Sensory Needs: Sexuality and Love/Belonging Needs PDF

NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs Sensory Needs: Sexuality and Love/Belonging Needs Harding University - Active Learning Guide, Module 14 Name: Sean Whitfield I. Sensory Needs: Chapter 38: Sensory Perception 1. Sensory functioning is necessary for gro...

NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs Sensory Needs: Sexuality and Love/Belonging Needs Harding University - Active Learning Guide, Module 14 Name: Sean Whitfield I. Sensory Needs: Chapter 38: Sensory Perception 1. Sensory functioning is necessary for growth, development, and survival. Explain this statement.  Growth: Adaptation: Sensory systems help an organism adapt to its environment, which is crucial for optimal growth. For example, plants grow towards light by sensing its direction—a process known as phototropism. Resource Acquisition: In animals, senses such as smell and vision help locate food and water sources, essential for physical growth and health.  Development: Neurological Development: In humans and many other animals, sensory experiences during early life stages are crucial for the development of the brain. Stimulation through sights, sounds, touches, tastes, and smells helps establish and strengthen neural connections. This sensory input is essential for cognitive, emotional, and social development. Learning and Behavioral Adjustment: Sensory experiences teach organisms about their environment, guiding behavioral adaptations that are essential for survival. For instance, a young animal uses sensory cues to learn which behaviors are safe or dangerous.  Survival: Predator Awareness and Avoidance: Sensory functions such as hearing and vision are critical for detecting predators. For example, the ability to hear subtle sounds or see at a distance can allow prey animals to evade predators. Reproduction: Sensory cues often play a role in the mating behaviors of many species, including visual displays, auditory calls, and pheromonal signaling, all of which are crucial for finding and attracting mates. Navigation and Migration: Many species rely on sensory cues for navigation. Birds use visual landmarks and magnetic field sensing for migration, while salmon use olfactory cues to return to their birthplace to spawn. 2. Types of stimuli in addition to the usual of visual, auditory, olfactory, tactile, and gustatory, are:  Kinesthetic: refers to awareness of the position and movement of body parts. For example, an individual walking is aware of which leg is forward. NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs    Stereognosis: the ability to perceive and understand an object through touch by its size, shape, and texture. For example, an individual holding a tennis ball is aware of its size, round shape, and soft surface without seeing it. Visceral: refers to any large organ within the body. Visceral organs may produce stimuli that make an individual aware of them (e.g., a full stomach). Vibratory: 3. Describe the steps of the sensory process.  Reception: is the process of receiving stimuli or data. These stimuli are either external or internal to the body.  Perception: or awareness and interpretation of stimuli, takes place in the brain, where specialized brain cells interpret the nature and quality of the sensory stimuli. The client’s level of consciousness affects the perception of the stimuli.  Reaction: 4. Factors which affect sensory function:  Developmental Stage: Perception of sensation is critical to the intellectual, social, and physical development of infants and children. Infants learn to recognize the face of their mother or caregiver and establish bonding essential to later emotional development. Young children respond to music by singing and dancing as they begin to interact with their peers in groups. As children grow, they learn to interpret visual and auditory signals when preparing to cross the street. Adults have many learned responses to sensory stimuli. The sudden loss or impairment of any sense, therefore, has a profound effect on an individual of any age.  Age: Vision: Presbyopia: The lens of the eye becomes less flexible, making it harder to focus on close objects. Decreased pupil size: This leads to the pupil reacting more slowly to changes in ambient lighting and reducing the eye’s ability to adapt to different lighting conditions. Vitreous and retinal changes: These can lead to floaters and reduced peripheral vision. Cataracts: Clouding of the lens often occurs, decreasing visual acuity and affecting color perception Age-related macular degeneration (AMD): This affects central vision, impacting activities that require fine detail like reading or sewing. Glaucoma: Increased pressure in the eye can damage the optic nerve, affecting peripheral vision Hearing: NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs Presbycusis: Age-related hearing loss where there is a gradual loss of hearing, particularly in detecting high-frequency sounds Tinnitus: Ringing or buzzing in the ears may become more common. Reduced auditory nerve function: Slower processing of sound signals can make it difficult to understand speech, especially in noisy environments Taste and Smell: Reduced number of taste buds: Older adults may have less sensitivity to the five taste types — sweet, sour, bitter, salty, and umami. Decreased sense of smell: This can be due to a reduction in olfactory nerve function or to blockages or reductions in the nasal passages. It can lead to difficulties in detecting dangers such as smoke or spoiled food and can reduce the enjoyment of food. Touch: Decreased skin sensitivity: There is often a reduction in nerve endings and circulation to extremities, which can affect the sense of touch, pressure, and vibration, especially in the fingers and toes. Decreased thermoreception: Older adults might have a diminished ability to perceive changes in temperature, which can increase the risk of hypothermia or heat stroke    Proprioception (Spatial Orientation and Balance):Reduced muscle strength, joint flexibility, and balance: Changes in proprioception combined with muscular and skeletal degenerative changes can affect balance and coordination, increasing the risk of falls. Culture: An individual’s culture may determine the amount of sensory stimulation that he or she considers usual or normal. For example, a child reared in a big-city neighborhood where extended families share responsibilities for all the children may be accustomed to more stimulation than a child reared in a suburb of scattered single-family homes. In 2014 Christian, Muslim, and Yazidis Iraqis were displaced from Iraq to Kurdistan. Due to this displacement the normal amount of stimulation associated with ethnic origin, religious affiliation, and income level, for example, affected the amount of stimulation an individual desires and believes to be meaningful. Stress/Emotions: During times of increased stress, people may find their senses already overloaded and thus seek to decrease stimulation. For example, a client dealing with physical illness, pain, hospitalization, and diagnostic tests may wish to have only close support people visit. In addition, a client may need the nurse’s help to decrease unnecessary stimuli (e.g., noise) as much as possible. On the other hand, clients may seek sensory stimulation during times of low stress. Medications: Certain medications can alter an individual’s awareness of environmental stimuli. Narcotics, antiepileptic agents, and sedatives, for example, can decrease awareness of stimuli. Some antidepressants can also alter perceptions of stimuli. When administering NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs   these medications the nurse is responsible for protecting the client from injury that can result from impaired sensory perception. The nurse should educate clients and their families on the effect medications produce that alter sensory perception. Anyone taking several medications concurrently may show alterations in sensory function. Older adults are at greatest risk for such alterations because they may have conditions that also alter perception and spatial orientation. Some medications, if taken in large doses or over a long period of time, become ototoxic, injuring the auditory nerve and causing hearing loss that may be irreversible. Some of these medications are aspirin, furosemide (Lasix), the aminoglycosides, and certain drugs given for cancer chemotherapy. Illness: Certain diseases, such as atherosclerosis, restrict blood flow to the receptor organs and the brain, thereby decreasing awareness and slowing responses. Uncontrolled diabetes mellitus can impair vision and is a leading cause of blindness in the United States; diabetic neuropathy can cause changes in the tactile sense as well. Some central nervous system diseases cause varying degrees of paralysis and sensory loss. Diseases of the inner ear can affect the kinesthetic sense. Lifestyle and Personality: Lifestyle can influence the quality and quantity of stimulation to which a client is accustomed. A client who is employed in a large company may be accustomed to many diverse stimuli, whereas a client who is self-employed and works in the home is exposed to fewer, less diverse stimuli. Clients’ personalities also differ in terms of the quantity and quality of stimuli with which they are comfortable. Some clients delight in constantly changing stimuli and excitement, whereas others prefer a more structured life with few changes. 5. Box 38.1 States of Awareness: Describe the six levels.  Excessive yawning, drowsiness, sleeping  Decreased attention span, difficulty concentrating, decreased problem-solving ability  Impaired memory  Periodic disorientation, general or nocturnal confusion  Preoccupation with somatic complaints, such as palpitations  Hallucinations or delusions  Crying, annoyance over small matters, depression  Apathy, emotional lability 6. Sensory Deprivation is: is generally thought of as a decrease in or lack of meaningful stimuli. When an individual experiences sensory deprivation, the balance in the RAS is disturbed. The RAS is unable to maintain normal stimulation to the cerebral cortex. Because of this reduced stimulation, an individual becomes more acutely aware of the remaining stimuli and often perceives them in a distorted manner. The individual often experiences alterations in perception, cognition, and emotion.  What are the causes/risk factors?  What are the signs and symptoms?  List nursing interventions. Increased quantity or quality of internal stimuli, such as pain, dyspnea, or anxiety NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs Increased quantity or quality of external stimuli, such as a noisy healthcare setting, intrusive diagnostic studies, or contacts with many strangers Inability to disregard stimuli selectively, perhaps as a result of nervous system disturbances or medications that stimulate the arousal mechanism. 7. Sensory Overload is: generally occurs when an individual is unable to process or manage the amount or intensity of sensory stimuli.  What are the causes/risk factors?  What are the signs and symptoms?  List nursing interventions. Sensory overload can prevent the brain from ignoring or responding to specific stimuli. Because of the many stimuli, the individual has difficulty perceiving the environment in a way that makes sense. As a result the individual’s thoughts race in many directions, causing restlessness and anxiety. The individual usually feels overwhelmed and does not feel in control. It is important for nurses to remember that sights and sounds that are familiar to them often represent overload to clients. Clients who have sensory overload may appear fatigued. They often cannot internalize new information and they experience cognitive overload. Factors such as pain, lack of sleep, and worry can also contribute to sensory overload. Box 38.2  Complaints of fatigue, sleeplessness   Irritability, anxiety, restlessness  Periodic or general disorientation  Reduced problem-solving ability and task performance  Increased muscle tension  Scattered attention and racing thoughts 8. Sensory deficit means: is impaired reception, perception, or both, of one or more of the senses. Blindness and deafness are sensory deficits. When the loss of sensory function is gradual, individuals often develop behaviors to compensate for the loss; sometimes these behaviors are unconscious. For example, an individual with gradual hearing loss in the right ear may unconsciously turn the left ear toward a speaker. However, sudden loss of one of the senses can result in disorientation, and compensatory behavior often takes days or weeks to develop. 9. Why is it important to assess the client’s environment related to their sensory-perceptual functioning? Client Environment A nurse should assess the client’s envir4onment for quantity, quality, and type of stimuli. The environment may produce insufficient stimuli, placing the client at risk for sensory deprivation, or excessive stimuli, placing the client at risk for sensory overload. Nonstimulating environments include those that (a) severely restrict physical activity and (b) limit social contact with family and friends. Because appropriate or meaningful stimuli decrease the incidence of sensory deprivation, the nurse must consider the client’s healthcare environment for the presence of the following stimuli: NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs      Electronic devices (computers, iPADs, tablets, television, smart phones) Clock or calendar Reading material (or toys for children) Number and compatibility of roommates Number of visitors. 10. List suggested nursing interventions for:  Impaired vision: For clients with impaired vision, nurses need to do the following in a healthcare setting:  Orient the client to the arrangement of room furnishings and maintain an uncluttered environment.  Keep pathways clear and do not rearrange furniture without orienting the client. Ensure that housekeeping personnel are informed about this.  Organize self-care articles within the client’s reach and orient the client to his or her location.  Keep the call light within easy reach and place the bed in the low position.  Assist with ambulation by standing at the client’s side, walking about 1 foot ahead, and allowing the client to grasp your arm. Confirm whether the client prefers grasping your arm with the dominant or nondominant hand.  Impaired hearing: For home safety, clients with impaired hearing need to obtain devices that either amplify sounds or respond with flashing lights to sounds such as a doorbell, phone, smoke detector, crying baby, or burglar alarm. The sounds of doorbells and alarm clocks may be amplified or changed to a lower frequency or buzzer-like sound. These devices can be obtained from hearing aid dealers, telephone companies, and appliance stores.  Impaired taste: Changes in health can lead to impaired taste, which can lead to inadequate intake of required nutrition. Clients who have disease processes such as cancer or nasal impairments can experience a diminished sense of taste.  Impaired sense of smell: Clients with an impaired sense of touch may not be aware of hot temperatures, which can cause burns, or pressure on bony prominences, which can produce pressure injuries. Clients with decreased sensation to temperature should have the temperature adjusted on their hot water heater and test water temperature with a thermometer before bathing. Clients with decreased sensation to pressure must change their position frequently.  Impaired tactile sense: Clients with an impaired sense of touch may not be aware of hot temperatures, which can cause burns, or pressure on bony prominences, which can produce pressure injuries. Clients with decreased sensation to temperature should have the temperature adjusted on their hot water heater and test water temperature with a thermometer before bathing. Clients with decreased sensation to pressure must change their position frequently. 11. Box 38.5 Communicating with Clients Who Have a Visual or Hearing Impairment. Discuss appropriate strategies to enhance communication. NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs Visual Impairment  Always announce your presence when entering the client’s room and identify yourself by name.  Stay in the client’s field of vision if the client has a partial vision loss.  Speak in a warm and pleasant tone of voice. Some individuals tend to speak louder than necessary when talking to an individual who is blind.  Always explain what you are about to do before touching the client.  Explain the sounds in the environment.  Indicate when the conversation has ended and when you are leaving the room. Hearing Impairment  Before initiating conversation, convey your presence by moving to a position where you can be seen or by gently touching the client.  Decrease background noises (e.g., television) before speaking.  Talk at a moderate rate and in a normal tone of voice. Shouting does not make your voice more distinct and in some instances makes understanding more difficult.  Address the client directly. Do not turn away in the middle of a remark or story. Make sure the client can see your face easily and that it is well lighted.   Avoid talking when you have something in your mouth, such as chewing gum. Avoid covering your mouth with your hand.  Keep your voice at about the same volume throughout each sentence, without dropping the voice at the end of each sentence.  Always speak as clearly and accurately as possible. Articulate consonants with particular care.  Do not “overarticulate”; mouthing or overdoing articulation is just as troublesome as mumbling. Pantomime or write ideas, or use sign language or finger spelling as appropriate.  Use longer phrases, which tend to be easier to understand than short ones. For example, “Would you like a drink of water?” presents much less difficulty than “Would you like a drink?” Word choice is important: “Fifteen cents” and “fifty cents” may be confused, but “half a dollar” is clear.  Pronounce every name with care. Make a reference to the name for easier understanding, for example, “Joan, the girl from the office” or “Walmart, the big downtown store.”  Introduce a new subject to the client at a slower rate, making sure that the client follows the switch to the new subject. 12. List five interventions to prevent sensory overload and five interventions to prevent sensory deprivation. ◦ Cognitive Stimulation ◦ Communication Enhancement: Hearing Deficit ◦ Communication Enhancement: Speech Deficit ◦ Communication Enhancement: Visual Deficit NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs ◦ ◦ ◦ ◦ ◦ ◦ ◦ Nutrition Management Environmental Management: Safety Fall Prevention Body Mechanics Promotion Peripheral Sensation Management Emotional Support Surveillance: Remote Electron NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs II. Sexuality and Love/Belonging Needs: Chapter 40: Sexuality 1. Define sexual health: is an individual and constantly changing phenomenon falling within the wide range of human sexual thoughts, feelings, needs, and desires. For most individuals, sexual health is not a concern until its absence or impairment is noticed. An individual’s degree of sexual health is best determined by that individual, sometimes with the assistance of a qualified professional. 2. Discuss the components of sexual health:  Sexual self-concept: (how one values oneself as a sexual being) determines with whom one will have sex, the gender and kinds of individuals one is attracted to, and the values about when, where, with whom, and how one expresses sexuality. A positive sexual self-concept enables individuals to form intimate relationships throughout life. A negative sexual selfconcept may impede the formation of relationships.  Body image: a central part of the sense of self, is constantly changing. Pregnancy, aging, trauma, disease, and therapies can alter an individual’s appearance and function, which can affect body image. How an individual feels about their body is related to the individual’s sexuality. Individuals who feel good about their bodies are likely to be comfortable with and enjoy sexual activity. Individuals who have a poor body image may respond negatively to sexual arousal. A major influence on body image for women is the media focus on physical attractiveness and breast size.  Gender identity: is one’s self-image as a female or male. It has a physical component and it also includes social and cultural norms. Gender identity results from developmental events that may or may not conform to an individual’s apparent biological sex. Once gender identity is established, it cannot be easily changed.  Gender expression: is the outward manifestation of an individual’s sense of maleness or femaleness as well as what is perceived as gender-appropriate behavior. Each society defines its roles for males and females. 3. Sexual orientation is: lies along a continuum with a wide range between extremes of exclusive attraction. This is one reason why the number of terms used to describe sexuality is increasing. The term LGBTQQ is frequently used. It stands for lesbian, gay, bisexual, transgender, queer, and questioning. In general, same-sex attraction has been called homosexuality; women attracted only to women are referred to as lesbians; men attracted to men are referred to as gay (although gay is also a general term for homosexual); individuals attracted to individuals of both genders are referred to as bisexual 4. Gender Identity → is one’s self-image as a female or male. It has a physical component and it also includes social and cultural norms. Gender identity results from developmental events that may or may not conform to an individual’s apparent biological sex. Once gender identity is established, it cannot be easily changed. Intersex: condition in which there are contradictions among chromosomal sex, gonadal sex, internal organs, and external genital appearance (Rich, Phipps, Tiwari, Rudraraju, & Dokpesi, 2016). The gender of such an infant is ambiguous. This means that an intersexed individual has NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs some parts usually associated with males and some parts usually associated with females. Two of the most common syndromes leading to intersex are congenital adrenal hyperplasia and androgen-insensitivity syndrome. Intersex anatomy may not be apparent at birth. Sometimes it is undetected until puberty, until the individual is identified as an infertile adult, or until the individual dies and is autopsied. Transgenderism: For the transgender individual, sexual anatomy contradicts gender identity. Those who are born physically male but are emotionally and psychologically female are called male-to-female (MtF) transgender persons. Those who are born female but are emotionally and psychologically male are called female-to-male (FtM) transgender persons. Transgender and transsexual are commonly confused terms that both refer to gender identity. Transgender is a broader term that includes all individuals who do not identify with the gender that corresponds to the sex they were assigned at birth. Why is this population considered a vulnerable population? 1. Social Stigma and Discrimination: Transgender people often face significant stigma and discrimination in many aspects of life, including in their families, workplaces, educational institutions, and communities. This discrimination can lead to exclusion, social isolation, and can significantly impact their mental health and well-being. 2. Legal and Institutional Barriers: In many countries, transgender individuals may struggle with legal recognition of their gender identity. This lack of recognition can affect their ability to access various services, including healthcare, banking, and employment, and can expose them to further discrimination and harassment. In some places, laws actively criminalize transgender people’s expressions of their gender identity. 3. Health Disparities: Transgender individuals often face significant health disparities compared to the general population. These disparities are due in part to reluctance to seek medical care because of previous experiences of discrimination in healthcare settings, lack of healthcare providers who are knowledgeable about transgender health needs, and in some cases, outright denial of healthcare. Additionally, mental health issues such as depression, anxiety, and especially high rates of suicide among transgender populations are of significant concern. 4. Violence and Safety Concerns: Transgender individuals are at a higher risk of violence, including physical and sexual violence, hate crimes, and bullying than their cisgender counterparts. This vulnerability to violence can lead to lasting psychological trauma and physical injury. 5. Economic Vulnerability: Due to workplace discrimination and educational barriers, transgender individuals may face unemployment or underemployment, leading to economic insecurity and poverty. Economic vulnerability further limits their access to necessary services, including healthcare, and safe housing. 6. Intersectionality: Many transgender individuals also belong to other marginalized groups (such as racial minorities, immigrants, or people with disabilities), compounding their experiences of discrimination and marginalization. NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs 7. Mental Health: Experiences of rejection, discrimination, and violence contribute to a higher prevalence of mental health issues among transgender individuals. These can include anxiety, depression, and post-traumatic stress disorder (PTSD), which are further exacerbated by insufficient access to culturally competent mental health services. Cross-Dressers: (dressing in the clothing of the other sex) makes individuals’ outward appearance consistent with their inner identity and gender role and increases their comfort with themselves. Cross-dressing is a conscious choice and may occur at home or in public settings. The frequency of the activity ranges from rarely to often. Cross-dressers may have a different name to go with the personality and wardrobe. If the social climate is one with rigid gender roles, some individuals may need to express their feminine or masculine identity by creating a separate world and persona within that social climate. 5. What are the guidelines all nurses should follow with all clients in relation to their sexual orientation? Based on nursing codes and standards, nurses have an obligation to treat transgender individuals according to the same ethical and social mandates as any other client. In 2018, the American Nurses Association authored the position statement Nursing Advocacy for LGBTQ+ Populations. The nurse should follow the following guidelines in care of all clients:  Do not assume the client’s gender or sexual orientation.  Use gender-neutral language as much as possible. Do not use terms such as “sir” or “miss” without confirming the client’s preference. If you make a mistake, acknowledge it.  Reflect and seek clarification if the client expresses a concept you do not understand.  Collaborate with all members of the healthcare team to create a welcoming and inclusive environment.  Identify community and web-based transgender health resources. 6. Describe factors which influence an individual’s sexuality.  Family: For the majority of us, the family is the earliest and most enduring social relationship. Families are the fabric of our day-to-day lives and shape the quality of our lives by influencing our outlooks on life, our motivations, our strategies for achievement, and our styles for coping with adversity. Within our families we develop our gender identity, body image, sexual self-concept, and capacity for intimacy. Through family interactions we learn about relationships and gender roles and our expectations of others and ourselves (Figure 40.3). From earliest beginnings, children observe their parents and model themselves after these role models. If parents can share affection with each other and other family members, children will most likely become adults who can give and receive affection. If parents seldom hug, hold hands, or kiss each other, their children may become adults who are very uncomfortable with romantic touch. If family expectations for gender expression is very rigid, arguments and hurt feelings will abound if an individual from this system is partnered NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs            with an individual who grew up in an androgynous family system. Family messages about sex range from “sex is so shameful it shouldn’t be talked about” to “sex is a joyful part of adult relationships.” The following are common sexual messages children get from their families: Sex is dirty. Premarital sex is sinful. Good girls don’t do it. Masturbation is disgusting. Men should be the sexual experts. Sex is mainly for procreating. Bodies, including genitals, are beautiful. Sex should be fun for both women and men. Sexual thoughts and feelings are natural. Masturbation is a common, pleasurable activity. There is great variety in sexual behaviors.  Culture: Culture influences the sexual nature of dress, rules about marriage, expectations of role behavior and social responsibilities, and sex practices. Societal attitudes vary widely. Attitudes about childhood sexual play with self or children of the same gender or other gender may be restrictive or permissive. Premarital and extramarital sex and homosexuality may be culturally unacceptable or tolerated. Polygamy (several mates or marriage partners) or monogamy (one mate or marriage partner) may be the norm. Gender expression also varies from culture to culture. Culture is so much a part of everyday life that it is taken for granted. We assume that others share our own views, including those for whom we provide care. It is impossible to provide sensitive nursing care if we believe that our own culture is more important than, and preferable to, any other culture.  Religion: Religion influences sexual expression. It provides guidelines for sexual behavior and acceptable circumstances for the behavior, as well as prohibited sexual behavior and the consequences of breaking the sexual rules. The guidelines or rules may be detailed and rigid or broad and flexible. Some religions view forms of sexual expression other than male– female intercourse as unnatural and hold virginity before marriage to be the rule. Many religious values conflict with the more flexible values of society that have developed during the past few decades (often labeled the “sexual revolution”), such as the acceptance of premarital sex, unwed parenthood, homosexuality, and abortion. These conflicts create marked anxiety and potential sexual dysfunctions in some individuals. See Chapter 41 for additional information about religious values.  Personal Expectations and Ethics: Although ethics is integral to religion, ethical thought and ethical approaches to sexuality can be viewed separately from religion. Cultures have developed written or unwritten codes of conduct based on ethical principles. Personal expectations concerning sexual behavior come from these cultural norms. What one individual or culture views as bizarre, perverted, or wrong may be natural and right to NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs another. Examples include values regarding masturbation, oral or anal intercourse, and cross-dressing. Many individuals accept a variety of sexual expressions if they are performed by consenting adults, are practiced in private, and are not harmful. Individuals need to explore and communicate clearly about various types of acceptable sexual expression to prevent domination of sexual decision-making by any individual. To assess a few of your personal values, complete the statements in Box 40.3. Box 40.3 Assessing Personal Sexual Values I believe sexual satisfaction is... When I think of my parents having sex, I... If I cared for a transgender client, I would... When I think about lesbians, gays, and bisexuals, I... Masturbation is... My beliefs about oral sex are... 7. Factors contributing to altered sexual function:  Sociocultural factors: interfering in sexual function include a very strict upbringing accompanied by inadequate sex education. Rigid gender socialization may inhibit exploration of sexual activities, positions, toys, and other lovemaking behaviors. If individuals’ religious affiliations lead them to believe that sex is only for procreation, they may have great difficulty in celebrating the pleasure and fun of a sexual relationship. Another factor may be parental punishment for normally exploring one’s genitals or for typical childhood sex play. In our current culture, the pressures of family and work often leave mature couples with too little time and not enough energy to enjoy sex.  Psychologic factors: may include negative feelings such as guilt, anxiety, or fear that interfere with the ability to experience pleasure and joy. Some individuals experience guilt when they enjoy sex or when they participate in what they label “unusual” sexual activities, or regarding their choice of partner. Adults sexually abused at any time of their lives may experience overwhelming anxiety when faced with the decision to engage in sex. Fears may include pregnancy, STIs, or pain. Because vulnerability and intimacy are inherent in most sexual relationships, fear of these may lead to an avoidance of sex. Fear of failure in sexual performance often becomes a vicious cycle; that is, fear of failure creates actual failure, which produces more fear. Individuals may worry excessively: “Am I going to lose my erection?” “Am I going to have an orgasm this time?” “My stomach is too flabby.” “When did his thighs get that fat?” Depressed individuals lose interest in sexual activity and often experience a loss of sexual desire and fulfillment.  Cognitive factors: include the internalization of negative expectations and beliefs. Those with low self-esteem may not understand how another individual could value and love them and also find them sexually attractive. For those who have not yet accepted their sexual orientation or gender identity, this cognitive conflict may interfere with sexual relationships. NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs  Relationship problems/poor communication: Sexual problems may also be symptomatic of relationship problems. Conflict and anger with one’s partner are not conducive to positive sexual interaction. Some individuals lose the physical attraction to another or feel more attracted to someone else.  Health factors: can interfere with individuals’ expression of sexuality. Physical changes brought on by illness, injury, or surgery may inhibit full sexual expression. There may be sexual side effects from several conditions such as heart disease, diabetes mellitus, joint disease, cancer, and mental disorders. Surgeries such as hysterectomy, prostate surgery, and radical surgeries alter an individual’s body image. Spinal cord injuries, traumatic amputations, or disfiguring accidents negatively affect sexual functioning. The presence of an STI in one partner induces fear of transmission in the other, often resulting in abstinence from sexual contact. In some situations, an STI is unknown and transmission occurs.  Medications: have side effects that affect sexual functioning beyond medications intended for that purpose. Most frequently, the impact is negative, but sometimes there is a positive impact. Table 40.4 provides an overview of the effects of medications on sexual function. For example, antidepressants may slow ejaculation. This may be a problem for the man who suddenly finds himself unable to ejaculate. If the man experiences rapid ejaculation, however, the antidepressant may “cure” this problem. Some street drugs such as marijuana, amphetamines, and cocaine enhance sexual functioning. Others, such as opioids and anabolic steroids, interfere with sexual functioning. 8. Briefly describe the following sexual disorders.  Sexual arousal disorders: Sexual arousal refers to the physiologic responses and subjective sense of excitement experienced during sexual activity. Lack of lubrication and failure to attain or maintain an erection are the major disorders of the arousal phase. In female sexual arousal disorder, the lack of vaginal lubrication causes discomfort or pain during sexual intercourse. The diagnosis of male erectile disorder is usually made when the male has erection problems during 25% or more of his sexual interactions. Some males cannot attain a full erection, and others lose their erection prior to orgasm. The term commonly applied to this condition, impotency, implies that the male is feeble, inadequate, and incompetent. The accurate term is erectile dysfunction (ED), which is objectively descriptive and nonjudgmental. The advent of medications effective in treating ED (see the Drug Capsule) can lessen the physical problem but psychologic or relationship issues may remain.  Orgasmic disorders: The term commonly applied in the past to women who did not experience orgasm, frigid, implied that the woman was totally incapable of responding sexually. The more accurate and objective term is female orgasmic disorder, which simply means that the sexual response stops before orgasm occurs. There are variations in the disorder depending on whether the female never experiences orgasm or reaches orgasm only under certain conditions such as masturbation. Preorgasmic is the term used for females who have never experienced an orgasm. Compounding the orgasmic difficulty is the associated anxiety. In the preoccupation with orgasm, the real goal of being sexual—mutual NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs pleasuring and intimacy—is lost, and the interchange becomes one of anxiety, frustration, and anger.   In male orgasmic disorder, the male can maintain an erection for long periods (an hour or more) but has extreme difficulty ejaculating, referred to as delayed ejaculation. In heterosexual intercourse, the difficulty may be limited to ejaculation in the vagina. Some males ejaculate after self-stimulation or manual or oral stimulation by the partner, whereas others have great difficulty ejaculating with any type of stimulation. This disorder is much less common than rapid ejaculation. Dyspareunia: Both women and men can experience dyspareunia, pain during or immediately after intercourse. It is associated with many physiologic causes, especially those that inhibit lubrication. Skin irritations, vaginal infections, estrogen deficiencies, and use of medications that dry vaginal secretions can cause women to experience discomfort with intercourse. Female pelvic disorders, such as infections, lesions, endometriosis, scar tissue, or tumors, can cause painful intercourse. Similarly, in males, infection or inflammation of the glans penis or other genitourinary organs can cause pain with intercourse. Also, some contraceptive foams, creams, sponges, or latex products can irritate either the vagina or penis.  Vaginismus: is the involuntary spasm of the outer one-third of the vaginal muscles, making penetration of the vagina painful and sometimes impossible. The woman often experiences desire, excitement, and orgasm with stimulation of the external sexual structures. Attempts at intercourse, however, elicit the involuntary spasm. She may have similar difficulty undergoing pelvic exams and inserting tampons or a diaphragm.  Vulvodynia: is constant, unremitting burning that is localized to the vulva with an acute onset. The girl or woman has problems in sitting, standing, and sleeping related to the intensity of pain.  Vestibulitis: Vestibulitis causes severe pain only on touch or attempted vaginal entry. Half of the women with vestibulitis report lifelong dyspareunia. 9. Why is it important to introduce the topic of sexual health to all clients? Sexual health is an individual and constantly changing phenomenon falling within the wide range of human sexual thoughts, feelings, needs, and desires. For most individuals, sexual health is not a concern until its absence or impairment is noticed. An individual’s degree of sexual health is best determined by that individual, sometimes with the assistance of a qualified professional. Sexual health is a state of well-being in relation to sexuality across the lifespan that involves physical, emotional, mental, social, and spiritual dimensions. Sexual health is an inextricable element of human health and is based on a positive, equitable, and respectful approach to sexuality, relationships, and reproduction that is free of coercion, fear, discrimination, stigma, NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs shame, and violence. Sexual health includes: the ability to understand the benefits, risks, and responsibilities of sexual behavior; the prevention and care of disease and other adverse outcomes; and the possibility of fulfilling sexual relationships. 10. What are the six basic skills nurses must possess in order to help clients in the area of sexuality? Nurses require six basic skills to help clients in the area of sexuality: Self-knowledge and comfort with their own sexuality Acceptance of sexuality as an important area for nursing intervention and a willingness to work with clients who express their sexuality in a variety of ways Knowledge of sexual growth and development throughout the life cycle Knowledge of basic sexuality, including how certain health problems and treatments may affect sexuality and sexual function and which interventions facilitate sexual expression and functioning Therapeutic communication skills Ability to recognize the need for all clients and family members to have the topic of sexuality introduced not only in written or audiovisual materials but also in a verbal discussion. 11. What are essential areas of sexual health education? Providing Sexual Health Teaching Educating about sexual health is an important component of nursing implementation. Many sexual problems exist because of sexual ignorance; many others can be prevented with effective sexual health teaching. Examples of important areas of teaching are sex education (including self-examination) and responsible sexual behavior. Sex Education Nurses can assist clients to understand their anatomy and how their body functions. Understanding the anatomy of the genitals may help women learn how their body responds to sexual stimulation. Both men and women need to learn the kind of stimulation that is pleasing and causes arousal. The importance of open communication between partners should also be encouraged. Women may also benefit from learning Kegel exercises. These exercises involve contraction and relaxation of the pubococcygeal muscle, the muscle that contracts when an individual prevents urine flow. The benefits of Kegel exercises include increased pelvic floor muscle tone; increased vaginal lubrication during sexual arousal; increased sensation during intercourse; increased genital sensitivity; stronger gripping of the base of the penis; earlier postpartum recovery of the pelvic floor muscle; and increased flexibility of episiotomy scars. Kegel exercises may also benefit males with ejaculatory control (Greenberg, Bruess, & Oswalt, 2017). The steps to perform Kegel exercises are discussed in Chapter 47 because these exercises are also used in bladder retraining. Teaching Self-Examination Breast self-examination (BSE) for women and testicular self-examination (TSE) for men may play a role in early detection of disease, although neither technique has medical evidence to prove its value in clients at average risk for breast or testicular cancer. Clients need to be assured that NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs most lumps discovered are not cancerous, but it is essential that all lumps or other detected abnormalities be checked by the client’s primary care provider for accurate diagnosis. Those clients who do wish to perform BSE should receive instruction and have their technique reviewed regularly. Responsible Sexual Behavior Responsible sexual behavior involves the prevention of STIs, the prevention of unwanted pregnancy, and the avoidance of sexual harassment or abuse. STI Prevention The prevention of STIs is an essential part of sexual health teaching (Figure 40.5). Increases in these infections are due to two factors: (1) changing views of sexuality that have resulted in increased sexual activity and (2) an increase in the number of sexual partners. Because STIs elicit feelings of guilt, shame, and fear, clients frequently do not seek medical help as early as they should. Clients need education about these infections, preventive measures, and early treatment. Many STIs can be treated quickly and effectively. Others may have serious consequences. Females may develop pelvic inflammatory disease (PID) resulting in damage to the reproductive structures and possible infertility. The anxiety about HIV, which may be acquired through sexual transmission, has caused many individuals to improve their safe sexual behavior, such as using a condom during genital or anal sex. Prevention of Unwanted Pregnancies Prevention of unwanted pregnancies must be addressed not only with adolescents but also with couples planning the time of births to space children or limit family size. Nurses need to be familiar with various contraceptive methods and their advantages, disadvantages, contraindications, effectiveness, safety, and cost (Figure 40.6). The various methods are outlined in Box 40.4. It is beyond the scope of this text to discuss contraceptives in detail. Avoiding Sexual Harassment and Abuse Sexual harassment exists when someone in a position of power threatens another individual’s job or status in exchange for unwanted sexual acts. Such harassment can be severe enough to be considered abuse, but sexual abuse (also called molestation) is forced, unwanted sexual activity of any kind. Prevention is the most important role of the nurse and this can best be accomplished through educating adult clients and families of children about their rights and support services available if they believe sexual harassment or abuse is occurring. Assessing for, diagnosing, and intervening in possible situations of sexual harassment or abuse is a significant undertaking and not every nurse will be skilled in these roles. Sexual assault nurse examiners have specialized training in the role of assessing and treating victims of sexual assault (Valentine, 2018). However, every nurse must know of the legal requirements and proper methods of reporting suspected abuse. Counseling for Altered Sexual Function NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs One technique nurses can use to help clients with altered sexual function is the PLISSIT model, developed by Annon (1976) for this purpose. The model involves four progressive levels represented by the acronym PLISSIT: P → Permission giving LI → Limited Information SS → Specific suggestions IT → Intensive Therapy Permission Giving Clients may feel that they need permission to be sexual beings, to ask questions, to show affection, and to express themselves sexually. Giving permission means that the nurse by attitude or word lets the client know that sexual thoughts, fantasies, and behaviors between informed consenting adults are allowed. Giving permission begins when the nurse acknowledges the client’s spoken and unspoken sexual concerns and conveys the attitude that sexual concerns and needs are important to health and recovery. Limited Information Clients need accurate but concise information. The nurse might explain what is common; how some medical conditions, treatments, injuries, or surgeries may affect sexuality and sexual functioning; or how aging may affect sexuality and functioning. Specific Suggestions At this level, the nurse requires specialized knowledge and skill about how sexuality and functioning may be affected by a disease process or therapy and what interventions might be effective. The nurse offers suggestions to help the client adapt sexual activity to promote optimal functioning, such as what measures might alleviate vaginal dryness, safe positions for intercourse following a total hip replacement, safe and unsafe sexual practices following a heart attack, and ways to handle ostomy appliances, urinary catheters, casts, or other devices (e.g., prostheses) during sexual activity. Similarly, nurses who work on a cardiac unit need specialized knowledge about sexual readjustment during cardiac rehabilitation, and nurses working with clients with spinal cord injuries need information about the sexual consequences of spinal injuries at various levels. Intensive Therapy At this level of intervention, nurses must have specialized preparation and knowledge of sexual and gender identity disorders. Nurses who function in the sex therapist role should meet the qualifications for practice identified by the American Association of Sexuality Educators, Counselors, and Therapists (AASECT), which differentiates sex counseling from sex therapy. Sex counseling helps clients incorporate their sexual knowledge into satisfying lifestyles and socially responsible behavior. Sex therapy is a highly specialized, in-depth treatment to help clients resolve serious sexual problems. The AASECT website includes a national directory of professionals certified to provide sex education, counseling, or therapy. NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs 12. What are possible reasons for clients to display inappropriate sexual behavior? Dealing with Inappropriate Sexual Behavior Any nurse may encounter a variety of sexually inappropriate behaviors for several reasons. The behavior may be aggressive or nonaggressive. Clients may act out sexually by: Exposing themselves. Asking the nurse to provide intimate physical care, such as bathing genital areas, when they can do this themselves. Touching or grabbing the nurse’s genitals or buttocks. Making blatant sexual statements to the nurse. Offering the nurse sex. Whistling; making comments about the nurse’s attractiveness or desirability. Making sexual comments to another client in the same room or to visitors about the “hot” nurse or what they would like to do sexually with the nurse. Possible reasons for this inappropriate behavior are: Fear or anxiety over future ability to function sexually. Unmet needs for intimacy and sexual closeness because of hospitalization, injury, illness, treatment, lack of a partner, or lack of privacy. Misinterpretation of the nurse’s behavior as sexual or provocative. Need for reassurance that they are still sexual beings and still sexually attractive. Need for attention. Confusion: Neurologic impairment or trauma can lead clients to use profane sexual language, engage in masturbation, expose themselves, or inappropriately touch or grab at the nurse. Need to control: Clients may experience loss of control over their lives because of hospitalization, injury, or illness. Need for power. Belief that flirtatious behavior is expected due to media portrayal of nurses as sexy, available, and experienced. 13. How should the nurse respond to situations of inappropriate sexual behavior? Before implementing any nursing interventions, the nurse should first ensure that the behavior is inappropriate and not an attempt to communicate a physical need. Clients may expose themselves if they are febrile, pull at the penis if a catheter is uncomfortable or irritating, or reach for the nurse if unable to communicate verbally. Nursing strategies to deal with inappropriate sexual behavior are listed in Box 40.5. Box 40.5 Nursing Strategies for Inappropriate Sexual Behavior Communicate that the behavior is not acceptable by saying, for example, “I really do not like the things you are saying,” or “I see you are not dressed. I will be back in 10 minutes and will help you with breakfast when you get your clothes on.” NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs Tell the client how the behavior makes you feel: “When you act like that toward me, I am very uncomfortable. It embarrasses me and makes it hard for me to give you the nursing care you need.” Identify the behavior you expect: “Please call me by my name, not ‘honey’” or “I expect you to keep yourself covered when I am in the room. If you are feeling hot or something is uncomfortable, let me know, and I will try to make you more comfortable.” Set firm limits: Take the client’s hand and move it away, use direct eye contact, and say, “Don’t do that!” Try to refocus clients from the inappropriate behavior to their real concerns and fears; offer to discuss sexuality concerns: “All morning you have been making very personal sexual comments about yourself. Sometimes clients talk like that when they are concerned about the sexual part of their life and how their illness will affect them. Are there things that you have questions about or would like to talk about?” Report the incident to the nurse in charge and, if appropriate, the primary care provider. Discuss the incident, your feelings, and possible interventions. Clarify the consequences of continued inappropriate behavior (avoidance, withdrawal of services, no chance to help resolve underlying concerns of client). 14. What concerns related to sexuality might each of the following clients experience?  56-year-old man post myocardial infarction: ◦ Fear of Heart Strain: One of the primary concerns might be the fear that sexual activity could place too much strain on the heart. Patients often worry that the physical exertion associated with sexual activity could lead to another heart attack. ◦ Erectile Dysfunction (ED): Cardiovascular disease can lead to erectile dysfunction due to impaired blood flow. Medications commonly prescribed after a myocardial infarction, such as beta-blockers, can also contribute to or exacerbate ED. This can cause significant stress, affecting the patient's sexual confidence and relationship dynamics. ◦ Reduced Libido: The emotional and physical stress of experiencing a heart attack, along with the effects of heart medications, can reduce libido. This reduction in sexual desire can be distressing for both the patient and their partner. ◦ Emotional and Psychological Concerns: The experience of a heart attack can lead to depression or anxiety, which in turn can negatively impact sexual desire and performance. The fear of death or another heart attack, feelings of vulnerability, or changes in body image can all contribute to sexual difficulties. ◦ Communication with Partner: After a heart attack, communication about sexual needs and fears between partners may become strained. There may be mutual anxiety about resuming sexual activity, with partners often feeling protective or unsure about how to approach the subject. NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs ◦ Medical Advice and Guidance: Patients may need clear guidance from healthcare providers regarding when it is safe to resume sexual activity. The lack of specific advice can lead to uncertainty and avoidance of sexual activity.  16-year-old girl receiving chemotherapy: Body Image Concerns: Chemotherapy often causes physical changes such as hair loss, weight gain or loss, and skin changes, which can significantly impact a young person's body image and self-esteem. These changes can make her feel less attractive or self-conscious, thereby affecting her sexual identity and confidence. Menstrual Changes: Chemotherapy can lead to temporary or permanent changes in menstrual cycles, including irregular periods or amenorrhea (absence of menstruation). This can lead to concerns about fertility and normal development, which are closely tied to a young woman’s sexual health and perception of femininity. Fertility Concerns: Some chemotherapy treatments can affect fertility, which might be a significant concern for a young woman thinking about her future reproductive choices. Concerns about potential infertility can impact her long-term considerations about relationships, sexuality, and family planning. Emotional and Psychological Impact: Dealing with a serious illness like cancer can lead to emotional distress, which might include anxiety and depression. These feelings can diminish sexual desire and energy, compounding stress related to evolving sexual identity during teenage years. Vulnerability and Dependency: Undergoing treatment at a young age can increase feelings of vulnerability and dependency on parents and caregivers, potentially delaying the development of independence. This can impact social and sexual relationships with peers, where establishing autonomy is crucial. Fear of Rejection: The physical and emotional changes, along with the stigma possibly associated with being a cancer patient, might lead to fears of rejection by peers and potential romantic partners. This fear can lead to social withdrawal or avoidance of forming close relationships. Exposure to Healthcare Environment: Frequent interactions with the healthcare system and its focus on her physical health might make her more conscious or uncomfortable about her body. Privacy concerns and physical examinations might lead to heightened body awareness or discomfort. Education and Peer Interaction: Missed school and social interactions due to treatment schedules can impact her social skills, knowledge about normal sexual development, and opportunities to form romantic relationships typical of her age group.  38-year-old woman after a mastectomy: NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs Body Image Concerns: The loss of one or both breasts can profoundly affect a woman's body image and sense of femininity. This change can lead to feelings of unattractiveness and alter how she perceives herself sexually. Self-Esteem and Identity: Breasts are often tied to cultural and personal ideals of beauty and femininity. A mastectomy can challenge these ideals, potentially leading to a crisis in selfesteem and sexual identity. Physical Discomfort and Sensation Loss: Post-surgery, women often experience physical discomfort and changes in sensation, which can include numbness or hypersensitivity in the chest area. This can affect comfort during sexual activity and diminish sexual pleasure. Emotional Distress: The emotional impact of cancer and its treatment can be significant, possibly leading to depression or anxiety. These emotional states can lower sexual desire and interest, further complicating her intimate relationships. Fear of Intimacy: Concerns about how a partner perceives her post-surgery body might lead to anxiety around intimacy. She might fear rejection or worry that her partner will no longer find her attractive, which can make her hesitant to engage in sexual activity. Partner's Response: The partner's reaction to the surgery and the changes it brings can significantly impact the woman’s emotional and sexual recovery. Supportive reactions can promote intimacy, whereas discomfort or withdrawal by the partner can exacerbate her insecurities. Concerns About Fertility and Menopause: Depending on the nature of her treatment, there might be concerns about fertility if chemotherapy was involved, which can cause premature menopause. Issues related to decreased fertility and hormonal changes can affect sexual function, desire, and overall reproductive health. Communication Challenges: Discussing these changes and feelings with a partner can be challenging. Many women find it hard to express their fears and needs, which can lead to misunderstandings and feelings of isolation within the relationship.  25-year-old paraplegic man: Changes in Physical Functioning: Depending on the level of his injury, he may experience varying degrees of loss of motor function and sensation below the level of the injury. This can directly impact sexual function, such as erectile function, sensation, and ability to achieve orgasm. Erectile Dysfunction: While many men with SCI can still achieve erections, they might be less consistent or require medical assistance such as medication, vacuum erection devices, or penile implants. Fertility Concerns: Issues with ejaculation are common in men with spinal cord injuries. This can affect fertility, requiring interventions like sperm retrieval techniques and assisted reproductive technologies if parenthood is desired. NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs Self-Image and Self-Esteem: Adjusting to life as a paraplegic can significantly impact selfesteem and body image. Concerns about being seen as less attractive or sexually capable can lead to reduced sexual confidence. Fear of Rejection: Anxiety about how potential partners might react to his disability can lead to fear of initiating romantic or sexual relationships. He may worry about rejection or about being perceived primarily through the lens of his disability. Adapting to New Pleasures: Learning and adapting to new ways of experiencing pleasure can be a challenge. He may need to explore and discover erogenous zones that have retained sensation, or learn to derive pleasure from giving pleasure to partners. Dependence and Autonomy: Issues of dependence on others for daily needs can complicate intimate relationships. Negotiating independence in intimacy and needing care can pose unique challenges in maintaining privacy and dignity. Communication with Partners: There may be difficulties in discussing sexuality and sexual needs with partners, particularly if he is newly injured and still adapting to his changed body and capabilities. Open communication is crucial but can be challenging to initiate and maintain. Access to Sexual Health Resources: Finding knowledgeable healthcare providers who can offer advice on sexual health, adaptive sexual techniques, and fertility options might be difficult but is crucial for maintaining sexual health and fulfillment. Psychological Adjustment: Psychological adjustments to a new self-identity as a person with a disability might include dealing with depression, anxiety, and grief over lost abilities, which can all impact sexual desire and relationships.  85-year-old woman in nursing home: Limited Privacy: Nursing homes typically offer limited privacy, which can make it difficult for residents to engage in intimate or sexual activities. This lack of privacy can inhibit her ability to express sexuality or maintain intimate relationships. Health-Related Physical Limitations: Age-related physical changes and health issues such as arthritis, chronic pain, or mobility limitations can affect her sexual activity. Conditions like diabetes or cardiovascular diseases can also impact sexual function. Cognitive Decline: If she is experiencing cognitive decline, such as dementia, this can affect her ability to consent to sexual activities. It also complicates how she communicates her desires and boundaries. Widowhood or Partner Separation: If she has lost a partner or is separated due to differing care needs, she may experience loneliness and a lack of physical intimacy, which can affect her emotional and psychological health. Attitudes of Staff and Family: There might be prejudices or uncomfortable feelings among staff or family members regarding sexual activity in older adults, particularly those in care NURS 3000 - Professional Nursing Sensory Needs: Sexuality and Love/Belonging Needs settings. This can lead to discouragement of sexual expression or lack of support in pursuing intimate relationships. Medication Side Effects: Many medications commonly prescribed to older adults can have side effects that affect sexual function, such as reduced libido or difficulties with arousal and orgasm. Fear of Sexually Transmitted Infections (STIs): While it might be a less common concern, the risk of STIs still exists, and there may be a lack of awareness or resources available to her regarding protection and testing. Perception of Asexuality: Society often views older adults as asexual beings, which can lead to feelings of invalidation or shame regarding sexual needs, impacting her self-esteem and desire for intimacy. Lack of Tailored Sexual Health Resources: There is often a scarcity of sexual health resources that are tailored to the needs of older adults, which can hinder her from receiving adequate guidance or support in maintaining a healthy sexual life. NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs Loss and Grief: Spiritual Needs Harding University - Active Learning Guide, Module 13 Name: Sean Whitfield Instructions Complete the module active learning guide as you work through the module content. Take notes, answer the questions on the guide, and respond to any case studies and client scenarios. All of these activities will assist in your preparation for exams, help you plan and implement care in the clinical setting, and facilitate your development as a Christian nurse servant. You will submit your completed guide to the instructor at the end of the week. The completed learning guide will be worth a maximum of 10 points. If you have questions or are unsure about your answers; or you may email your instructor for clarification. Note: The Active Learning Guide provides a general outline of topics covered in this module; it is not all inclusive of all information needed for the exam. You are responsible for all content in readings and activities throughout the module. I. Loss and Grief: Chapter 43: Loss, Grieving, and Death 1. Define loss: is an actual or potential situation in which something that is valued is changed or no longer available. 2. Describe the sources of loss:  External Objects: Loss of external objects includes (a) loss of inanimate objects that have importance to the individual, such as losing money or the burning down of a family’s house; and (b) loss of animate (live) objects such as pets that provide love and companionship.  Familiar Environment: Separation from an environment and individuals who provide security can cause a sense of loss. The 6-year-old is likely to feel loss when first leaving the home environment to attend school. The university student who moves away from home for the first time also experiences a sense of loss.  Loved Ones: Losing a loved one or valued individual through illness, divorce, separation, or death can be very disturbing. In some illnesses (such as Alzheimer’s disease), an individual may undergo personality changes that make friends and family feel they have lost that individual.  Aspect of Self: Losing an aspect of self changes an individual’s body image, even though the loss may not be obvious. A face scarred from a burn is generally obvious; loss of part of the stomach or loss of the ability to feel emotion may not be as obvious. The degree to which these losses affect an individual largely depends on the integrity of the individual’s body image.  Life: Everyone experiences loss, grieving, and death during his or her life. Individuals may suffer the loss of valued relationships through life changes, such as moving from one city to another; separation or divorce; or the death of a parent, spouse, or friend. Individuals may grieve changing life roles as they watch grown children leave home or they retire from their lifelong work. Losing valued material objects through theft or natural disaster can evoke NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs feelings of grief and loss. When individuals’ lives are affected by civil or national violence, they may grieve the loss of valued ideals such as safety, freedom, or democracy. 3. Describe types of loss:  Actual: can be recognized by others.  Perceived: is experienced by an individual but cannot be verified by others.  Anticipatory: is experienced before the loss actually occurs.  Situational: Loss, especially loss of a loved one or a valued body part, can be viewed as either a situational or a developmental loss and as either an actual or a perceived loss (both of which can be anticipatory). Losing one’s job, the death of a child, and losing functional ability because of acute illness or injury are situational losses.  Developmental: Losses that occur in normal development—such as the departure of grown children from the home, retirement from a career, and the death of aged parents—are developmental losses that can, to some extent, be anticipated and prepared for. 4. Describe how grief, mourning, and bereavement differ. ◦ Grief is the total response to the emotional experience related to loss. Grief is manifested in thoughts, feelings, and behaviors associated with overwhelming distress or sorrow Definition: Grief is the internal feeling one experiences in response to loss. It is the personal and emotional reaction that includes a range of feelings from deep sadness to anger, and can also involve thoughts, physical symptoms like changes in sleep or appetite, and behaviors. Grief can vary greatly from person to person and can be influenced by the nature of the loss, the relationship to the deceased, personal beliefs, and cultural factors. ◦ Mourning is the behavioral process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and custom. Definition: Mourning is the external expression or the act of showing grief. It encompasses the cultural and social rituals and practices that people engage in to express their grief and commemorate the deceased. This could include wearing specific clothes (such as black attire), holding funeral ceremonies, or participating in certain religious or spiritual practices. Mourning is heavily influenced by cultural norms and societal expectations and serves as a way for individuals to process their grief and receive community support. ◦ Bereavement is the subjective response experienced by the surviving loved ones. Definition: Bereavement refers to the state of having lost a significant person in one's life through death. It is the objective situation of having experienced a loss. Bereavement is the period following a death during which grief and mourning occur. The duration and intensity of bereavement can vary greatly among different individuals and cultures. 5. Describe the different types of grief.  Abbreviated: nificantly important to the grieving individual or may have been replaced immediately by another, equally esteemed object.  Anticipatory: is experienced in advance of the event such as the wife who grieves before her ailing husband dies. NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs      Disenfranchised: occurs when an individual is unable to acknowledge the loss to others. Situations in which this may occur often relate to a socially unacceptable loss that cannot be spoken about, such as suicide, abortion, or giving a child up for adoption. Other examples include losses of relationships that are socially unsanctioned and may not be known to others (such as with extramarital relationships). Unresolved/chronic: Inhibited: many of the normal symptoms of grief are suppressed and other effects, including physiologic, are experienced instead. Delayed: occurs when feelings are purposely or subconsciously suppressed until a much later time. Exaggerated: A survivor who appears to be using dangerous activities as a method to lessen the pain of grieving may experience exaggerated grief. 6. Table 43.1 Client Responses and Nursing Implications in Kübler-Ross’s Stages of Grieving  List and describe the five stages of grieving as described here. o Denial: Refuses to believe that loss is happening. Is unready to deal with practical problems, such as prosthesis after the loss of a leg. May assume artificial cheerfulness to prolong denial. o Anger: Client or family may direct anger at nurse or staff about matters that normally would not bother them. o Bargaining: Seeks to bargain to avoid loss (e.g., “let me just live until [a certain time] and then I will be ready to die”). o Depression: Grieves over what has happened and what cannot be. May talk freely (e.g., reviewing past losses such as money or job), or may withdraw. o Acceptance: Comes to terms with loss. May have decreased interest in surroundings and support people. May wish to begin making plans (e.g., will, prosthesis, altered living arrangements). 7. Factors Influencing the Loss and Grief Responses.  Age: Age affects an individual’s understanding of and reaction to loss. With familiarity, individuals usually increase their understanding and acceptance of life, loss, and death.  Significance: The significance of a loss depends on the perceptions of the individual experiencing the loss. One individual may experience a great sense of loss over a divorce; another may find it only mildly disrupting. Several factors affect the significance of the loss: Importance of the lost individual, object, or function Degree of change required because of the loss The individual’s beliefs and values.  Culture: Culture influences an individual’s reaction to loss. How grief is expressed is often determined by the customs of the culture. Unless an extended family structure exists, grief is handled by the nuclear family. The death of a family member in a typical nuclear family leaves a great void because the same few individuals fill most of the roles. In cultures where several generations and extended family members either reside in the same household or are physically close, the impact of a family member’s death may be softened because the roles of the deceased are quickly filled by other relatives. NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs       Spiritual Beliefs: Spiritual beliefs and practices greatly influence both an individual’s reaction to loss and subsequent behavior. Most religious groups have practices related to dying, and these are often important to the client and support people. To provide support at a time of death, nurses need to understand the client’s particular beliefs and practices (see Chapter 41). Gender: The gender roles into which many individuals are socialized in the United States affect their reactions at times of loss. Males are frequently expected to “be strong” and show very little emotion during grief, whereas it is acceptable for females to show grief by crying. When a wife dies, the husband, who is the chief mourner, may be expected to repress his own emotions and to comfort sons and daughters in their grieving. Socioeconomic Status: The socioeconomic status of an individual often affects the support system available at the time of a loss. A pension plan or insurance, for example, can offer an individual who is widowed or disabled a choice of ways to deal with a loss; an individual who is confronted with both severe loss and economic hardship may not be able to cope with either. Support System: The individuals closest to the grieving individual are often the first to recognize and provide needed emotional, physical, and functional assistance. However, because many individuals are uncomfortable or inexperienced in dealing with losses, the usual support people may instead withdraw from the grieving individual. In addition, support may be available when the loss is first recognized, but as the support people return to their usual activities, the need for ongoing support may be unmet. Sometimes, the grieving individual is unable or unready to accept support when offered. Cause of Loss: Individual and societal views on the cause of a loss or death may significantly influence the grief response. Some diseases are considered “clean,” such as cardiovascular disorders, and engender compassion, whereas others may be viewed as repulsive and less unfortunate. A loss or death beyond the control of those involved may be more acceptable than one that is preventable, such as a drunk driving incident. Injuries or deaths that occur during respected activities, such as “in the line of duty,” are considered honorable, whereas those occurring during illicit activities may be considered the individual’s just rewards. Previous Losses: Determining how much and what type of home care follow-up is needed is based in great part on the nurse’s knowledge of how the client and family have coped with previous losses. 8. What are some of the responses the client may have when experiencing a loss? Refuses to accept loss, Anger may be directed at agency, nurses, or others, Conducts rituals of mourning, May accept more dependent relationship with support person, Represses all negative and hostile feelings toward lost object, importance of lost object as source of support. 9. Describe some of the religious and cultural practices r/t death. Why is it important for the nurse to be aware of the client’s beliefs? Culture influences an individual’s reaction to loss. How grief is expressed is often determined by the customs of the culture. Unless an extended family structure exists, grief is handled by the nuclear family. The death of a family member in a typical nuclear family leaves a great void because the same few individuals fill most of the roles. In cultures where several generations NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs and extended family members either reside in the same household or are physically close, the impact of a family member’s death may be softened because the roles of the deceased are quickly filled by other relatives. Some individuals believe that grief is a private matter to be endured internally. Therefore, feelings tend to be repressed and may remain unidentified. Individuals socialized to “be strong” and “make the best of the situation” may not express deep feelings or personal concerns when they experience a serious loss. Some cultural groups value social support and the expression of loss. In some groups, expressions of grief through wailing, crying, physical prostration, and other outward demonstrations are acceptable and encouraged. Other groups may frown on this demonstration as a loss of control, favoring a more quiet and stoic expression of grief. In cultural groups where strong kinship ties are maintained, physical and emotional support and assistance are provided by family members. 10. Box 43.1 Signs of Impending Clinical Death Describe these signs and note why the nurse needs to assess for these. Loss of Muscle Tone ◦ Relaxation of the facial muscles (e.g., the jaw may sag) ◦ Difficulty speaking ◦ Difficulty swallowing and gradual loss of the gag reflex ◦ Decreased activity of the gastrointestinal tract, with subsequent nausea, accumulation of flatus, abdominal distention, and retention of feces, especially if narcotics or tranquilizers are being administered ◦ Possible urinary and rectal incontinence due to decreased sphincter control ◦ Diminished body movement Slowing of the Circulation ◦ Diminished sensation ◦ Mottling and cyanosis of the extremities ◦ Cold skin, first in the feet and later in the hands, ears, and nose (the client, however, may feel warm if there is a fever) ◦ Slower and weaker pulse ◦ Decreased blood pressure Changes in Respirations NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs ◦ Rapid, shallow, irregular, or abnormally slow respirations ◦ Noisy breathing, referred to as the death rattle, due to collecting of mucus in the throat ◦ Mouth breathing, dry oral mucous membranes Sensory Impairment ◦ Blurred vision ◦ Impaired senses of taste and smell Assessing To gather a complete database that allows accurate analysis and identification of appropriate nursing diagnoses for dying clients and their families, the nurse first needs to recognize the states of awareness manifested by the client and family members. In cases of terminal illness, the state of awareness shared by the dying client and the family affects the nurse’s ability to communicate freely with clients and other healthcare team members and to assist in the grieving process. Three types of awareness that have been described are closed awareness, mutual pretense, and open awareness (Glaser & Strauss, 1965). 11. What are the major goals of nursing care for the dying client? Major goals for dying clients are (a) maintaining physiologic and psychologic comfort and (b) achieving a dignified and peaceful death, which includes maintaining personal control and accepting declining health status. Many clinical agencies and organizations have created documents that describe the dying client’s rights. When planning care for dying clients, these guides can be useful guides. 12. How can the nurse assist the client in dying with dignity? Helping Clients Die with Dignity Nurses need to ensure that the client is treated with dignity, that is, with honor and respect. Dying clients often feel they have lost control over their lives and over life itself. Helping clients die with dignity involves maintaining their humanity, consistent with their values, beliefs, and culture. By introducing options available to the client and significant others, nurses can restore and support feelings of control. Some choices that clients can make are the location of care (e.g., hospital, home, or hospice facility), times of appointments with health professionals, activity schedule, use of health resources, and times of visits from relatives and friends. Clients want to manage the events preceding death so they can die peacefully. Nurses can help clients to determine their own physical, psychologic, and social priorities. Dying individuals often strive for self-fulfillment more than for self-preservation, and may need to find meaning in continuing to live if suffering. Part of the nurse’s challenge is to support the client’s will and hope. 13. What is hospice care? NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs Hospice care focuses on support and care of the dying client with a life expectancy of 6 months or less and the family, with the goal of facilitating a peaceful and dignified death. Hospice care is based on holistic concepts and emphasizes team-based care to improve quality of life rather than cure, support the client and family through the dying process, and support the family through bereavement. Assessing the needs of the client’s family is just as important as caring for the client who is receiving hospice care (Figure 43.3). 14. Describe palliative care. an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care: provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten nor postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patient’s illness and in their own bereavement; uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated; will enhance quality of life, and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. (para. 1) Palliative care “attends to the physical, functional, psychologic, practical, and spiritual consequences of a serious illness. It is a person- and family-centered approach to care, providing seriously ill people relief from the symptoms and stress of an illness. Through early integration into the care plan of seriously ill people, palliative care improves quality of life for both the patient and the family” (National Consensus Project for Quality Palliative Care, 2018, p. i). This care may differ from hospice because the client is not necessarily believed to be imminently dying. Both hospice and palliative care can include end-of-life care, that is, the care provided in the final weeks before death. 15. Table 43.5 Physiologic Needs of Dying Clients. Discuss these. Airway clearance: Fowler position: conscious clients Throat suctioning: conscious clients Lateral position: unconscious clients Nasal oxygen for hypoxic clients Anticholinergic medications may be indicated to help dry secretions Air hunger NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs Open windows or use a fan to circulate air Morphine may be indicated in an acute episode Bathing and hygiene Frequent baths and linen changes if diaphoretic Mouth care as needed for dry mouth Liberal use of moisturizing creams and lotions for dry skin Moisture-barrier skin preparations for incontinent clients Physical mobility Assist client out of bed periodically, if able Regularly change client’s position Support client’s position with pillows, blanket rolls, or towels as needed Elevate client’s legs when sitting up Implement pressure injury prevention program and use pressure-relieving surfaces as indicated Nutrition Antiemetics or a small amount of an alcoholic beverage to stimulate appetite Encourage liquid foods as tolerated Constipation Dietary fiber as tolerated Stool softeners or laxatives as needed Urinary elimination Skin care in response to incontinence of urine or feces Bedpan, urinal, or commode chair within easy reach Call light within reach for assistance onto bedpan or commode Absorbent pads placed under incontinent client; linen changed as often as needed Catheterization, if necessary Keep room as clean and odor free as possible Sensory and perceptual changes Check preference for light or dark room Hearing is not diminished; speak clearly and do not whisper Touch is diminished, but client will feel pressure of touch Implement pain management protocol if indicated 16. Discuss ways the nurse can provide spiritual support to the dying client. What do you believe the client might see in the care provided by a Christian nurse that the client might not see in the nurse who does not profess to be a Christian? The nurse has a responsibility to ensure that the client’s spiritual needs are attended to, either through direct intervention or by arranging access to individuals who can provide spiritual care. Nurses need to be aware of their own comfort with spiritual issues and be clear about their own NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs ability to interact supportively with the client. Nurses have an ethical and moral responsibility to not impose their own religious or spiritual beliefs on a client but to respond to the client in relation to the client’s own background and needs. Communication skills are most important in helping the client articulate needs and in developing a sense of caring and trust. Interventions may include facilitating expressions of feeling, prayer, meditation, reading, and discussion with clergy or a spiritual adviser. It is important for nurses to establish an effective interdisciplinary relationship with spiritual support specialists. 17. How can the nurse support the family of a client who is dying? The most important aspects of providing support to the family members of a dying client involve using therapeutic communication to facilitate their expression of feelings. When nothing can reverse the inevitable dying process, the nurse can provide an empathetic and caring presence. The nurse also serves as a teacher, explaining what is happening and what the family can expect. Due to the stress of moving through the grieving process, family members may not absorb what they are told and may need to have information provided repeatedly. The nurse must have a calm and patient demeanor. 18. What is essential in post-mortem care?  Body Positioning:  Eyes and Mouth:  Removing tape, etc.  Describe rigor mortis → is the stiffening of the body that occurs about 2 to 4 hours after death. Rigor mortis starts in the involuntary muscles (heart, bladder, and so on), then progresses to the head, neck, and trunk, and finally reaches the extremities. algor mortis → is the gradual decrease of the body’s temperature after death. When blood circulation terminates and the hypothalamus ceases to function, body temperature falls about 1°C (1.8°F) per hour until it reaches room temperature. Simultaneously, the skin loses its elasticity and can easily be broken when removing dressings and adhesive tape. livor mortis → After blood circulation has ceased, the red blood cells break down, releasing hemoglobin, which discolors the surrounding tissues. This discoloration, referred to as livor mortis, appears in the lowermost or dependent areas of the body. II. Spiritual Needs: Chapter 41: Spirituality 1. Define spirituality: is generally thought to refer to the human tendency to seek meaning and purpose in life, inner peace and acceptance, forgiveness and harmony, hope, beauty, and so forth. 2. Define religion: is usually applied to ritualistic practices and organized beliefs. Indeed, there has been a tendency in nursing—as in psychology and other fields—to separate these two concepts. Yet trying to make religion an opposite of spirituality (e.g., institutional versus personal, objective versus subjective, narrow versus broad, cerebral versus emotional, bad versus good) is unfair to both concepts. NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs 3. What is the difference between an atheist and an agnostic? An atheist is one without belief in a deity. Atheists report that they often feel discriminated against (Brewster, Hammer, Sawyer, Eklund, & Palamar, 2016) or perceived as angry (Meier, Fetterman, Robinson, & Lappas, 2015) by those in our culture who experience and value spirituality or religion. An agnostic is an individual who doubts the existence of God or believes the existence of God has not been proved. Does a client professing to be an atheist or agnostic have spiritual needs? If so, describe them. Yes, clients who identify as atheist or agnostic can still have spiritual needs. Spirituality is a broad concept that encompasses more than just religious beliefs or practices; it can include any element relating to a person's sense of peace, purpose, ethics, values, and connection to oneself, others, and the world. Addressing Spiritual Needs in Care Settings For healthcare providers, counselors, and other professionals working with atheist or agnostic clients, recognizing that these clients may have spiritual needs is important. Addressing these needs involves: Asking Open-Ended Questions: Questions about what gives them meaning, joy, or comfort can help clarify where their spiritual needs lie. Respecting Their Beliefs: Clearly acknowledging and respecting their beliefs (or lack of religious beliefs) avoids alienating the client and creates a supportive environment. Providing Relevant Resources: This could include referrals to community groups, philosophical discussions, art therapy, or other non-religious forms of support that align with their values and interests. Encouraging Self-Expression: Facilitating avenues for self-expression, whether through art, writing, or conversation, can help meet spiritual needs related to understanding oneself and one’s place in the world. Understanding that spirituality is not confined to religious expression allows professionals to better support the holistic well-being of atheist and agnostic clients, respecting their unique perspectives and supporting their spiritual journeys in a broad and inclusive manner. 4. Box 41.1 Spiritual Needs. Review responses seen in clients who are experiencing an impairment in meeting their spiritual needs. Need for satisfying meaning to ascribe to illness, to life, to dying, to any loss or serious challenge “Why would this happen to me? Having cancer is a celestial crapshoot!” “This is so unfair.” “Why do bad things happen?” Need for purpose, vocation, mission NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs “Now that I can’t work anymore, what good is it for me to keep on living?” “What’s there for me to do now with my old body?” Need for believable beliefs, sensible worldview “I’ve been told God is in control and is loving, but that doesn’t make sense to me anymore.” Guilt, need to restore relationship “I wonder if I’m being punished for something I did when I was younger.” “I know I have to meet my Maker soon, so I’d better get things right with Him.” Shame, imperfection, unworthiness “I never was good enough for... , but now look how sick/disabled/scarred I am!” “I am going to do whatever my family wants me to do.” “I’m just using up society’s resources. I’m such a burden to my family.” Need to worship, transcend self “I am so tired/sick/befuddled/anxious, I’m beside myself.... I wish I could feel God was involved in this situation.” “I never get to go to church because I’m always taking care of my husband.” Need for peace, composure “I don’t feel comfortable being alone or in silence.” “I just wish I could make it all turn out the way I want it to.” Need to be grateful “I know I should count my blessings; things could be worse.” Need to express love “I keep my problems to myself, because I don’t want to trouble my family any more than necessary.” “You nurses do so much for me; I wish I could do nice things for you.” Isolation, abandonment, betrayal “Why don’t they come to visit anymore?” “It just seems like all my prayers bounce back to me without being heard.” 5. Components of the spiritual dimension: Considering these five needs, assess your own current spiritual health state.      Meaning/Purpose: To be helpful. Identity: Murse. Love: Yes. It is in my heart. Hope: I hope to be consistent. Forgiveness: Is the only way to move forward. 6. Interventions for spiritual health: Describe:  Providing Presence: Presencing is a term describing the art of being present, or just being with a client during his or her suffering. To be fully present to a client, a nurse must be purposefully attentive (Fahlberg & Roush, 2016). To be comfortable being fully present to NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs another individual, however, one must be comfortable being fully present to oneself (du Plessis, 2016).  Conversing about spirituality: Initiating conversation about spiritual or religious concerns with a healthcare professional is likely hard for clients; they presumably wait for an appropriate time with a “safe” clinician. Both physicians and nurses typically find it difficult to talk with clients about this intimate and sometimes socially taboo topic (Best, Butow, & Olver, 2016; Wittenburg, Ragan, & Ferrell, 2017). Sometimes clients do not want to talk about deep inner pain, spiritual or emotional. They may instead find comfort and help from the nurse who genuinely shows interest in their life, family, and hobbies. However, sometimes clients do want to have overtly spiritual discussions with their nurse.  Assisting with prayer or meditation: Many nurses pray with clients when they request it (Minton, Isaacson, & Banik, 2016; Taylor, Park, & Pfeiffer, 2014). Prayer allows individuals to connect with each other and with the divine. To pray for another is also a way for loving individuals to express care. While most clients may say that prayer makes them feel better, it is also possible that prayer could raise to awareness a spiritual struggle or a disappointment and questions about “unanswered prayers” (Taylor, 2012).  Referring to spiritual care experts: Referring Clients to Spiritual Care Experts There are times when spiritual care is best referred to other members of the healthcare team. Referrals can be made for hospitalized clients and their families through the hospital chaplain’s office if one is available. Nurses in home and community health settings can identify spiritual resources by checking directories of community service agencies, telephone directories, or religious directories that describe available spiritual counselors and the services provided through the religious community. Many religious counselors will assist members of their faith who are not members of their specific religious community. For example, a priest may attend a client in the hospital or at home even though the client is not a member of the priest’s parish. Be sure to obtain a client’s approval before initiating a referral. The client often will have a preferred spiritual care provider to contact.  Supporting religious practices: During the assessment of the client, the nurse will have obtained specific information about the client’s religious preference and practices. Nurses need to consider specific religious practices that will affect nursing care, such as the client’s beliefs about birth, death, dress, diet, prayer, sacred symbols, sacred writings, and holy days as discussed earlier in this chapter. See Practice Guidelines for ways the nurse can help clients to continue their usual spiritual practices. Box 41.2 provides health-related information about specific religions. 7. Religious Practices the Nurses Should Know pp. 1031-1034. Familiarize yourself with these ideas. Discuss something you learned from this section which enhanced your awareness of potential spiritual needs of clients. NURS 3000 - Professional Nursing Loss and Grief: Spiritual Needs Many traditional religious practices and rituals are related to life events such as birth, transition from childhood to adulthood, marriage, illness, and death. Religious rules of conduct, typically influenced concurrently by culture, may also apply to matters of daily life such as dress, food, social interaction, menstruation, childrearing, and sexual relationships. When individuals get sick, they frequently rely on prayer and other spiritual practices. Decisions about health and end-of-life care are guided by spiritual or religious beliefs. Given this deep connection between spiritual or