The role of oncology nurse in sexual management Eun-Young Jun, RN, KOCN, PhD Department of Nursing, Daejeon University, Korea
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Surgery, Radiation therapy, Chemotherapy, Hormonal manipulation, Cytostatic medication Excision(radical), ostomy, catheterization, repeated test, immobilization, medication, removal of sexual organ Prostate (70%), breast (50%), gynecologic (50%), genitourinary cancers Sexual dysfunction Reproductive dysfunction Psychosocial distress - 3/22 -
(Seminars in Oncology Nursing. 2008; 24(2), 80-90) - 4/22 -
Linking sexuality with health Initiating discussion of potential sexuality-related issues and concerns Conducting a brief sexual assessment may prevent or minimize future complications - 5/22 -
Lack of time : initiating or continuing discussions Lack of knowledge : specific sexual dysfunctions associated with various diseases or treatments Lack of training : initiate a discussion or carry out assessment no an expected role for a nurse - 6/22 - (Nursing Times. 2011; 107(48), 20-22)
Gender identities and roles, sexual orientations, feelings of pleasure and intimacy, reproductive process thoughts, dress, attitudes, values, relationships Sexuality is like pain or fatigue Focus on body image and sexuality Oncology nurses like to say that we provide holistic care (Oncology Nursing Forum. 2006; 33(5), 905-910) - 7/22 -
Effective sexual assessment Broad and specific discussion questions Patient s potential and actual sexual problems Depending on the level of expertise of the nurse amount of time, pt s interest & ability (brief / intensive) Topics: disease and treatment issues, relationships, patterns of sexual activity, satisfaction, intimacy, communication, coping skills - 8/22 -
The oncology nurse Identifies past/ present sexual patterns and expressions Discuss the effects of disease/ Tx on body image Describes the effects of disease/ Tx on sexual function Discerns the psychological response of patient/ partner to disease and treatment - 9/22 -
How has cancer affected the way you feel about yourself as a woman or man? How has cancer affected the way your partner feels about you as a woman or man? How has cancer affected your role as partner? What aspects of your sexuality have been affected by cancer? How has cancer affected your ability to function sexuality? - 10/22 -
Avoid medical jargon & value-oriented terminology : professional and straightforward manner, neutral sexual orientation, gender-neutral Appropriate eye contact Possible sitting positions From less sensitive to more sensitive topics Verbal non-verbal forms communications Continually clarify and reflect on the issues Acknowledge importance & value of discussion Appropriate to refer the patients - 11/22 -
Permission Limited Information Specific Suggestions Intensive Therapy P LI SS IT (Clinical J of Oncology Nursing. 2011; 15(1), 15-17) - 12/22 -
Achieving comfort and confidence with your own sexuality and with talking about sexuality Gaining sufficient knowledge about sexuality, illnesses, and treatments that affect sexuality Honing effective communication skills Identifying practitioners who can help you incorporate sexual healthcare into your practice - 13/22 -
Importance of communication & openness Potential alterations in body image & self-esteem The need for exercise, rest, adequate nutrition The use of contraception Setting the stage for sexual activities Experimentation with alterative methods of intimacy Liberal & adequate use of lubricants, foreplay, positions Energy conservation techniques & information - 14/22 -
Physical Manifestation Mastectomy scar Mastectomy wound Patient s Adaptation Patient & partner can disrobe together Camouflage with camisole, fancy nightgown Direct view of treated Br Change positions during intercourse to side lying or rear entry Change in body contour Make love by candlelight, change light bulb in lamp to red; Concentrate on new sexual task Vaginal dryness Hot flashes Use a lubricant privately or during foreplay, vaginal moisturizer can be used for daily dryness Medication (antidepressant) Stress management - 15/22 -
Vaginal moisturizers (Replens) : Increase vaginal moisture and elasticity : Return vaginal ph to premenopausal state Water-based lubricants (Astroglide, K-Y Liquid) Analgesic Discuss the less risky alternative to systemic HRT : Significant effect on decreasing UTI and urogenital symptoms : Not commonly used d/t concern of hormonal stimulation Kegel strengthening exercises : to relax the pelvic floor muscles and increase elasticity - 16/22 -
Pharmacologic intervention : Clonidine (alpha-adrenergic agonist) : Provera, Megace (progestational agent) : Vitamin E, soy contained supplements Some cautions must be concerned : Drug interaction / Effect vs Side effect Behavioral strategies : Relaxation / Regular physical exercise : Cool environment : Dietary change with avoidance of caffeine and alcohol - 17/22 -
Ensure rested and relaxed state Encourage an emphasis on comfort, warmth and joy Be positive and affirming Encourage intimacy in order forms including touching and hugging Encourage communication Encourage alternate sexual activities Use specific aids when needs - 18/22 -
Oocyte cryopreservation Use of GnRH agonist during chemotherapy : Controversial Counseling is important : Issue of life, potential death, cost, stress, emotions, time, rate of failure Should provide adequate information and discussion on reproduction and fertility Should refer to reproductive endocrinologist before chemotherapy - 19/22 -
Selection of Sexual Health elements Physical Psychological Relational ㆍ Sign & Sx related to treatments ㆍ Sign & Sx related to sexual life ㆍ Loss of body ㆍ Problems related to disease ㆍ Problems related to sexual life ㆍ Body image ㆍChanged relationship ㆍChanged sexual life - 20/22 -
Themes, objectives, and goals of the program Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Theme Relaxation of tension Perception of problems Exposure Solving problems Acceptance Reframing Object 유방암치료로인한억압된몸과마음의긴장해소 성문제인식과도출몸과마음의문제해결을위한방안모색 의사소통의중요성인식대화를통한몸과마음의노출 문제에따른방안표현을통한몸과마음의문제해결 표현과피드백을통한몸과마음의수용 새로운몸과마음의재구성 Introduction GO AL 호흡을통한이완 참여자간관계형성 프로그램에대한이해와필요성인식 호흡을통한이완 몸과관련된심리상태표현 호흡을통한이완 내면화된 나 표현과자기이해도모 호흡을통한이완 호흡을통한이완 수용된나의몸과마음표현및자기이해증진 호흡을통한이완 새롭게재구성된나의몸표현 Main Activity GO AL 내재된자아의식표출 치료와관련되어경험한문제도출및해결방안제시 성생활점검및성관련문제도출 성문제이해와해결방법습득 의사소통문제파악의사소통의중요성인식 효과적인부부대화법습득 이미지로나의몸과마음표현 효과적인성관련스트레칭과마사지방법습득 신체상과관련된사례경험 나의몸과마음에대해편안해하기 재구성된나의몸과마음에대한생각과느낌 재구성된성적인존재로서의나표현 Conclusion GO AL 부부의사소통상태점검 1 회차프로그램에따른달성정도평가 부부갈등시의사소통상황분석 부부의사소통개선에대한필요성인식 2 회차프로그램에따른달성정도평가 유방암환자의작품을통한타인의심리상태경험 3 회차프로그램에따른달성정도평가 유방암환자의작품을통한타인의심리상태경험 효과적인부부대화법적용사례평가 4 회차프로그램에따른달성정도평가 효과적인부부대화법적용사례평가 5 회차프로그램에따른달성정도평가 전체프로그램과정및효과평가 전체프로그램에따른달성정도평가 - 21/22 -
Element and approach of the program theme Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Relaxation of tension Perception of problems Exposure Solving problems Acceptance Reframing pproach Percep Cogni Appli. Percep Cogni Appli Percep Cogni Appli. Percep Cogni Appli. Percep Cogni Appli. Percep Cogni App Physi. 정보제공 이완이완이완이완이완이완 Psycho 참여이해 참여기대 무의식도출 상태표현 무의식도출 자기이해 의식화 자기이해 의식화 수용표현 Rela. 소개관계관성 Physi. Psycho Rela. 정보제공 그룹상담 문제도출 무의식도출 해결방법습득 상태표현 정보제공 / 그룹상담 문제도출과이해 해결방법실습 정보제공 대리경험 해결방법실습 정보제공 의식화 해결방법실습 자기이해 대리경험 느낌과생각표현 수용표현 / 목표설정 Physi. Psycho Rela. 상태점검 평가 상황분석 필요성인식 문제도출 평가 간접경험 평가 간접경험 평가 평가 평가 - Percep.(Perception), Cogni.(Cognition), Appli.(Application) - Physi.(Physical), Psycho.(Psychological), Rela.(Relational) - 22/22 -