Sexual dysfunctions and related variables with sexual function in patients who undergo dialysis for chronic renal failure.

AIMS AND OBJECTIVES: To evaluate personality characteristics and psychological symptoms believed to have an effect on the sexual functions and performances of patients undergoing dialysis treatment. BACKGROUND: Chronic renal failure is a life-threatening condition which can often have a poor prognosis. The loss of vital kidney function and other complications can affect almost all age groups. DESIGN: A quantitative descriptive study. METHODS: The study sample included 225 patients selected randomly from patients who have undergone dialysis treatment for at least 3 months at a dialysis centre in a university hospital. In this study, the Golombok Rust Inventory of Sexual Satisfaction (GRISS), the Eysenck Personality Inventory (EPI) and the Brief Symptom Inventory (BSI) were used. RESULTS: In the correlation test, made to investigate the relation between the patients' sexual satisfaction and their personalities, a significant positive relation was found between the communication subscale of the GRISS and the Lie dimension of the EPI, and a significant negative relation was found between the Communication subscale of the GRISS and the Lie dimension of the EPI, and between the Vaginismus and Orgasm subscales of the GRISS and the Extroversion dimension of the EPI. CONCLUSION: Results showed that sexual problems, in the areas of nonsensuality, anorgasmia, avoidance and communication, are associated with extroversion and psychological symptoms. RELEVANCE TO CLINICAL PRACTICE: Sexual health and the psychological well-being of patients with renal failure is an important issue that should be considered in nursing practice. Nurses should take the psychological problems of patients and their relations with partners into account and consider these problems in a holistic manner within the framework of nursing practice. They would then be able to play an effective role in intervening at an early stage and would be better equipped to help and control the psychological and sexual problems that some patients may experience.

A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol.

INTRODUCTION: Prostate cancer is common and the incidence is increasing, but more men are living longer after diagnosis, and die with their disease rather than of it. Nonetheless, specific and substantial physical, sexual, emotional and mental health problems often lead to a poor quality of life. Urology services increasingly struggle to cope with the demands of follow-up care, and primary care is likely to play the central role in long-term follow-up. The present phase II trial will evaluate the feasibility and acceptability of a nurse-led, person-centred psychoeducational intervention, delivered in community or primary care settings. METHODS AND ANALYSIS: Prostate cancer survivors diagnosed in the past 9-48 months and currently biochemically stable will be identified from hospital records by their treating clinician. Eligible men would have either completed radical treatment, or would be followed up with prostate specific antigen monitoring and symptom reporting. We will recruit 120 patients who will be randomised to receive either an augmented form of usual care, or an additional nurse-led intervention for a period of 36 weeks. Following the health policy in Wales, the intervention is offered by a key worker, is promoting prudent healthcare and is using a holistic needs assessment. Outcome measures will assess physical symptoms, psychological well-being, confidence in managing own health and quality of life. Healthcare service use will be measured over 36 weeks. Feedback interviews with patients and clinicians will further inform the acceptability of the intervention. Recruitment, attrition, questionnaire completion rates and outcome measures variability will be assessed, and results will inform the design of a future phase III trial and accompanying economic evaluation. ETHICS AND DISSEMINATION: Ethics approval was granted by Bangor University and North Wales REC (13/WA/0291). Results will be reported in peer-reviewed publications, at scientific conferences, and directly through national cancer and primary care networks. TRIAL REGISTRATION NUMBER: ISRCTN 34516019.

Talking about sex as part of our role: making and sustaining practice change.

Sexual issues are common for consumers of mental health services and have many adverse consequences for quality of life as well as impacting negatively on the mental illness itself. Nurses in mental health settings are well placed to assess for the presence of and provide interventions for sexual concerns. To date, little research has been undertaken to explore nurses' attitudes and whether sexual issues would be accepted as part of their care. This paper presents findings from the third stage of a qualitative, exploratory research study with mental health nurses working in an Australian mental health service. The findings from the first two stages suggested that the participants had tended to avoid discussion of sexual issues, but a brief education intervention had produced a greater willingness to address sexual issues as part of care. The aim of the third stage was to determine the degree to which changes in practice had continued over time. Two main themes that emerged from this data were: (i) holism, from rhetoric to reality; and (ii) part of what I do. Addressing sexual issues became part of practice, a change sustained 2 years following the intervention, because participants recognized its importance for holistic nursing care.

Sexual problems in cardiac patients: how to assess, when to refer.

It is increasingly realized that discussing sexuality is an important issue in the holistic care for cardiac patients. In this review article, the conditions of a good assessment of sexual problems are identified such as creating an appropriate environment, ensuring confidentiality, and using appropriate language. Second, we present different styles and approaches that can be used to start the assessment, differing between settings, persons, or disciplines. The PLISSIT (permission, limited information, specific suggestion, and intensive therapy) model can be helpful to initiate discussion about sexuality with the cardiac patient and his/her partner. This model is a stepwise approach using various levels of discussion or treatment. Open-ended question can facilitate discussion about sexual concerns, and validated questionnaires or diaries can be used to assess sexual problems. Patients with sexual concerns and problems should be counseled and/or treated appropriately, and adequate follow-up is needed. Additional training and research are needed to further improve the quality of sexual assessment and counseling in cardiac patients.

Cardiac disease and sexuality: implications for research and practice.

Many symptoms of cardiovascular disease can impact the patient's level of sexual desire. Nurses are in a position to assess sexuality of the cardiovascular patient and to provide a high degree of counseling on the subject; yet, nurses frequently complain that they lack the proper knowledge to provide this education and counseling. This article attempts to provide the necessary information regarding the physiologic effects of sexual intercourse on the heart, the role of sexuality in various types of cardiovascular disease, and the evidence-based nursing interventions needed to provide holistic care to patients with cardiovascular disease.

Arthritis and sexuality.

More than 120 kinds of arthritis exist. This article focuses on the more common types of musculoskeletal disorders, which are osteoarthritis, rheumatoid arthritis, and osteoporosis. Because of the pain, fatigue, and joint stiffness associated with arthritis, physical intimacy may be difficult. These symptoms can be ameliorated during sexual activity by good communication between the partners, timing medication, and experimenting with different positions. Clients may need to be taught to be creative and to be willing to experiment. Learning the relaxation response, in addition to fantasizing and guided imagery, can enhance the sexual experience for people who have arthritis.

Sexuality and spinal cord injury.

In the United States, more than 250,000 people are living with spinal cord injury (SCI). SCI is most often the result of direct trauma to the spinal cord, but can also be associated with congenital or degenerative disease. These individuals experience physical and psychologic consequences that have a profound impact on their sexual health. Using a holistic, developmental, team approach to care, the nurse is well positioned to address the acute and long-term sexual rehabilitation needs of the SCI patient. By assisting SCI patients through the grieving process and promoting a positive, yet realistic, self-concept, nurses can mitigate potential problems in body image disturbances, decreased self-esteem, and gender-specific sexuality issues.

Using the extended PLISSIT model to address sexual healthcare needs.

Sexual health is a holistic concept which encompasses much more than the prevention of infections and unwanted pregnancy. This article defines sexuality and sexual health before discussing the nurse's role in identifying and meeting patients' sexuality and sexual health needs. The Ex-PLISSIT model is proposed as a useful tool for nurses working in primary care to address sexuality and sexual health.

Inequality in provision of sexual health information.

Sexual health is important to quality of life, and therefore to all areas of nursing, generalist and specialist. Disparity exists between what is available to men and to women, as regards range and availability of information and services. The lack of information available for men has potential consequences for health, and for the provision of quality nursing and health care.

Sexuality: a challenge for nursing practice.

Nursing has made significant progress towards individualised, holistic patient care. Yet caring for patients who have concerns about sexuality and body image remains a challenge, despite considerable literature on the subject. This article explores reasons for this and suggests learning exercises to enable nurses to examine their own attitudes to body image and sexuality.

PIP: This article explores why caring for patients who have concerns about sexuality and body image have remained a challenge to nurses. Also suggested in this article are learning exercises to enable nurses to examine their own attitudes to body image and sexuality. Nurses have failed to address their patients' needs in relation to sexuality because of lack of knowledge, lack of role models, embarrassment, inability to initiate a conversation, belief that it is someone else's responsibility, and belief that an expert is required. Two simple exercises for nurses to carry on such duties include overcoming inhibitions, and role-playing. Nurses need practice in order to become competent in addressing patients' sexual concerns. Nurses can lead the way by using these exercises at work and then applying the principles in their interactions with patients.

Unlocking sexual issues. Counseling strategies for nurses.

Providing truly holistic care means that nurses must recognize that their clients are sexual beings and that they often suffer from sexual concerns and problems related to their past history and their current medical problems. In addition to helping clients move toward physical wellness, nurses should intervene with intrapersonal and interpersonal problems affecting client's sexual feelings and behaviors.