Sexuality and intimacy in palliative care Flashcards
Definition of sexuality and intimacy
There is an assumption that sexuality means sexual intercourse and
function.
Medicalisation of sexual function has emphasised this point (examples?)
WHO defines human sexuality as:
▪ ” a central aspect of being human throughout life, encompassing sex,
gender identities and roles, sexual orientation, eroticism, pleasure, intimacy
and reproduction.”
▪ Sexuality is experienced and expressed in thoughts, fantasies, desires,
beliefs, attitudes, values, behaviours, practices, roles and relationships”
What are the barriers to intimacy in
palliative care?
lack of privacy, sharing a room with other patients,
constant interruptions, and single beds.
Shyness of patients to initiate the conversation
Embarrassment by the health personnel if the patient should
mention the topic.
A diffusion of responsibility: whose role is it to do this?
Myths about sexuality in palliative care
Have to be young to be sexual
Have to be beautiful and desirable (media defined)
Have to have a (heterosexual) partner to have sex.
If your partner dies, it’s the end of your sex life.
Older people should be looking after their grandchildren, not being sexual!
Derogatory terms about older people prevalent.
Myths of aging – tend to be negative
You can’t have sexual needs if you are sick.
The good news old age sex
Physiological changes not to be confused with the capacity for love and
intimacy.
We may be satiable when it comes to sex but insatiable when it comes to
being loved
Adult psychological health associated with sexual compatability and
connectedness
No fixed biological limit to a satisfactory sex life during old age
Older people’s sexual activity level is correlated to their sexual activity and
enjoyment before, during and after their middle years .
Essential elements of successful aging – positive feedback, physical fitness,
general activity levels, higher levels of sexual activity
Why is sexuality and intimacy
important in palliative care?
Sometimes, there is a deep regret in the bereaved person, that they were
unable to provide the intimacy that they knew their partner wanted .
This emphasises the need to determine who should be responsible for
initiating the conversation and the importance of providing training to
health personnel involved in this care.
In the study done by Lemieux et al (2004), patients identified home nurses
and physicians as the appropriate caregivers to address these needs, and
emphasised that a holistic approach to palliative care includes a
professional discussion of sexuality, which is as important as physical
symptoms.
Why should we learn about death?
There is a LOWER incidence of burnout in palliative care nurses
than in the general nursing population, because these nurses have
learnt how to face death and therefore have a greater
appreciation of life (Baumrucker, 2002).
A study showed that student nurses who had taken an elective in
caring for the dying, showed better preparedness for caring for the
dying and also more appreciative of life.
Burnout
Burnout is a syndrome of emotional exhaustion, feelings of disillusion
and disenchantment, characterised by depersonalisation and
reduced accomplishment.
Usually occurs in health workers and others who work in human
services.
Burnout occurs when the stressors exceed the person’s ability to cope.
It is frequently assessed using the Maslach Burnout Inventory, which
has been well validated and is widely used in research.
Signs of burnout
Negative or cynical attitudes about patients and their needs
Negative attitudes to work, the workplace, and/or
colleagues
Pervasive feelings of dissatisfaction and unhappiness related
to work, and
Physical and emotional symptoms (fatigue, boredom,
irritability, headaches, weight loss, etc) which can be
associated with absenteeism
Blocking behaviour
Often, nurses use this style of communication to protect
themselves against death anxiety.
They avoid intimate conversations with patients by
“changing the subject”, ignoring cues from patients
wishing to have “difficult conversations”, making jokes or
focussing on the ‘easy’ aspect of the patient’s question.
They may overwhelm the patient with medical information,
and concentrate only on physical care, ignoring
emotional or spiritual needs.
In this way, the nurse can stay on emotional safe ground.
Compassion fatigue
Compassion fatigue is similar to burnout but not the same.
It occurs quite suddenly, as a result of accumulated trauma
or experiences.
The nurse/health worker suddenly realises that they no longer
care.
Symptoms include an inability to maintain empathy and
objectivity, depression, anger, blaming, “ heavy
heartedness” at work.
This may occur in palliative care because of the constant
need to make new relationships, just to suffer losses.
Resilience
Resilience is the capacity to adapt under stress, and the ability to thrive
and find satisfaction from producing good outcomes in difficult situations.
The resilient palliative care provider is able to monitor their own levels of
distress and identify and deal with potential problems in their practice.
There is an evolving literature on resilience and how to promote the
qualities that also support professional survival and growth.
Those who work in well-functioning palliative care teams often experience
some powerfully protective factors:
Supportive teams allow opportunities for reflection and debriefing
They create an emotionally open work environment, and
They have a shared culture of care and accumulated wisdom about
supporting patients and families at the end-of-life.
How to avoid stress and burnout.
Ensure that you have the professional skills to do your job:
educate, train and take opportunities to develop skills.
• Limit workload (how much OVERTIME are you working?)
• Where possible, vary work to enhance satisfaction and
intellectual stimulation ( work part time in palliative care and
part time as a midwife!)
• Take regular annual leave holidays, long-service and/or
sabbatical leave, and pursue alternative interests or hobbies
to enhance fulfilment.
• Develop realistic expectations of what you can and can’t do
for your patients. (Circle of influence and circle of concern)
• Understand what the threat of death, aloneness and
meaninglessness, and personal freedom mean to you.
• Identify supportive colleagues and encourage contact with
them, and also identify negative colleagues and avoid them.
• Have outside interests and have a supportive person to talk to
who isn’t in your field of work.
• Have fun and enjoy life!
