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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Sexuality Patterns, Altered - Impotence; Intimacy
Ann Filipski, RN, MSN, CS, PsyD
Jeff Zurlinden, RN, MS

NANDA: The state in which an individual expresses concern regarding his or her sexuality

The patient or significant other expresses concern regarding the means or manner of sexual expression or physical intimacy within their relationship. Alterations in human sexual response may be related to genetic, physiological, emotional, cognitive, religious, and/or sociocultural factors or a combination of the factors just mentioned. The problem of altered patterns of sexuality is not limited to a single gender, age, or cultural group; it is a potential problem for all patients whether the nurse encounters them in the hospital or in the community. All of these factors play a role in determining what is normative for each individual within a relationship. It is probable that most couples reach a point in their relationship where patterns of sexual expression become altered to the dissatisfaction of one or both members of the couple. The ability to communicate effectively, to seek professional help whenever necessary, and to modify existing patterns to the mutual satisfaction of both members are skills that enable the couple to grow and evolve in this aspect of their relationship. The nurse is in a unique position to provide anticipatory guidance relative to altered patterns of sexual function when the problem is an inevitable or probable result of illness or disability. The ability to discuss these issues openly when the patient raises concerns about sexual expression highlights the legitimacy of the couple's feelings and the normalcy of sexual expression as a part of intimacy, as well as emotional and physical well-being.

Related Factors

Physical changes or limitations (may be time limited or chronic) Fear or anxiety Knowledge deficit Emotional factors Situational factors

Defining Characteristics

Expected Outcomes

Ongoing Assessment

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Assess level of understanding regarding human sexuality and functioning.
Many persons have misconceptions about facts as they relate to sexual intimacy.
(i) Explore current and past sexual patterns, practices, and degree of satisfaction.
To determine realistic approach to care planning.
(i) Identify level of comfort in discussion for patient and/or significant other.
It is important for the nurse to create an environment where the couple or patient feels safe and comfortable in discussing his/her/their feelings.
(i) Identify potential or actual factors that may contribute to current alteration in sexual functioning. (See Related Factors of this care plan.)
(i) Solicit information from the patient about the nature, onset, duration, and course of sexual difficulty.

Therapeutic Interventions

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Use a relaxed, accepting manner in discussing sexual issues. Convey acceptance and respect for patient concerns.
Patients are often hesitant to report such concerns and/or difficulties because sexuality remains a private, uncomfortable matter for many within our culture.
(i) Provide privacy and adequate time to discuss sexuality.
Respecting the individual and treating his or her concerns and questions as normal and important may foster greater self-acceptance and decrease anxiety.
(i) Encourage sharing of concerns, feelings, and information between patient and current or future partner. Whenever possible, involve both in sexual health education and counseling efforts.
For some sexual problems it is the couple's relationship that provides the focus for intervention.
(i) Discuss the multiplicity of influences on sexual functioning (physiological, emotional). Offer opportunities to ask questions and express feelings.
(i) Explore awareness of and comfort with a range of sexual expression and activities (not just sexual intercourse).
(i) Assist patient and significant other in identifying possible options to overcome situational, temporary, or long-term influences on sexual functioning.
(i) Encourage patients and significant others to locate and read relevant educational materials regarding sexuality.
Many excellent books are available that undo myths and errors and promote increased knowledge and communication about sexual concerns.

Education/Continuity of Care

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Provide accurate and timely health teaching regarding "normal" range of sexual expression and sexual practices throughout the life cycle.
Satisfying sexual functioning and practice are not automatic and need to be learned.
(i) Discuss range of possibilities and consequences (both positive and negative) associated with sexual expression of all types (change in relationship, impact on physical and/or emotional health, possibility of pregnancy, STDs and others).
(i) Offer information regarding birth control methods, "safe" sex practices and others.
(i) Explain the effects on sexual functioning of patient's medication(s), illness or disease process, health alteration, surgery, or therapy.
(i) Be specific in providing instruction to patient and significant other regarding any limitations on sexual activity resulting from illness, surgery, or other events.
(i) Explain alternative means or forms of expressing intimacy and/or sexual expression, such as alternative positions for intercourse that decrease discomfort or degree of physical exertion for those with impaired mobility or cardiopulmonary disease. Consider concerns imposed by patient's or significant other's health status, illness, or other situation.
(i) Consider referral for further work-up and/or treatment (e.g., primary health care provider, specialized physician or mental health consultant, substance abuse treatment program, or sexual dysfunction clinic).
The counseling needs of the couple or patient may be beyond the skill or training of the nurse.
(c) Consider referral to self-help and/or support groups (i.e., Reach for Recovery, Ostomy Association, Mended Hearts, Huff and Puff, Sexual Impotence Resolved, Us Too, HIV Support Groups, Y Me, Survivors of Abuse, or Resolve).
Self-help support groups are unique sources of empathy, information, and successful role models.

NIC

Sexual Counseling; Anticipatory Guidance; Teaching: Sexuality

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