Sexual care for patients receiving dialysis: A cross-sectional study identifying the role of nurses working in the dialysis department

The relationship between the sexual care attitudes, beliefs and self-efficacy of nursing students and gender roles: A cross-sectional study

PURPOSE

The aim of the research is to determine the relationship between the gender role approaches and the sexual care attitudes, beliefs, and self-efficacy of nursing students.

DESIGN AND METHODS

This cross-sectional study included 109 nursing students.

FINDINGS

A negative correlation was found between the Gender Roles Attitude Scale and the Sexual Attitudes and Beliefs Scale (p < 0.001). A positive correlation was found between the Gender Roles Attitude Scale and the self-efficacy in clinical performance scale total score and its assessment, diagnosis, planning, and implementation subscales (p < 0.05).

PRACTICE IMPLICATIONS

This study is considered to be useful to specify the education and awareness strategies that will contribute to better preparation of the nursing students for sexual health services.

Sexual Dysfunction Among Patients With Chronic Kidney Disease

Sexual dysfunction (SD) in patients with chronic kidney disease is common and negatively impacts quality of life. SD is often under-appreciated because of overall low awareness. Diagnosis of SD is subjective, and manifestations can be different among men and women. Causes of SD are multifactorial, including psychological disorders, hormonal imbalances, vascular disorders, neurological disorders, and medication side effects. Non-specific approaches to improving sexual function include addressing underlying psychological disorders, promoting lifestyle modifications, optimizing dialysis care, and facilitating successful kidney transplantation, whereas treatment with phosphodiesterase type 5 inhibitor, hormone replacement, and mechanical devices can be offered to patients with specific indications.

Sexual function, depressive symptoms and quality of life of people undergoing hemodialysis therapy

Objective to analyze the correlation between sexual function, depressive symptomatology and quality of life of people on hemodialysis treatment. Method a cross-sectional study developed with 54 participants. Data collection occurred between the months of March and May 2020. The data were analyzed with the Mann-Whitney and Spearman Correlation tests, with a 95% confidence interval. Results the correlation between sexual function and depressive symptomatology was only clinically relevant for women (ρ= -0.724). Regarding quality of life, it was observed that the overall sexual function of men is negatively correlated with the pain dimension (ρ= -0.349) and with the social function (ρ= -0.347). For women, overall sexual function is positively correlated with physical function (ρ= 0.501), general health (ρ= 0.737), mental component (ρ= 0.497), sleep (ρ= 0.753), quality of social interaction (ρ= 0.621), and patient satisfaction (ρ= 0.457). Conclusion and implications for the practice increased sexual function was strongly correlated with reduced depressive symptoms and increased quality of life, implying the need to strengthen sexual approaches through protocols that provide referral flows to specialized trans-disciplinary teams.

Função sexual, sintomatologia depressiva e qualidade de vida de pessoas submetidas à terapia hemodialítica

RESUMO Objetivo analisar a correlação entre função sexual, sintomatologia depressiva e qualidade de vida de pessoas em tratamento hemodialítico. Método estudo transversal desenvolvido com 54 participantes. A coleta de dados ocorreu entre os meses de março a maio de 2020. Os dados foram analisados com os testes de Mann-Whitney e Correlação de Spearman, com intervalo de confiança de 95%. Resultados a correlação entre a função sexual e a sintomatologia depressiva somente foi clinicamente relevante para as mulheres (ρ= -0,724). Já em relação à qualidade de vida, observou-se que a função sexual geral dos homens está negativamente correlacionada com a dimensão dor (ρ= -0,349) e com a função social (ρ= -0,347). Já para as mulheres, a função sexual geral está positivamente correlacionada com a função física (ρ= 0,501), saúde geral (ρ= 0,737), componente mental (ρ= 0,497), sono (ρ= 0,753), qualidade da interação social (ρ= 0,621) e com a satisfação do paciente (ρ= 0,457). Conclusão e implicações para a prática o aumento da função sexual esteve fortemente correlacionado com a redução de sintomatologia depressiva e com o aumento da qualidade de vida, implicando a necessidade de fortalecer as abordagens sexuais por meio de protocolos que ofereçam fluxos de encaminhamento às equipes transdisciplinares especializadas.

A Scoping Review to Identify Barriers and Enabling Factors for Nurse-Patient Discussions on Sexuality and Sexual Health

Background: Sexuality and sexual health (SSH) are essential aspects of care that have evolved since a 1975 World Health Organization (WHO) report on SSH. However, nurses still consider discussing the subject with patients a challenge. This scoping review aimed to map, synthesize, and summarize findings from existing literature regarding barriers and enabling factors for nurse–patient SSH discussions in care contexts. Methods: A scoping review model inspired by Arksey and O’Malley was used to search for and synthesize studies published between 2009 and 2019. The databases searched were the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System Online, i.e., MEDLARS Online. A total of nineteen articles were eligible to be included. Results: Two main categories of enabling factors were identified, i.e., a professional approach via using core care values and availability of resources. Three major categories of barriers were identified: beliefs and attitudes related to age, gender, and sexual identity; fear and individual convictions; and work-related factors. Conclusions: Applying professionalism and core care values as well as making resources available are likely to promote SSH discussions between nurses and patients. Moreover, there is a need for a norm-critical approach in education and practice.

Sexual health counselling by Dutch HIV care providers: A cross-sectional survey among physicians and nurses in the Netherlands

To improve sexual health among people living with HIV, sexual health should be addressed during consultations in routine HIV care. The aim of the present study was to investigate to what extent Sexual Health Counselling (SHC) is incorporated into routine Dutch HIV care and to explore differences between physicians and nurses in their practices and views regarding SHC. A cross-sectional survey was conducted among all HIV physicians (N=110) and HIV nurses (N=82) in the Netherlands. A questionnaire assessed socio-demographic characteristics, current SHC practice, topics addressed, and factors associated with engaging in SHC. The response rate was 53.6% (N=59) among physicians and 60.0% (N=40) among nurses. SHC was performed by 26.1% of physicians and 83.9% of nurses (Χ² (1) = 27.68, p<.001). The most frequently reported barrier for SHC was the presence of a third party, endorsed by 50.9% of physicians and 60.4% of nurses. Nurses were more likely to address issues related to sexual wellbeing, while physicians mainly discussed medical topics. While, both HIV physicians and nursed felt responsible for providing SHC, nurses were more likely to address SHC that physicians. There is scope for improving SHC for PLHIV through a multidisciplinary approach based on clear guidelines for physicians and nurses.

Nurse's practices and attitudes toward sexual health, wellbeing, and function in people receiving haemodialysis: A scoping review

BACKGROUND

Sexual health, wellbeing, and function are important parts of a person's identity. Chronic diseases, such as kidney failure can alter, impair, and profoundly, affect sexual wellbeing and function.

OBJECTIVE

To conduct a scoping review of studies about renal nurses' practice and attitudes towards sexual health, wellbeing, and function in people with kidney failure receiving haemodialysis.

METHODS

Using Arksey and O'Malley's framework, seven databases were searched (CINAHL, MEDLINE, EMBASE, OvidPsycINFO, Scopus, Cochrane library, and JBI library). The search included studies published in English from January 2009 to January 2020.

RESULTS

Four studies met the review criteria (two cross-sectional surveys and two qualitative). Role confusion in discussing sexual issues, lack of training, and education in addressing sexual concerns, personal, and workplace related barriers were four factors that emerged from the review of the studies. This review identified that renal nurses were uncomfortable and hesitant in initiating discussions about sexual health, wellbeing, and function with people receiving haemodialysis.

CONCLUSION

Renal nurses experience role confusion about whose responsibility it is to initiate and discuss sexual concerns with patients, as well as who's role is it to conduct sexual health assessments. Work related and personal barriers impeded nurses' practice regarding sexual health, wellbeing, and function. Nurses working in renal units need knowledge and practical training about how to initiate and address sexual concerns in those affected by kidney disease.

Knowledge and attitude of nursing students regarding older adults' sexuality: A cross-sectional study

BACKGROUND

Although older adults are sexual, sexuality is infrequently discussed with them by health care professionals. Nursing students, as future professionals, can make an important contribution by developing competences in discussing intimacy and sexuality with older adults to increase quality of life and to prevent sexual problems. In order to improve these competences, current levels of knowledge and attitude need to be explored.

OBJECTIVES

To investigate i) knowledge and attitudes of nursing students regarding intimacy and sexuality of older adults, ii) the difference in knowledge and attitudes of nursing students in different years of study and iii) frequency of discussing intimacy and sexuality with older adults.

DESIGN

Cross-sectional.

SETTINGS

A University of Applied Sciences in the Netherlands.

PARTICIPANTS

Nursing students, ≥16 years who were able to read and write in Dutch.

METHODS

The Ageing Sexual Knowledge and Attitudes Scale was used among nursing students. Furthermore, demographic information and frequencies were collected. Data was analyzed using SPSS.

RESULTS

In total, 732 students participated. The mean knowledge-score was 43.9 (SD = 8.9), the mean attitude-score 64.3 (SD = 16.0). Unlike attitude, the level of knowledge differed significantly per year of study: first year students had the lowest and third year students the highest knowledge. Most students stated they 'never' (54.1%) or 'once' (13.2%) discussed intimacy and sexuality with older adults. Reasons to avoid talking about intimacy and sexuality were feelings of 'not being the right person' (17.3%) and 'incompetence' (14.0%).

CONCLUSIONS

Nursing students had moderate knowledge and positive attitudes toward older adults' intimacy and sexuality. The knowledge-level differed per year of study, the attitude level did not. Only a minority discussed intimacy and sexuality with older adults. Moderate knowledge and positive attitudes do not mean that intimacy and sexuality is discussed. To ensure students feel responsible and competent, interventions should focus on continuous knowledge dissemination, role clarification and role modelling.

Addressing Sexuality Among People Living With Chronic Disease and Disability: A Systematic Mixed Methods Review of Knowledge, Attitudes, and Practices of Health Care Professionals

OBJECTIVE

To systematically review health care professionals' practices and attitudes toward addressing sexuality with people who are living with chronic disease and disability.

DATA SOURCES

Scopus, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, and MEDLINE were searched to August 2020 for English language publications. Reference lists of relevant publications were also searched.

STUDY SELECTION

Eligible studies reported on knowledge, attitudes, and behaviors of health care professionals about addressing sexuality in the context of chronic disease and disability. The search yielded 2492 records; 187 full texts were assessed for eligibility and 114 documents were included (103 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool.

DATA EXTRACTION

Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or by a third author.

DATA SYNTHESIS

A sequential, exploratory mixed studies approach was used for synthesis. Pooled analysis showed that 14.2% (95% CI, 10.6-18.9 [I²=94.8%, P<.001]) of health professionals report routinely asking questions or providing information about sexuality. Professionals reported limited confidence, competence, and/or comfort when initiating conversations about sexuality or responding to patient questions. Sexual rehabilitation typically focused on the effect of disease, disability, and medication on sexual function. Broader dimensions of sexuality were rarely addressed.

CONCLUSION

Despite recognizing the value of sexuality to health and well-being, most health professionals regardless of clinical context fail to routinely include assessment of sexuality in their practice. Professionals have limited knowledge and confidence when addressing sexuality and experience significant discomfort when raising this topic with people living with chronic disease and disability. Multicomponent implementation programs are needed to improve health professionals' knowledge, competence, and comfort when addressing sexuality for people living with chronic disease and disability.

Improving Sexual Function in People With Chronic Kidney Disease: A Narrative Review of an Unmet Need in Nephrology Research

Purpose of review:

Sexual dysfunction occurs commonly in people with chronic kidney disease (CKD) and has been recognized as a research priority. We sought to evaluate the current state of the literature addressing sexual dysfunction in people with CKD and identify barriers and strategies to improve our management of this important symptom.

Sources of information:

OVID Medline and Google Scholar were searched for English, peer-reviewed studies using keywords and terms related to “Chronic Kidney Disease,” “sexuality,” and “sexual dysfunction OR function.”

Methods:

In this narrative review, we describe definitions of sexual dysfunction and contributors exacerbated by CKD, barriers to researching sexual dysfunction in people with CKD, and possible avenues for future research.

Key findings:

Sexual dysfunction is common in people with CKD and results from a combination of kidney disease itself, as well as its associated physical (ie, comorbidities) and nonphysical factors. Barriers to the study of sexual dysfunction in CKD include inconsistent disease definitions, stigma, variable efficacy and safety of established therapies, and evolving gender roles in sexual function. Potential avenues for future research to improve the sexual function in people with CKD may include evaluating the safety and efficacy of established therapies in people with CKD using a variety of observational and interventional study designs, engaging people with CKD and multidisciplinary team members in research, and using implementation science methods to translate what is known about sexual function into clinical practice. Concerted efforts are required to break down barriers and improve sexual function in people with CKD. Patients have identified this as an important research priority, and national networks need to direct efforts to reduce symptom burden.

Limitations:

This narrative review was limited by a paucity of high-quality studies examining sexual dysfunction specifically in people with kidney disease.

Sexuality and sexual dysfunctions in older people: a forgotten problem

This article considers sexuality in older adults and the associated stereotypes and stigmas that lead to this area being underappreciated. Normal physiological changes in ageing are discussed and how they can cause sexual dysfunction. The elderly population has a higher burden of comorbid physical illness and this review considers evidence on the interplay between physical health and sexual health. Mental illness is also strongly linked with sexual functioning and is discussed, as is the evidence on psychotropics and sexual side-effects. Attitudes on sexuality in long-term care settings are highlighted and approaches to managing sexual disinhibition are included.