NCLEX-RN: Nursing Concepts

Nursing Concepts: Human Sexuality

Focus topic: Nursing Concepts

Nursing Concepts: Overview of Human Sexuality

Focus topic: Nursing Concepts

 

✦A. Biological sexuality is determined at conception.

  • Male sperm contributes an X or a Y chromosome.
  • Female ovum has an X chromosome.
  • Fertilization results in either an XX (female) or an XY (male).

B. Preparation for adult sexuality originates in the sexual role development of the child.

  • Significant differences between male and female infants are observable even at birth.
  • Biological changes are minimal during childhood, but parenting strongly influences a child’s behavior and sexual role development.
  • Anatomical and physiological changes occur during adolescence that establish biological sexual maturation.
  • Learning about sexuality has several stages.
    a. First stage: Person becomes aware that he or she is a sexual being and accepts the fact.
    b. Second stage: Person seeks to learn about the sexual self—experiments with bodies and emotions.
    c. Third stage: Involves sharing self with a partner.

C. Human sexuality pervades the whole of an individual’s life.

  • More than a sum of isolated physical acts.
  • Functions as a purposeful influence in human nature and behavior.
  • Observable in everyday life in endless variations.

D. Each society develops a set of normative behaviors, attitudes, and values in respect to sexuality, which are considered “right” and “wrong” by individuals.

E. Freud described the bisexual (androgynous) nature of the person.

  • Each person has components of maleness–femaleness, masculinity–femininity, and heterosexuality–homosexuality.
  • These components are physiological and psychological in nature.
  • All components influence an individual’s sexuality and sexual behavior.

F. Gender identity (identified at birth) refers to whether a person is male or female.

  • Cases of “ambiguous genitalia” are rare (1/3000 births) and require special care for the infant and parents.
  • Ambiguous genitalia is a clinical label similar to slang term morphodite, or biological term hermaphrodite.

G. Sexual object choice is the selection of a mode of outlet for sexual desire, usually with another person.

  • Generally occurs during adolescence and beyond.
  • Includes heterosexuality, homosexuality, bisexuality, celibacy, and narcissism/onanism.

H. Sexual object choice has strong influence on a person’s lifestyle.

  • Individual must establish patterns of intimacy and sexual behavior that are acceptable to self, to significant others, and to society to a certain extent.
  • Psychological demands and expectations throughout life influence an individual’s sexual interest, activity, and functional capacity.
  • Sexual object choice can affect a person’s choices in life such as whether to be a parent, where to live, and which career to pursue.

Nursing Concepts: Sexual Behavior

Focus topic: Nursing Concepts

A. Sexual behavior is a composite of developed patterns of intimacy, psychological demands and expectations, and sexual object choice.

  • Can be genital (sexual intercourse), intimate (holding, hugging), or social (dating, choice of clothing).
  • Beyond the obvious examples, one never stops “behaving sexually.”
  • Dress, communication, and activity are all expressions of sexuality.
  • Every person exhibits sexual behavior continually; no one is sexless.

B. Transvestite and transsexual are two terms that often cause confusion and need definition and differentiation.

  • Transvestite refers to one who enjoys wearing clothing of the opposite sex; may or may not be homosexual.
  • Transsexual is a person who chooses sexual reassignment: a complex physical (surgical), psychological, and social process of taking on the gender identity, sex role, sexual object choice, and sexual behavior of the opposite sex.

C. Sexuality, although difficult to define, is pervasive from birth to death, and nurses need to look beyond the framework of reproduction and procreation to understand the influence of sexuality on clients’ health and illness.

Nursing Concepts: Characteristics

Focus topic: Nursing Concepts

A. Difficult to define precisely, human sexuality is considered to be a pervasive life force and includes a person’s total feelings, attitudes, and behavior.
B. It is related to gender identity, sex-role identity, and sexual motivation.
C. Touching, intimacy, and companionship are factors that have unique meaning for each person’s sexuality.
D. Sex role describes whether a person assumes masculine or feminine behaviors, usually a combination of both.

  • This role is generally considered to be fairly established by age 5.
  • Usually referred to by the concepts boy/girl and man/woman.

Nursing Concepts: Assessment

Focus topic: Nursing Concepts

A. If necessary, obtain a full sexual history.
B. Include consideration of each client’s sexuality in assessing health and illness status.
C. Assess primary sexual concerns.
D. Listen for nonverbal cues of sexual problems.
E. Elicit verbalization of underlying concerns.
F. Identify major problem area.

  • Be aware that the most common problem is the need for sexual recognition of each client.
  • Allow sexual expression within appropriate limits.
  • Assess whether client has correct information or misconceptions about sexuality.
  • Assess the relationship between each client’s health problems and his or her sexuality needs.

Nursing Concepts: Implementation

Focus topic: Nursing Concepts

A. Provide sex education and counseling.

  • Clients consider nurses to be experts in sexuality.
  • Intervention requires knowledge and skill.
  • Nurses need to know referral sources for interventions beyond their ability.

✦B. Give clients “permission” or acceptance to maintain sexuality and sexual behavior.

C. Be aware of the effect of medications on clients’ sexuality and sexual functioning.

  • Oral contraceptives are considered by some to have played a major role in creating a sense of sexual freedom in contemporary society.
  • Drugs that decrease sexual drive or potency may act directly on the physiological mechanisms or may decrease interest through a depressant effect on the central nervous system.
  • Drugs with an adverse effect on sexual activity include antihypertensive drugs, antidepressants, antihistamines, antispasmodics, diuretics, sedatives and tranquilizers, ethyl alcohol, and some hormone preparations and steroids.

D. Medications for sexual dysfunction.

  • Example—sildenafil (Viagra): oral therapy (25–100 mg) for erectile dysfunction.
    a. Rapidly absorbed, 30–120 minutes, with resulting ability to achieve an erection sufficient for sexual intercourse.
    b. Appropriate for healthy young and elderly males.
  • Precautions: any male who is at cardiac risk, has peptic ulcer disease.

✦E. Be aware of the problems to which nursing personnel should direct themselves in relation to the area of human sexuality.

  • Attitudes.
    a. Nurses should increase their self-awareness of their own attitudes and the effect of these attitudes on the sexual health care of their clients.
    b. Nurses should suppress negative biases and prejudices and/or make appropriate referrals when they cannot give effective or therapeutic sexual health care.
  • Knowledge.
    a. May have to be actively sought, although nursing programs are increasing the sexuality content in their curricula.
    b. Also available through books, journal articles, classes and workshops, and preparation for sexuality therapy on the graduate level.
  • Skills.
    a. Primary skills needed are interpersonal techniques such as therapeutic communication, interviewing, and teaching.
    b. As with any skill, practice is needed for proficiency in sexual-history taking, education, and counseling.

Nursing Concepts: Sexual Behaviors Related to Health

Focus topic: Nursing Concepts

A. Masturbation.

  • A common sexual outlet for many people.
  • For clients requiring long-term care, masturbation may be the only means for gratifying their sexual needs.
  • Nurses frequently react negatively to any type of masturbatory activity, especially by male clients.
  • Clients should be allowed privacy; if a nurse walks in on a client masturbating, he or she should leave with an apology for having intruded on the client’s privacy.
  • Frequent or inappropriate masturbation may be harmful to the client’s health.
    a. Nurse should use team planning to identify what need the client is attempting to meet.
    b. Limits need to be set to protect client and other clients if behavior is inappropriate.

B. Gender identity issues—homosexuality.

  • Homosexuality is accepted as a viable lifestyle.
  • Nurses may have negative attitudes based on incorrect knowledge about homosexuality.
  • A client’s homosexual (gay) or lesbian lifestyle should be accepted and respected. These clients should be treated without judgments.
  • As with any client, visitors should be encouraged as appropriate for the health/illness status, and these people should not be embarrassed or ridiculed.
  • For chronically ill clients, such as in a nursing home, it is essential that sexuality needs be considered in the total care plan and special efforts be made to have these needs met.

C. Inappropriate sexual behavior.

  • Difficult to precisely define “inappropriate” sexual behavior.
  • Sometimes sexual behavior is in reaction to unintentional “seductive” behavior of nurses.
  • Specific nursing interventions.
    a. Set limits to unacceptable behavior immediately.
    b. Interact without rejecting client.
    c. Help client express feelings in an appropriate manner.
    d. Teach alternative behaviors that are acceptable.
    e. Provide acceptable outlets to sexual feelings.

D. Venereal disease.

  • Based on reported cases, the incidence of gonorrhea and syphilis is increasing slowly.
  • Both syphilis and gonorrhea can be cured with appropriate antibiotic therapy. (Recently there has occurred a strain of syphilis resistant to antibiotic therapy, so prevention is an important teaching concept.)
  • Treatment and care should be given without judgment.
  • Case finding and treatment are still very difficult, especially for adolescents who may need parental consent to obtain health services.

✦E. Contraception.*

  • Nurses are considered experts on forms of birth control.
  • Nurses should be familiar with different methods and relative effectiveness of each one.
  • Clients should be assisted to make their own choices as to whether to use contraception and which method is best for them.

F. Therapeutic abortion.†

  • Clients need information about resources for and procedures of therapeutic abortions.
  • Clients should be given nonjudgmental assistance and support in decision-making process.
  • If nurse cannot in good conscience assist the client because of conflicting religious or spiritual beliefs, referral should be made to someone who can.

Nursing Concepts: Sexuality and Disability

Focus topic: Nursing Concepts

A. Physically and developmentally disabled persons are sexual beings also.
✦B. Developmentally disabled persons should be given sexuality education and counseling in preparation for sexual expression and behavior.
C. After spinal cord injury, the level of the lesion and degree of interruption of nerve impulses influence sexual functioning; adaptation of previous sexual practices may be needed after the injury.
D. Fertility and the ability to bear children are usually not compromised in women with spinal cord injury.
✦E. Nurses working with disabled clients must make special effort to include sexuality in total health care and services.

  • Discuss sexual needs openly with client so he or she will not feel embarrassed to ask questions.
  • Discuss previous sexual activity and how current needs can be met.
  • Nurse must maintain a nonjudgmental attitude or relationship will be jeopardized.
  • Support client and partner during sexual adjustment period.
  • Refer to therapy support groups for ongoing support.

Nursing Concepts: Child Sexual Abuse*

Focus topic: Nursing Concepts

A. There is only a beginning awareness of this problem area.
B. Most child sexual abuse involves a male adult and female child, but male children can also be victims of female or male sexual abusers.
C. The child may need special protection or temporary placement outside the home, but often the family unit can be maintained.
✦D. Child sexual abuse or molestation is a form of child abuse, and nurses should know local regulations and procedures for case finding and reporting.
✦E. Nursing interventions.

  • Establish a safe environment for the child.
  • Allow and encourage child to verbalize or communicate in his or her own way (through drawings or play acting).
  • Observe for appearance of symptoms over time (withdrawal, depression, phobias).
  • Encourage ongoing therapy to work through trauma.

Nursing Concepts: Joint Commission National Patient Safety Goals , 2014

Focus topic: Nursing Concepts

A. The purpose of the National Patient Safety Goals is to improve client safety. The goals focus on problems in healthcare safety and how to solve them.

B. In 2014, TJC created an official “Do Not Use” List of Abbreviations.

  • Applies to all orders and all medication-related documentation that is handwritten (including free-text computer entry) or on preprinted forms.

C. The Institute of Medicine’s strategies for reducing medication errors (see Appendix 3-1 for a list of commonly confused drug names).

  • Complete steps to improve communication between clients and providers.
  • Improve drug naming, labeling, and packaging.
  • Assign appropriate groups (FDA) to create easy-to- understand drug information for consumers.
  • Write all prescriptions electronically.
  • Inform clients of clinically significant medication errors made in their care, even if the mistake did not lead to harm.

Nursing Concepts: NATIONAL PATIENT SAFETY GOALS 2014

Focus topic: Nursing Concepts

Nursing Concepts

Nursing Concepts: OFFICIAL “DO NOT USE” LIST

Focus topic: Nursing Concepts

Nursing Concepts

Nursing Concepts: Alternative and Complementary Therapies

Focus topic: Nursing Concepts

A. Alternative or complementary medicine became popular in the early 1990s.

  • More than 600 million Americans use alternative therapy.
  • Bills in Congress have authorized healthcare providers to give alternative treatments.

B. There are more than 200 alternative methods available. A short sampling of these treatment modes follows:

  • Acupuncture: Use of sharp needles inserted along energy lines called meridians. Used for pain and to treat diseases caused by blocked or a lack of energy in the body.
  • Chiropractic: Manipulation of bones and muscles to realign the spinal column as well as other areas in the body, thus enabling the body to heal itself.
  • Energy Medicine: Use of varying frequencies of light and sound to heal the body. This mode is based on the premise that the body is made of electronic and magnetic vibrations.
  • Herbal Medicine: Plant-based remedies with a long history of safety and efficacy used as an adjunct or in place of drugs to treat diseases and conditions.
  • Homeopathy: A system of treatment that uses a minute dose of a substance (may be herbal or chemical) that mimics a disease resulting in a positive effect on the body. The principle with this therapy is that “like cures like.”
  • Massage: The oldest form of alternative medicine, massage is the application of touch to the skin to relieve stress and tension. This is a nonpharmacological approach to relieve pain.
  • Naturopathy: A more global alternative therapy that includes natural therapies such as nutrition, herbs, homeopathy, massage, body work (Rolfing), and other treatments, all designed to help the body heal itself.
  • Relaxation and Visualization: A form of therapy that uses exercise, visualization, and mental imagery to control the autonomic nervous system. These techniques have proven to be beneficial in controlling stress, oxygen consumption, respiratory and heart rate, and blood pressure.

C. Other therapies of note in the alternative medicine arena include ayurveda, biofeedback, aromatherapy, kinesiology, reflexology, Tai Chi, and yoga.

Nursing Concepts: Case Management

Focus topic: Nursing Concepts

Definition: Case management is the process of organizing and coordinating resources and services in response to individual healthcare needs along the illness and care continuum. This occurs in hospital-based and community based settings.

Goals: The goals of case management are to:

  • treat clients at optimal times to:
    a. keep them healthy and
    b. out of the hospital
  • center services around the client’s needs
  • foster client self-managed care, and
  • maximize efficient and cost-effective use of health resources
  • linking clients back to their:
    a. community
    b. primary care physician and
    c. local resources.

Focus: The focus is:

  • cost-saving through
    a. adherence to:
    i. plan of care
    ii. medication regime
    iii. understanding of importance of self monitoring

Case management nurses (CMN) are specialized registered nurses who manage the long-term care plans for clients with chronic or complicated medical conditions. They work collaboratively with all members of the healthcare team to assess the medical, physical, social, financial and emotional needs of clients and their families. These nurses work closely with clients and their loved ones to evaluate clients’ needs and come up with a comprehensive healthcare plan that speaks to their preferences and goals. The case managers work to honor client choices, minimizing time constraints, maintaining a holistic focus, linking care-team members, and impacting quality and cost. They act as advocates to ensure that each client receives the most cost-effective care possible while exploring resources available to assist the client with achieving or maintaining independence. Advocacy includes medication management and scheduling medical testing and any necessary followup to ensure that each client is heard and afforded the care he needs.

A CMN consults with attending and primary care physicians, while collaborating with insurance-based case managers to develop a posthospital treatment plan by using clinical pathways in assessment and monitoring of clients and healthcare delivery. The CMN is responsible for the coordination of care and services, case finding, screening, determination of eligibility, comprehensive assessment; development, monitoring, and evaluation of the plan of care and use of resources and arrangement of services needed to reach outcomes in specific time frames. The critical help they provide provides peace of mind and a sense of security to clients and their families.

Using research and evidence-based practice, case managers participate in quality assurance and quality improvement processes to evaluate the impact of performance improvement measures on client care and resource utilization.

Nursing Concepts: Quality and Safety Education for Nurses

Focus topic: Nursing Concepts

Today, healthcare facilities are operating in an interconnected, globalized world with demands for quality and safety in care provided. Client demands, government policies, and third-party insurer regulations are changing rapidly and will impact professional nursing practice and client outcomes. Against this background of increasing complexity, a new set of challenges faces nurses, requiring them to demonstrate specific interdisciplinary core competencies. The concepts from which these competencies have been derived are from the Quality and Safety Education for Nurses (QSEN) Institute (2012). The goal of these competencies is to ensure that clients receive care that is safe and of the highest quality. The complexities that are ubiquitous in today’s healthcare system require nurses to work within a simple yet comprehensive framework. The QSEN framework and competencies are used to assure that clients are receiving safe, quality care that is planned in collaboration with all disciplines involved to improve client outcomes. These competencies are expected to be part of the nurses’ practice on a daily basis to ensure they perform safely and successfully in all areas of the complex heath care systems in which they work.

QSEN provides the framework for the knowledge, skills and attitudes (KSAs) required for nurses to demonstrate competency in these vital areas, which include:

Client-Centered Care: The focus is that the client is in control and a full partner in all decision making related to their health care. It is important that we involve the client in all we do. The care is focused on client goals and solving problems based on respect for the client’s personal, religious, and cultural preferences, values, and needs. This helps to promote relationship building with clients. When we offer more control and choices that support individualization of care, clients’ outcomes improve.

Teamwork and Collaboration: This helps nurses to achieve quality client outcomes by effectively communicating with nurses and inter-professional teams having mutual respect and shared decision making while acknowledging other team members’ contributions. The synergistic effect of valuable interdisciplinary collaboration is the interaction of multiple elements in the collaboration efforts to produce a result different from or greater than the sum of their individual effects.

Evidence-Based Practice (EBP): The goal of EPB is to integrate best current evidence into practice, while supporting client preferences and values to deliver optimal health care. EBP translates new knowledge into practice and provides guidance in weighing evidence and the opportunity to share the evidence. It then links studies to optimum clinical outcomes and business results. This approach reduces variability through evidence and the integration of standards. It becomes “a way to do” as opposed to “another thing to do.” Examples of very successful evidence-based initiatives include hand washing and hand hygiene, pressure ulcer prevention (HAPU bundle); ventilator-associated pneumonia prevention (VAP bundle), catheter-associated urinary tract infection (CAUTI) and catheter-related bloodstream infections (CRBSI).

Quality Improvement (QI): The goal of QI programs is to monitor outcomes of care processes and use improvement methods to test changes and design mistake-proof processes to improve the healthcare system. It helps to develop a “just culture” and a culture of safety where individuals are comfortable in reporting errors, adverse events, and near misses without the fear of loss of job. QI provides systematic investigations of problems where it is safe to ask for help, look at waste and variation, and eliminate it. QI processes help to identify where to make changes and often result in system wide transformations. Individual nursing sensitive indicators reflect the structure, process, and outcomes of nursing care and are benchmarks for QI. Often QI projects use the PDSA (plan, do, study, act) model when problems are identified. This model helps to answer the questions: What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement?

Safety: Client safety competencies are implemented to minimize risk of harm to clients and providers. Here the focus is through both system effectiveness and individual performance. This competency looks at human factors and other basic safety design principles as well as commonly used unsafe practices that impact on client care. A culture of safety is a just culture that provides learning opportunities to identify errors in a safe environment.

Informatics and Technology: The goal is to learn to use information and technology to communicate, enhance knowledge, mitigate error, and support safe, effective processes of care and decision making. Nursing involvement in design, selection, implementation, and evaluation of information technologies to support client care are important. In addition, navigating resources such as medical records and databases effectively are crucial.

FURTHER READING:

Resources:

Leave a Reply

Your email address will not be published. Required fields are marked *