SCHOOL OF NURSING RN-BSN PROGRAM

COLLEGE  OF  HEALTH  AND URBAN AFFAIRS

Transition to Professional Nursing
SEXUALITY

To e-mail the instructor  phillips@fiu.edu

DEFINITIONS OF SEXUALITY

Sexuality

• Biological and social influences on sense of self and relationships with others.

• Holistic concept which is often viewed from a narrow focus (e.g. physiological dysfunction, physical satisfaction).

Sexuality

• All of those aspects of the human being that relates specifically to being boy or girl, man or woman.

• An entity subject to lifelong dynamic change.

Sex--denotes biologic male or female status; also describes specific sexual behavior.

Biologic sex--all of the human beings genetically determined anatomy and physiology which is also 
influenced by intrauterine conditions.

Gender identity--an individual's persisting inner sense of being male or female.

Gender role--all behaviors reflecting the individuals learned sense of masculinity and femininity.

PSYCHOSEXUAL DEVELOPMENT

Prenatal to adolescence--see Freud's Stages of Psychosexual Development.

Adult sexuality

• Early adulthood  

  • Development of value system that influences type of and conditions for sexual expression.

  • Long term commitment to another person which may include marriage and parenting.  

• Middle adulthood  

  • Menopause.  

  • Gradual decline in testosterone.  

• Later adulthood  

  • Physiological changes--Decreased lubrication, rate of attaining erection, intensity of sensation.

CONTEXT OF SEXUALITY

• Historical perspectives

• Ethnocultural perspectives

• Religious-ethical perspectives

• Contemporary perspectives

CHARACTERISTICS OF SEXUAL HEALTH

• Expression of a positive body image.

• Cognitive knowledge about human sexuality.

• Congruence between biologic sex, gender identity, and gender role behavior.

• Behavior consistent with self-concept.

• Awareness of own sexual feelings and attributes.

• Capacity for physical and psychosexual responsiveness, which is enhancing to self and others.

• Comfort with a range of sexual behavior and lifestyles.

• Acceptance of responsibility for pleasure and reproduction.

• Ability to create effective interpersonal relationships with both sexes.

• Value system that is developing and usable.  
  

NURSING AND SEXUALITY ISSUES

• Contraception

• Menopause

• Homosexuality

• HIV/AIDS

• Sexual harassment

• Sexual assault

• PMS  
  

SEXUALITY AND THE NURSING PROCESS

ASSESSMENT

• Factors influencing alterations and sexual functioning  

  • Ineffective or absent role models.  

  • Altered body structure or function due to disease, trauma, drugs, pregnancy, childbirth, or genitalia abnormalities.

  • Lack of knowledge or misunderstanding about sexuality.  

  • Physical abuse, such as sexual assault.  

  • Psychosocial abuse.

  • Value conflict.  

  • Loss or lack of a partner.  

  • Vulnerability.  

• Integrating sexuality into the nursing history  

  • Levels of sexual assessment  

    • I--screening for sexual function/dysfunction  

    • II--sexual history conducted by advanced practice nurse  

    • III--sexual problem history conducted by qualified sex therapist  

    • IV--psychiatric/psychosexual history conducted by professional specialist in sex therapy

NURSING DIAGNOSES
·        Altered sexual patterns
·        Sexual dysfunction

PLANNING
The client (Example: will have homeostatic sexual functioning) as evidenced by:
·        Verbalizing understanding of sexual anatomy and function.
·        Identifyng personal stressors that contribute to dysfunction, etc.

INTERVENTIONS
Develop self awareness
Select appropriate interventions

P-LI-SS-IT Model--a clinical model for treating clients with sexual concerns.

• Permission--client reassured that behavior is normal and obtains permission to continue.

• Limited information--factual information provided for a specific situation.

• Specific suggestions--sexual history obtained to decide on a brief therapeutic approach.

• Intensive therapy--provided by clinician specifically prepared to treat sexual problems.

Sexual Health Model--specifically developed for nurses to use for self-assessment and for 
interacting with clients.
Life experience level

• Identify intuitively helpful and destructive behaviors.

Basic level  

• Obtain requisite knowledge.  

• Use of awareness, cognition, attitudes, perceptions, clinical expertise.  

• Provide general sexual health education—STDs, contraception, etc.

Intermediate level

• Provided by professionals with post-graduate or specialized training. \

• Obtain sexual history.

• Information giving.  

• Permission--reassure client that behavior is permissible.  

• Plan for detailed sexual education and counseling if indicated by history.

Advanced level

• Provided by professionals with advanced education and training.  

• Advanced therapies related to sexuality.  

• Educational programs, research.