If You Don’t Ask Me…Don’t Expect Me to Tell: A Pilot Study of the Sexual Health of Hospice Patients

Introduction

Problem Statement and Purpose

Sexual health of Hospice patients has been an important issue of discussion devoted to the overall quality of care that patients are exposed to. Many issues have risen pertaining to poor communication between healthcare providers and hospice patients on this subject. Many nurses do not feel very comfortable talking with the patient about his or her sexual health. Likewise, patients do not open up about their needs especially at the time when their passing is near. In the Pilot Study of the Sexual Health of Hospice Patients, the purpose of this study was to determine the views of hospice patients and nurses regarding sexual health and their relationships.

Review of Literature

This research project aimed to

1. identify the current status of hospice patients’ concerns regarding sexual health and
2. document the perceptions of hospice nurses regarding their understanding of the patients’ concerns regarding sexual health. The breakdown of this data indicated that a comprehensive assessment and understanding of sexual health in the life of the patients was needed. The findings showed that hospice patients lacked these needs even in the final stage of their disease.

Theoretical Framework

The theoretical framework for this study was the Sexual Health Model. The model reflects the human sexuality in ten categories to determine healthy sexuality. The ten components of this model are: discussion about sex, culture and sexual identity, sexual anatomy and functioning, sexual healthcare, overcoming challenges to sexual health, body image, masturbation and fantasy, positive sexuality, intimacy and relationships, and spirituality and values. These aspects of sexual health were implied in the study in all areas to find out what intimacy and sexual health were to the patient and provider. When compiling this study many questions and hypothetical statements were drawn. Though the field of scope was very broad the main two hypothetical questions were met to be evaluated.

1. What are the perceptions of hospice nurses regarding the sexual health needs of hospice patients and
2. what are the sexual health needs of hospice patients.

These questions are addressed and studied throughout the procedure for evidence of sexual health communication between nurse and patient.

When setting up this study, the author implemented several methods that attributed to the feedback that was researched. In this pilot, cross-sectional, survey-design study, the author (M.M.) constructed a series of structured telephone and in-person interviews with a sample of hospice nurses and patients regarding issues of sexual health. This research study was approached in two forms. The first part aimed at documenting perceptions of hospice nurses regarding their understanding of their patients’ concerns regarding sexuality and intimacy; the second part focused on hospice patients’ perceptions and needs regarding sexual health. For both nurses and patients, written consent was obtained from each participant, and then demographic information was obtained from the various individuals. To assume a effective, corresponding relationship steps were followed to promote efficiency:

1. all interviews were carried out by the same researcher;
2. interviews were performed in the patient’s home to verify there everyday experiences and attitudes;
3. all interviews were accomplished with the researcher taking notes throughout the interview process;
4. Individual inspection occurred throughout the interviews, which consisted of the researcher restating, summarizing, and paraphrasing the individual’s information to ensure that the research notes were precise ; and
5. the research team implied the data with frequent checks for reliability.

Methods and Sample Populations

In the study, Nurses were evaluated first on their reasoning of dealing with sexual health situations with hospice patients. Data was collected using open-ended in-person or telephone interviews. The author (M.M.) identified individuals by starting with five hospice nurses at an agency where they were formerly employed and used snowballing to identify 15 others. Diversity was brought into interviewing nurses from two geographically states, Oklahoma and New Hampshire. Nurses chose to participate in the study when asked. The nurse interview questions were detailed and designed to bring forth current practices regarding assessing of sexual health. The results obtained showed that the nurses had a couple of areas that needed refinement in for proper assessment of patient. The interviews with hospice nurses revealed six issues regarding sexual health:

1. lack of assessment,
2. sensitivity of the matter,
3. topic lacked priority,
4. patient characteristics were of significance,
5. no assessment standard, and
6. rea not covered in their nursing education.

Results

A majority of nurses did not assess their patient’s sexual needs, but every nurse at least knew of one of their patients showed a need for intimacy. A lot of the nurses also said the issue with these findings was of lack of assessment and not a priority at the time. To end the study, many of the nurses said that this issue was not covered in their nursing education, causing for a ineffective assessment of patients needs.

The second part of the study reviewed how hospice patients categorized sexual health and how the relationships between them and the nurse were brought about with this topic. This study used standard assessment tool to identify the current status of hospice patients’ concerns regarding sexuality and intimacy. Hospice patients were interviewed using the 100-item WHO Quality of Life Assessment questionnaire formed to assess sexuality and intimacy. A method of sampling was used for hospice patients who met certain criteria for the project. The selection consisted of meeting with hospice nurses to explain the study and ask for help in recruitment. Patients who qualified for the study were those enrolled in hospice, assessed by the hospice nurse to be cognitively intact, and able to hear. Individuals signed a consent form, and were told that participation was voluntary.

The following questions were measured on a 5-point Likert-type scale: (“How would you rate your quality of life?”), (“Are you satisfied with your opportunities for sexual contact and closeness?” and “level of intimacy in your life?”), (“How satisfied are you with your personal relationships?”), and (“How would you rate your sex life?”; “How well are your sexual needs fulfilled?”; and “Are there any difficulties in your sex life?”). Each of these (ranking 1-5) was followed by an open-ended question asking the participants to tell the interviewer more about their view of the question. The patients ranged in age from 37 to 97 years; 53% were women and 47% were men. Thirty-four percent of the respondents rated their sex life as poor or very poor, while 60% were satisfied with the level of intimacy in their life.

Results

Many of the hospice patients just needed someone to open up to them about their sexual health. Nurses need to know that sexual health is just important in hospices patients as with the concept of dying in their homes or areas of care. Assessing an individual about the possibilities of their sexual health could implement harmony and excitement instead of pain throughout the end of their life.

As hospice patients since that the end of their life is near, it is extremely important as a nurse that you are there for them and understand about their health and sexual health. As an up and coming nurse, I feel that understanding of a hospices patient’s sexual health is a very important component of their everyday life. I hope to one day use all of the information that I have acquired to help someone progress through their life with a since of recognition and aspiration. To know that I changed someone’s life even at the end, gives me satisfaction as a nurse that I didn’t just help a patient but a human being. In my scope of practice, I want to be knowledgeable and caring when the circumstances show their selves.

Reference

1. Marianne Matzo PhD, GNP-BC, FAAN. Kamal Hijjazi PhD, RN. (2009). If You Don’t Ask Me…Don’t Expect Me to Tell: A Pilot Study of the Sexual Health of Hospice Patients. Journal of Hospice and Palliative Nursing. 11(5), 271-281