association scientific statement, and decreased sexual activity among cardiac patients is frequently reported.(2) Rates of erectile dysfunction (ED) among men with cardiovascular disease (CVD) are twice as high as those in the general population, with similar rates of sexual dysfunction in females with CVD.(3) ED and vaginal dryness may also be presenting signs of heart disease and may appear 1-3 years before the onset of angina pectoris. Estimates reflect that only a small percentage of those with sexual dysfunction seek medical care;(4) therefore, routine assessment of sexual problems and sexual counselling may be of benefit as part of effective management by physicians, nurses, and other healthcare providers.
Collapse
|
28
|
Steinke EE, Mosack V, Hertzog J, Wright DW. A social-cognitive sexual counseling intervention post-MI-development and pilot testing. Perspect Psychiatr Care 2013; 49:162-70. [PMID: 23819666 DOI: 10.1111/j.1744-6163.2012.00345.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Individuals experiencing myocardial infarction (MI) report anxiety, depression, diminished quality of life (QOL), and reduced sexual activity. DESIGN AND METHODS We examined return to sexual activity post-MI, and pilot tested a comprehensive sexual counseling intervention based on social-cognitive theory. The intervention in this pretest/posttest preexperimental study used an informational video, newsletters, and telephone counseling, with cardiac patients (N = 10) and partners (N = 3). Measures included QOL; knowledge; sexual anxiety, depression, self-efficacy, and satisfaction. FINDINGS At 8 weeks, only 60% had returned to sexual activity, with low QOL and sexual satisfaction for patients and partners. PRACTICE IMPLICATIONS Supportive interventions by nurses are needed to assist MI patients and partners return to sexual activity.
Collapse
Affiliation(s)
- Elaine E Steinke
- School of Nursing, Wichita State University, Wichita, Kansas, USA.
| | | | | | | |
Collapse
|
29
|
Steinke EE. How Can Heart Failure Patients and Their Partners Be Counseled on Sexual Activity? Curr Heart Fail Rep 2013; 10:262-9. [DOI: 10.1007/s11897-013-0138-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
30
|
Driel AGV, de Hosson MJJ, Gamel C. Sexuality of patients with chronic heart failure and their spouses and the need for information regarding sexuality. Eur J Cardiovasc Nurs 2013; 13:227-34. [PMID: 23575920 DOI: 10.1177/1474515113485521] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Psychological and physiological effects of chronic heart failure (CHF) can influence sexuality. Both CHF patients and their partners may experience changes and have questions about sexuality. Despite this, healthcare professionals give little information regarding sexuality. This may be due to the paucity of literature describing patients' concerns and questions about sexuality and CHF. AIMS The aims of this study were to describe the sexuality of patients and their partners and to describe their needs for information regarding sexuality. METHODS A prospective, descriptive cross-sectional design was used. A convenience sample was obtained in three hospitals (Belgian and the Netherlands). Patients and partners completed two questionnaires: Sexual Adjustment Scale (SAS) and the Needs of Sexual Counseling Scale for Chronic Heart Failure (NSCS-CHF). RESULTS There were 52 patients and 32 partners who participated in the study. No or slight disturbance was seen in sexual discussions and intimacy. Marked or serious disturbance was reported in sexual activity. A mixed profile was seen in sexual performance, sexual interest and sexual pleasure. The majority of patients with CHF and their partners want information regarding sexuality. The NSCS-CHF clearly identified the information needs of patients and partners and most needs concerned the areas of symptoms, the relationship and relaxation. CONCLUSION The questionnaires were easy to complete and changes in sexuality and information needs were identified. The NSCS-CHF needs further validation as a research instrument. Healthcare professionals can use both questionnaires to bring up the topic of sexuality and to identify topics that require further discussion or counselling with patients and partners.
Collapse
|
31
|
Verschuren JEA, Geertzen JHB, Enzlin P, Dijkstra PU, Dekker R, van der Sluis CK. Addressing Sexuality as Standard Care in People with an Upper Limb Deficiency: Taboo or Necessary Topic? SEXUALITY AND DISABILITY 2013. [DOI: 10.1007/s11195-013-9298-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
32
|
Verschuren JEA, Enzlin P, Geertzen JHB, Dijkstra PU, Dekker R. Sexuality in people with a lower limb amputation: a topic too hot to handle? Disabil Rehabil 2013; 35:1698-704. [PMID: 23350757 DOI: 10.3109/09638288.2012.751134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to analyze whether, and by whom sexuality is discussed in amputation departments. The focus was on whether professionals received questions about sexuality from their patients with a lower limb amputation and whether they addressed sexuality themselves, as well as on the knowledge and comfort level, approach and attitudes toward sexuality of these professionals. METHOD An online questionnaire, including questions on self-perceived sexological competence and the Knowledge, Comfort, Approach and Attitudes towards Sexuality Scale. RESULTS Seventy-eight percent of the professionals had not received questions about sexuality from their patients and 67% had not addressed sexuality. Self-perceived knowledge about sexuality and self-perceived ability to recognize sexual problems increased the odds of receiving a question about sexuality and the odds of addressing this issue. CONCLUSIONS Sexuality is rarely discussed by professionals in the amputation department. It is, however, the responsibility of the professional to do so. By addressing sexuality in a systematic way and discussing this as a common topic professionals "give permission" to patients and other team members to discuss eventual sexual problems or concerns. Therefore, the professionals' self-perceived sexological competence and feeling of comfort with the topic of sexuality need to be increased. Implications for Rehabilitation Sexuality is rarely discussed by professionals in the amputation department, even though sexual problems do occur in patients with a lower limb amputation (LLA). By addressing sexuality in a systematic way and discussing this as a common topic professionals "give permission" to patients and other team members to discuss eventual sexual problems or concerns. Our study shows that self-perceived knowledge about sexuality and self-perceived ability to recognize sexual problems increases the odds of receiving a question about sexuality and the odds of addressing this issue. Investing in courses that focus on increasing the knowledge and feeling of comfort concerning sexuality of professionals working with people with a LLA is therefore of important value.
Collapse
Affiliation(s)
- J E A Verschuren
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
| | | | | | | | | |
Collapse
|
33
|
Exploring Nurses’ Perceptions of Providing Sexual Health Counseling for Patients With Cardiac Disease. Dimens Crit Care Nurs 2013; 32:191-8. [DOI: 10.1097/dcc.0b013e31829980d1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|
34
|
Hoekstra T, Lesman-Leegte I, Couperus MF, Sanderman R, Jaarsma T. What keeps nurses from the sexual counseling of patients with heart failure? Heart Lung 2012; 41:492-9. [DOI: 10.1016/j.hrtlng.2012.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/10/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
|
35
|
Patients' experiences with symptoms and needs in the early rehabilitation phase after coronary artery bypass grafting. Eur J Cardiovasc Nurs 2012; 11:14-24. [PMID: 21030311 DOI: 10.1016/j.ejcnurse.2010.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The first month after discharge for Coronary artery bypass graft (CABG) is particularly challenging for the patients. A larger interview study is warranted to elicit CABG patients' detailed experiences, and give direction for future clinical practice. AIM To explore the CABG patients' symptoms and needs in the early rehabilitation phase. METHODS A qualitative, mixed method design integrating qualitative and quantitative approaches was used. Ninety-three CABG patients aged 39-77, participated in interviews at home after 2 and 4 weeks. The semi-structured interview guide covered: experiences of relief of angina pectoris after surgery, experiences with prescribed discharge medications, psychological experiences: anxiety, depression, sexuality, health professional contact persons, and patient defined experiences. RESULTS Two weeks after CABG the patients symptoms and needs were characterised by a substantial amount of uncertainty and worries related to what to expect and what was normal for postoperative pain, assessment and sensation of surgical site, different experiences with physical activity/exercise, uncertainty about medications, difficulties with sleep pattern, irritability, postoperative complications,uncertainty about return to work, and insufficient information at discharge. Four weeks after surgery the patients' symptom level was decreased, and they experienced life beginning to return back to normal. Patency with grafts after CABG, decision to drive a car, impotence (erectile dysfunction), and a missing link to the hospital remained challenges. CONCLUSION CABG patients' experiences indicate a need to extend the hospital's discharge care to the first month after surgery for specific themes to promote rehabilitation outcomes.
Collapse
|
36
|
Nilsson UG, Svedberg P, Fridlund B, Alm-Roijer C, Thylén I. Sex knowledge in males and females recovering from a myocardial infarction: a brief communication. Clin Nurs Res 2012; 21:486-94. [PMID: 22589462 DOI: 10.1177/1054773812437241] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this article was to explore sexual knowledge in persons who had suffered from myocardial infarction (MI). Seventy-six Swedish persons completed the "Sex after MI Knowledge Test" questionnaire. Overall, 53% of the men and 45% of the women scored maximum in the test. In a comparison between sexes, the men scored significantly more often a correct answer compared to the women for two out of the 25 items. The levels of correct answers were less then 50% for 14 out of the 25 items in both sexes. In conclusion we found that people who had suffered MI had poor levels of knowledge about sex and that there were some differences concerning lesser knowledge among the females in comparison to males. In regard to application, using a validated instrument facilitates an interactive communication between the patient and health care professionals, and opens up for a tailored education in line with the patient's and his or her partner's needs.
Collapse
|
37
|
Hoekstra T, Jaarsma T, Sanderman R, van Veldhuisen DJ, Lesman-Leegte I. Perceived sexual difficulties and associated factors in patients with heart failure. Am Heart J 2012; 163:246-51. [PMID: 22305843 DOI: 10.1016/j.ahj.2011.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/26/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sexual dysfunction is a common problem of increasing incidence in patients with heart failure (HF). However, there is no knowledge on which demographic, clinical, and quality of life (QoL) aspects are related to difficulties in sexual activity nor on the course of sexual difficulties in patients with HF. METHODS Data on sexual difficulties were collected at 1 and 18 months after an HF hospitalization (n = 792, mean age 69 ± 12 years, 35% female, mean left ventricular ejection fraction 33% ± 14%) by the question on sexuality of the Minnesota living with HF questionnaire. Demographic and clinical factors were assessed from medical records and QoL by Minnesota living with HF questionnaire, Medical Outcome Study 36-item General Health Survey, and Ladder of Life. RESULTS In total, 48% (n = 380) of the patients perceive difficulties in sexual activity at 1 month after discharge, and 70% continued to perceive this at 18 months. Furthermore, 27% of the patients without difficulties at 1 month developed them during follow-up. Living with a partner (OR 3.76, 95% CI 2.58-5.48), younger age (OR 0.96, 95% CI 0.94-0.97)), male gender (OR 3.08, 95% CI 2.10-4.43), overall well-being (OR 1.13, 95% CI 1.00-1.27), and physical (OR 1.06, 95% CI 1.06-1.08) and emotional (OR 1.07, 95% CI 1.03-1.10) QoL were independently associated with perceived difficulties in sexual activity. CONCLUSIONS Perceived difficulties in sexual activity are common in patients with HF, particularly in younger and male patients and continue over time. Patients who perceive difficulties in sexual activity report a significant lower QoL and overall well-being than those who do not.
Collapse
Affiliation(s)
- Tialda Hoekstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands.
| | | | | | | | | |
Collapse
|
38
|
Levine GN, Steinke EE, Bakaeen FG, Bozkurt B, Cheitlin MD, Conti JB, Foster E, Jaarsma T, Kloner RA, Lange RA, Lindau ST, Maron BJ, Moser DK, Ohman EM, Seftel AD, Stewart WJ. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2012; 125:1058-72. [PMID: 22267844 DOI: 10.1161/cir.0b013e3182447787] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
39
|
Reese JB, Shelby RA, Taylor KL. Sexual quality of life in patients undergoing coronary artery bypass graft surgery. Psychol Health 2011; 27:721-36. [PMID: 22149897 DOI: 10.1080/08870446.2011.623781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Despite improvements in many domains of functioning, sexual quality of life often remains impaired following coronary artery bypass graft (CABG) surgery. This study examined associations among sexual quality of life, fear of sexual activity and receiving information from providers about sexual activity in CABG patients. METHODS Participants completed a survey assessing sexual activity, mental health and physical health at baseline (3-5-day post-surgery; n=60) and 2-month post-surgery (n=42). RESULTS Sexual quality of life showed moderate difficulties at baseline and did not improve by follow-up (p values≥0.09). At follow-up, greater patient fear was associated with lower sexual quality of life in some domains; receiving information was related to lower fear (p values≤0.03) and greater sexual satisfaction and interest (p values≤0.04). Suggestive of mediation, there was a significant indirect effect of information on patient fear and of patient fear on sexual interest (p=0.05). CONCLUSIONS Though data were cross-sectional, findings suggest that fears of sexual activity may play a role in lowering CABG patients' motivation for sexual activity and that receiving information from a medical provider may assist in hastening sexual rehabilitation. Prospective and intervention studies are needed to support findings.
Collapse
Affiliation(s)
- Jennifer Barsky Reese
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, 5510 Nathan Shock Dr. Suite 100, Baltimore, MD 21224, USA.
| | | | | |
Collapse
|
40
|
Changes in Myocardial Infarction-Specific Sexual Counseling by Cardiac Nurses. Dimens Crit Care Nurs 2011; 30:331-8. [DOI: 10.1097/dcc.0b013e31822faa9c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
41
|
Factors Associated With Sexual Quality of Life in Patients Before and After Coronary Artery Bypass Grafting Surgery. J Cardiovasc Nurs 2011; 26:487-96. [DOI: 10.1097/jcn.0b013e3182050269] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
42
|
Altıok M, Yılmaz M. Opinions of Individuals Who have had Myocardial Infarction About Sex. SEXUALITY AND DISABILITY 2011. [DOI: 10.1007/s11195-011-9217-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
43
|
Steinke EE, Mosack V, Barnason S, Wright DW. Progress in sexual counseling by cardiac nurses, 1994 to 2009. Heart Lung 2011; 40:e15-24. [DOI: 10.1016/j.hrtlng.2010.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 09/23/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
|
44
|
Barnason S, Steinke E, Mosack V, Wright DW. Comparison of Cardiac Rehabilitation and Acute Care Nurses Perceptions of Providing Sexual Counseling for Cardiac Patients. J Cardiopulm Rehabil Prev 2011; 31:157-63. [DOI: 10.1097/hcr.0b013e3181f68aa6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
45
|
|