Learning Objectives
By the end of this section, you will be able to:
- Describe how the nurse acts as an educator
- Recognize how the nurse will be a role model when providing care
- Identify how the nurse is a mandatory reporter
From describing medication side effects to teaching patients about their medical conditions, one of the main roles of the nurse is acting as an educator. This is especially true for sexual health. There are many aspects of sexual health that require the nurse to act as an educator, some of which are described in more detail in the following sections.
Nurse as an Educator
Providing education related to sexual health can be sensitive and difficult at times, both for the nurse and for the patient receiving it. It is important to remember that sexual preferences and health are highly personal and can be uncomfortable to discuss, even if the nurse and patient have a good relationship. The nurse must possess an extensive knowledge base about sexual health topics including STIs, contraception (methods used to prevent pregnancy resulting from sexual intercourse), and reproduction to provide information to the patient that is accurate and easily understandable. Additionally, the nurse must be able to address any misconceptions about sexual health that the patient may have to help dispel misinformation and promote understanding.
The nurse as an educator must create a safe and supportive environment for the patient to openly discuss their sexual concerns and be able to provide referrals and other resources as needed to fully address the concerns. While acting as an educator, the nurse should acknowledge and respect the patient’s cultural and religious beliefs, even if they do not align with the nurse’s personal beliefs. Overall, the nurse acts as an educator by empowering patients to take responsibility for their sexual health by providing them with the information and support that they need to make informed decisions about their health. Some of the common topics requiring education to be provided by the nurse include STIs, pregnancy, and fertility, all of which are discussed in more detail in the following sections.
Sexually Transmitted Infections
An infection that is primarily spread through sexual contact, known as a sexually transmitted infection (STI), may develop after sexual contact with an infected individual (Table 33.7). These infections can range from asymptomatic to severe depending on the specific type of infection as well as the baseline health status of the infected person. Safe sex practices such as limiting sexual partners or using appropriate protection such as condoms can decrease the risk for developing STIs. Nurses caring for patients at risk for STIs must not only be able to adequately treat the physical condition and symptoms, but also be able to provide counseling and education regarding effective prevention strategies.
| Sexually Transmitted Infection (STI) | Signs/Symptoms |
|---|---|
| Chlamydia |
|
| Gonorrhea |
|
| Herpes simplex virus (HSV) |
|
| Human papillomavirus (HPV) |
|
| Syphilis |
|
Clinical Judgment Measurement Model
Form a Hypothesis: Recognizing a Potential STI
A 22-year-old female seeks care at a sexual health clinic due to lower abdominal pain and vaginal discharge following unprotected intercourse with a new partner. The nurse begins by gathering a comprehensive sexual history, probing for details about recent sexual activity, contraceptive practices, and symptoms experienced. Concurrently, a pelvic examination is conducted to assess for physical cues such as abnormal discharge, cervical tenderness, or lesions indicative of infection. Analyzing these cues, the nurse considers the patient's individual risk factors, including her age, sexual practices, and recent exposure, to determine the likelihood of STI transmission. Diagnostic tests, including nucleic acid amplification tests (NAATs) for common STIs such as chlamydia and gonorrhea, are ordered to confirm the presence of infection. Based on the identified cues and analysis, the nurse forms hypotheses regarding potential STIs such as chlamydia, gonorrhea, or trichomoniasis, considering the risk of coinfection and associated complications. This systematic approach to clinical judgment empowers the nurse to provide targeted, evidence-based care, facilitating timely diagnosis and treatment to optimize patient outcomes in sexual health management.
Fear of Pregnancy
Nurses play a crucial role in supporting patients who have a fear of pregnancy by providing them with information, empathy, and resources. Nurses can act as educators by offering detailed information about contraception methods, including their effectiveness, benefits, and potential side effects. They can explain how to properly use contraceptives and address any misconceptions or concerns the patient may have. Nurses can then assist patients in selecting the most appropriate contraceptive method based on their individual needs, preferences, and medical history. They can also provide guidance on emergency contraception options for situations where contraception has failed or was not used. Most importantly, the nurse should create a supportive and nonjudgmental environment that allows the patient to feel comfortable discussing their fears and concerns related to pregnancy.
Fear of Infertility
While some patients are fearful of becoming pregnant, others may express fears related to infertility, or the inability to conceive a child. Nurses can act as educators in these situations by providing detailed information about fertility, including factors that can affect fertility, common causes of infertility, and available treatment options. They can explain the various diagnostic tests used to assess fertility and discuss potential lifestyle modifications that may improve fertility. Dealing with the fear of infertility can be emotionally challenging for patients. Nurses can offer empathetic support and nonjudgmental listening allowing patients to express their fears, concerns, and emotions openly. Validation of their feelings and providing a safe space for expression can be immensely helpful. Nurses may also empower patients by providing information about fertility preservation options such as egg freezing or sperm banking. This is especially helpful for patients who are facing medical conditions or treatments that could negatively impact their fertility in the future.
Nurse as a Role Model
In addition to acting as educators, nurses are also often viewed as role models. Specifically, when caring for the sexual health of patients, nurses demonstrate characteristics of a good role model by understanding human sexuality, possessing self-awareness and communication skills, and being able to recognize patient problems and provide competent care.
Clinical Safety and Procedures (QSEN)
Enhancing Patient Safety and Quality Care: Addressing Patient Sexuality
As nurses, it is essential to recognize and address the diverse needs and concerns related to patient sexuality to ensure the provision of safe, competent, and patient-centered care. Incorporating patient sexuality into nursing practice contributes to improved patient outcomes and enhances the overall quality of care. Here's how addressing patient sexuality relates to each of the QSEN competencies:
- Patient-centered care: Recognizing and respecting patient sexuality is fundamental to providing patient-centered care. By acknowledging and validating patients' sexual identities, preferences, and concerns, nurses demonstrate a commitment to meeting the individual needs and values of each patient.
- Teamwork and collaboration: Collaborating with interdisciplinary teams, including social workers, counselors, and sexual health specialists, allows nurses to address the multifaceted aspects of patient sexuality effectively. By working collaboratively, nurses can ensure that patients receive comprehensive and holistic care that addresses their sexual health and well-being.
- Evidence-based practice: Utilizing evidence-based guidelines and best practices in addressing patient sexuality enhances the quality and safety of care. Nurses should stay updated on the latest research and recommendations related to sexual health assessment, counseling, and interventions to provide optimal care based on current evidence.
- Quality improvement: Engaging in continuous quality improvement efforts related to patient sexuality involves evaluating current practices, identifying areas for improvement, and implementing strategies to enhance patient outcomes. Nurses can participate in quality improvement initiatives aimed at promoting inclusive and affirming care environments for patients of all sexual orientations and gender identities.
- Safety: Ensuring the safety of patients in matters related to sexuality involves creating a supportive and nonjudgmental environment where patients feel comfortable discussing sensitive topics. Nurses must prioritize patient confidentiality, privacy, and emotional well-being while addressing sexual health concerns, thereby promoting a culture of safety and trust within healthcare settings.
- Informatics: Leveraging health informatics tools and technologies can facilitate the assessment, documentation, and communication of patient sexuality-related information. Nurses should utilize electronic health records and other informatics resources to capture patient preferences, concerns, and interventions accurately, thereby enhancing continuity of care and promoting patient safety and satisfaction.
By integrating patient sexuality into nursing practice and addressing it through the lens of the QSEN competencies, nurses can promote patient-centered care, improve patient outcomes, and contribute to a culture of inclusivity, respect, and safety within healthcare settings.
Understanding of Human Sexuality
First and foremost, to act as a role model when caring for the sexual health of their patients, nurses must demonstrate a thorough understanding of human sexuality. To provide high quality patient care, nurses must be knowledgeable about the topic at hand. In this context specifically, nurses must be knowledgeable about concepts related to gender identity, sexual preferences, and clinical symptoms that could be indicative of sexual health disorders. Although most nursing programs offer at least an introduction to these topics, it is important for nurses to participate in continuing education courses to stay abreast of changes in terminology or clinical guidelines to assist them in providing the highest quality care for patient sexual health concerns.
Self-Awareness
The ability to recognize, understand, and accurately perceive one’s own thoughts, feelings, beliefs, attitudes, and behaviors, known as self-awareness, is imperative for nurses, especially in the context of sexuality. By being self-aware, nurses can provide care that is empathetic and respectful. To do this, nurses should reflect on their own attitudes, beliefs, and biases regarding sexuality. Awareness of personal biases enables nurses to provide nonjudgmental care and avoid imposing their values on patients. Nurses may encounter situations that evoke strong emotions or discomfort when discussing sexual health topics. By acknowledging and managing their emotional reactions, nurses can maintain professionalism and provide supportive care to patients without allowing their personal feelings to interfere. Additionally, nurses must establish and maintain appropriate professional boundaries when discussing sensitive sexual health issues with patients. Self-awareness helps nurses recognize and address any boundary issues that may arise to ensure patient comfort and trust. And finally, nurses should engage in regular self-reflection that allows them to assess their performance, identify areas for improvement, and enhance their ability to provide patient-centered care (PCC). Reflective practices, such as journaling or peer supervision, can help nurses deepen their self-awareness and refine their approach to caring for patients' sexual health.
Communication Skills
Communication skills are crucial for nurses when caring for patients' sexual health as they facilitate open dialogue, build trust, and ensure that patients feel comfortable discussing sensitive topics. First, nurses should practice active listening, which involves giving the patient their full attention while they are speaking, maintaining eye contact, and providing nonverbal cues to show they are engaged and listening to what the patient is saying. When speaking to the patient, nurses should use clear, nonjudgmental language when discussing sensitive sexual health topics. They should avoid using medical jargon or slang terms that may be confusing to the patient. Using inclusive language promotes open communication and helps the patient feel comfortable asking questions about their sexual health. When communicating with patients, nurses should be sensitive to cultural differences related to sexual health. Culturally sensitive care fosters trust and respect, enhancing the nurse-patient relationship and promoting effective communication.
Link to Learning
Communication skills are important for all nurses to have, especially when caring for patients experiencing sensitive issues related to their sexual health. This video provides some therapeutic communication techniques that may be helpful to use when communicating with patients about sensitive topics.
Recognize Problems
Nurses can recognize problems when caring for patients' sexual health through various means, including observation, assessment, and collaboration. Nurses can observe patients for physical signs or symptoms that may indicate sexual health problems, such as unusual genital discharge, sores, rashes, or discomfort during urination or sexual activity. Additionally, changes in behavior or mood, such as increased anxiety or depression, may also signal underlying sexual health concerns. Nurses conduct thorough assessments of patients' sexual health by asking relevant questions about sexual activity, contraception use, sexual function, reproductive history, and any concerns or symptoms they may be experiencing. Assessment tools, such as standardized questionnaires or screening tests for STIs or sexual dysfunction, may also be used to gather comprehensive information. Additionally, nurses collaborate with other healthcare professionals to identify and address complex sexual health problems. Interdisciplinary teamwork allows for comprehensive assessment, diagnosis, and management of patients' sexual health concerns, ensuring that they receive holistic, high-quality care.
Unfolding Case Study
Unfolding Case Study #5: Part 2
Refer back to Unfolding Case Study #5: Part 1 for a review on the patient data.
| Nursing Notes | 1035: Patient expresses concern about erectile dysfunction. He reports frustration about being unable to participate fully in sexual intercourse with his wife. He reports his wife is also frustrated with the situation, especially given her new diagnosis of breast cancer. He states, “I don’t want to start taking Viagra in my 40s. That’s just embarrassing. Surely there is something else I can do. My wife thinks I don’t want to have sex with her because she has cancer, which isn’t even remotely true. My body is failing me.” |
Nurse as a Mandatory Reporter
Mandatory reporting laws require that individuals who have contact with at-risk populations report suspected mistreatment or abuse to proper authorities. At-risk populations are defined as children, individuals with disabilities, and older adults. Examples of mandatory reporters include
- childcare providers,
- clergy,
- coaches,
- counselors,
- teachers,
- law enforcement, and
- healthcare providers, including nurses.
These laws cover several kinds of abuse and mistreatment including physical, sexual, emotional, and financial. For this unit, we will focus on the different types of sexual abuse and mistreatment including sexual discrimination, sexual harassment, and sexual assault.
Sexual Discrimination
More commonly called “sex discrimination,” sexual discrimination refers to when an individual is treated less favorably because of their sex, which includes sexual orientation, gender identity/expression, pregnancy, and any other sex-related stereotypes. In many cases, sexual discrimination occurs in the workplace. Some examples of sexual discrimination include the following:
- refusing to hire or promote an individual because they identify as being Transgender
- creating a hostile work environment though unwelcome sexual advances, comments, or behaviors (e.g., inappropriate jokes, indecent gestures)
- denying access to reproductive healthcare services (such as contraception or abortion) based on their a person's sex or gender
- denying housing to an individual because they are gay
Sexual Harassment
A specific type of sexual discrimination, sexual harassment includes unwelcome sexual advances, requests for sexual favors, and other forms of physical or verbal harassment of a sexual nature in any environment, including online. Some examples of sexual harassment include the following:
- offering a promotion to an individual only if they have sex with the manager first
- jokes about an individual’s sexual preferences
- sending unwanted sexual photos, emails, or texts
- touching an individual when the contact is not wanted
Sexual Assault
A sexual assault involves sexual contact or behavior, often physical, that occurs without permission or consent from the victim. Although sexual harassment violates civil laws in many cases, sexual assault violates criminal laws. Like other types of assault, the threat of assault and/or using the threat of assault to force someone to perform or submit to an act can both be considered sexual assault. Examples of sexual assault include
- rape,
- forcing a victim to perform sexual acts, and
- fondling or unwanted sexual touching.
A serious global issue called sex trafficking involves the exploitation of individuals through force, fraud, or coercion for the purposes of sexual exploitation. Sex trafficking is deeply intertwined with sexual assault because it involves coercing or forcing individuals into sexual activities against their will or under conditions where consent is not gained. Victims of sex trafficking are often manipulated through threats, deception, or physical force to engage in commercial sex acts for the financial gain of traffickers.
Link to Learning
Healthcare providers must be acutely aware of the signs and necessary interventions of sex trafficking to identify and aid potential victims.