How do continence nurses address sexual function and a history of sexual abuse in daily practice? Results of a pilot study

Unravelling sexual care in chronically ill patients: the perspective of GP practice nurses; Health Service Research

BACKGROUND

Assessment of sexual health is important in chronically ill patients, as many experience sexual dysfunction (SD). The general practice nurse (GPN) can play a crucial part in addressing SD.

OBJECTIVE

The aim of this cross-sectional study was to examine to which extent GPNs discuss SD with chronically ill patients and what barriers may refrained them from discussing SD. Furthermore, we examined which factors had an association with a higher frequency of discussing SD.

METHODS

A cross-sectional survey using a 48-item questionnaire was send to 637 GPNs across the Netherlands.

RESULTS

In total, 407 GPNs returned the questionnaire (response rate 63.9%) of which 337 completed the survey. Two hundred and twenty-one responding GPNs (65.6%) found it important to discuss SD. More than half of the GPNS (n = 179, 53.3%) never discussed SD during a first consultation, 60 GPNs (18%) never discussed SD during follow-up consultations. The three most important barriers for discussing SD were insufficient training (54.7%), 'reasons related to language and ethnicity' (47.5%) and 'reasons related to culture and religion' (45.8%). More than half of the GPNs thought that they had not enough knowledge to discuss SD (n = 176, 54.8%). A protocol on addressing SD would significantly increase discussing during SD.

CONCLUSIONS

This study indicates that GPNs do not discuss SD with chronically ill patients routinely. Insufficient knowledge, training and reasons related to cultural diversity were identified as most important reasons for this practice pattern. Implementation of training in combination with guidelines on SD in the general practice could improve on the discussing of sexual health with chronic patients.

Fertility preservation counselling in Dutch Oncology Practice: Are nurses ready to assist physicians?

Cancer and its treatments may result in impaired fertility, which could cause long-term distress to cancer survivors. For eligible patients, fertility preservation (FP) is available to secure future reproductive potential. Many physicians, however, feel inhibited about discussing FP. Oncology nurses may serve as an initiator for discussing the subject and provide additional support. Our aim was to investigate their knowledge about FP, the way they apply this, and possible barriers to discussing FP with patients of reproductive age. A questionnaire was administered via mail, Internet and the Dutch Oncology Nursing Congress. Four hundred and twenty-one oncology nurses participated, a third of whom (31.1%) had "sufficient" knowledge of FP. Twenty-eight per cent of participants reported that they "never/hardly ever" discussed FP; 32.2% "almost always/always." FP discussions were more frequently performed by graduate nurses, academic nurses, experienced nurses and nurses with sufficient knowledge. Reasons for not discussing FP were a "lack of knowledge" (25.2%), "poor prognosis" (16.4%) and "lack of time" (10.5%). In conclusion, several obstacles may result in FP not being routinely discussed, specifically a lack of knowledge. Yet nurses feel responsible for addressing the issue, indicating that assistance with FP discussions should be encouraged. Educational training about FP is recommended.

Sexual Concerns after (Pelvic) Radiotherapy: Is There Any Role for the Radiation Oncologist?

INTRODUCTION

Sexual function is an important aspect of quality of life, and may be impaired after (pelvic) radiation.

AIM

The aim of this study was to identify practice, responsibility attitudes, knowledge, and barriers of Dutch radiation oncologists regarding sexual counseling.

METHODS

A cross-sectional survey was performed using a 28-item questionnaire sent to all members of the Dutch Society for Radiotherapy and Oncology.

MAIN OUTCOME MEASURES

Self-reported practice, knowledge, barriers, need for training and responsibility attitudes in regard to demographic characteristics.

RESULTS

Of the surveyed sample, 54.6% of the radiation oncologists completed the instrument (n = 119). Frequency of discussing sexual function was fluctuating, depending on the type of tumor. The majority of the responding radiation oncologists (75%) agreed that discussing sexual function is their responsibility, about one-third (33.6%) pointed at the involved specialist (surgeon, urologist, gynecologist, or oncologist), a fifth also considered the general practitioner responsible (21%). Additional training about discussing sexuality was required according to 44.4%, the majority agreed that sexual counseling should be a regular component of radiation oncology residency (n = 110, 94%). Barriers most mentioned included patient is too ill (36.2%), no angle or reason for asking (32.4%), advanced age of the patient (27%) and culture/religion (26.1%). For prostate cancer patients, phosphodiesterase 5 inhibitor information was supplied regularly (49.2%) and often (40.7%).

CONCLUSIONS

Radiation oncologists generally perform sexual counseling in case of pelvic radiation therapy, but not consistently in case of gastrointestinal, breast, and other cancers. The majority of radiation oncologists considered counseling on sexual functioning as a part of their job, some also pointed at the referring specialist or general practitioner. The findings suggest that awareness about sexual dysfunction is present among radiation oncologists, but responsibility for active counseling is uncertain. Results emphasize the need for providing educational and practical training, as well as a list for specialized referral.

Discussing Sexual Dysfunction with Chronic Kidney Disease Patients: Practice Patterns in the Office of the Nephrologist

INTRODUCTION

Sexual dysfunction (SD) is a common problem in patients suffering from chronic kidney disease (CKD). Sexual health remains a difficult subject to detect and discuss. Although many studies have been performed on the incidence of SD, little is known about practice patterns when it concerns quality of life (QoL)-related questions such as SD in the nephrologists' practice.

AIM

The aim of this study was to determine to which extent nephrologists, important renal care providers, discuss SD with their patients and their possible barriers toward discussing this subject.

METHODS

A 50-item questionnaire was sent to all Dutch nephrologists (n = 312).

MAIN OUTCOME MEASURES

The survey results.

RESULTS

The response rate of the survey was 34.5%. Almost all responders (96.4%) stated to address SD in less than half of their new patients. The most important barrier not to discuss SD was patients not expressing their concern regarding SD spontaneously (70.8%). Other important barriers were: "the lack of a suitable moment to discuss" (61.9%) and "insufficient time" (46.9%). Eighty-five percent of the nephrologists stated that insufficient attention was paid to SD and treatment options during their training. Sixty-five percent of the respondents stated to be in need of extending their knowledge on the discussing of SD.

CONCLUSIONS

Dutch nephrologists do not discuss problems with sexual function routinely. The lack of knowledge, suitable education, and insufficient time are factors causing undervaluation of SD in CKD patients. Implementation of competent sexual education and raising awareness among nephrologists on the importance of paying attention to SD could improve care and QoL for patients with CKD. More research should be performed among patients and other renal care providers to develop an adequate method to enhance our current system.

Factors Influencing the Sexual Function of Women with Urinary Incontinence

PURPOSE

Sexual function involves a complex interaction of emotions, body image, and intact physical responses. The purpose of this study was to determine the sexual functioning of women who are incontinent and to identify associated factors.

METHODS

For this descriptive correlation study, data were collected from 147 women with urinary incontinence. Data were analyzed using t-test, ANOVA, and stepwise multiple regression.

RESULTS

Mean scores were 22.39 (sexual dysfunction < or =26.55) for sexual function, 13.38 (of 63) for depression, and 55.47 (range of score 17~85) for body image. Urinary symptoms and daily life symptoms averaged 36.04 (range of score 20~100) and 16.03 (range of score 8~40). Sexual function had a positive correlation with body image and negative correlation with daily life symptoms. Sexual satisfaction, daily life symptoms, marital satisfaction, and frequency of sexual intercourse were factors affecting sexual function.

CONCLUSION

Study results indicate that urinary incontinence has a negative impact on various aspects of sexual function. Nurses should be aware of the wider consideration that needs to be made in relation to general and sexual quality of life when caring for clients suffering from urological diseases.

[Childhood sexual abuse: how important is the diagnosis to understand and manage sexual, anorectal and lower urinary tract symptoms]

OBJECTIVE

To understand and manage the sequels of childhood sexual abuse on sexual, anorectal and lower urinary tract functions.

MATERIAL AND METHODS

Review of articles published in the Medline database, selected according to their scientific relevance and published guidelines on this subject together with our own experience.

RESULTS

A history of sexual abuse is frequently found when assessing dysfunction or symptoms of the lower urinary tract. In this context, urinary stress incontinence is rarely involved but it can be linked by epidemiological factors. Dysuria with urgency is the most frequent expressed symptom. When associated with anorectal disorders and pelvic pain or a sexual disorder in particular dyspareunia, a sexual abuse should be evoked and specific questions asked to the patient. Although these symptoms are frequently encountered in 12 to 33% of women, and 8 to 16% of men, few practitioners, whatever their speciality ask about them as routine. It is important that the physician diagnose the existence of sexual abuse, in particular when the symptoms mentioned by the patient are not conclusive, in spite of thorough urological assessment. Patients finding the initial examination difficult and painful and the failure of the initial treatment should lead to questions concerning abuse, if neglected by the initial medical inquiry.

CONCLUSIONS

Clinicians involved in perineal functional pathology are able to acquire standardized modalities of inquiry about child sexual abuse for a better time management and efficacy in the therapeutic approach. The interest of a multidisciplinary diagnostic and therapeutic approach is primordial, associating psychological therapy and if necessary perineal re-education. This can avoid unnecessary tests and out-patient visits. Directing patients towards a multidisciplinary approach is highly advisable.

Nursing interventions on sexual health: validation of the NISH Scale in baccalaureate nursing students in Taiwan

INTRODUCTION

No widely accepted tool is available to assess nursing interventions on patient's sexual health among nursing students. Consequently, nursing school faculty cannot determine the sexual healthcare-related skills of nursing students.

AIM

The aim of this article was to develop and test a scale to assess nursing interventions on sexual health.

METHODS

A 19-item instrument Nursing Interventions on Sexual Health (NISH) was developed using 10 semi-structured interviews of senior nursing students, expert review, and comparative analysis of text and field notes. A total of 198 senior nursing students were recruited from two nursing schools in central Taiwan to test the instrument. Exploratory factor analysis (EFA) was used to measure construct validity and Cronbach's alpha to measure internal consistency.

MAIN OUTCOME MEASURES

Validity and reliability of the NISH scale based on the Permission, Limited Information, Specific Suggestion, and Intensive Therapy (PLISSIT) model.

RESULTS

Three factors (permission, limited information, and specific suggestion) were retained after EFA of the 19 items of NISH. Cronbach's alpha for the subscales increased from 0.71-0.93 to 0.74-0.94 and from 0.93 to 0.95 for the total scale, with 72.42% of the cumulative variance explained by these three factors. Nursing students' age (P=0.019) correlated positively with total score.

CONCLUSIONS

NISH is a useful and reliable scale for assessing the frequency of PLISSIT-related behaviors used by nursing students to address patient's sexual health concerns. Nursing faculties can use this scale to assess students' performance and find their omitted behaviors in clinical practice regarding sexual health care.