Sean Whitfield - NURS 3000 - ALG 14 Sensory Needs_ Sexuality, Love, Belonging - Accessible Version - Completed (1).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.