Sexuality and cancer: How oncology registered nurses assess patients' sexuality in clinical practice
Sexuality can be negatively affected by cancer when illness or treatments cause disturbances in self-concept and/or body image or result in difficulties with sexual function. A diagnosis of cancer raises critical issues regarding sexuality, including: motherhood, fatherhood, femininity, masculinity, and fertility. A hermeneutic phenomenological approach was used to explore oncology nurses' experiences of performing sexuality assessments when caring for oncology patients. The research was conducted at a large, comprehensive cancer center in the southwest United States. Data were gathered through a sequence of audio taped interviews of 20 practicing oncology nurses, which were subsequently transcribed and analyzed.
Study results revealed that sexuality assessment is an enormous dilemma that nurses face in their practices. Most nurses verbalized understanding of the importance of sexuality assessment. While nurses were able to ask patients for information about many other sensitive issues, personal constraints often prevented them from addressing the topic of sexuality. A list of identified, often self-imposed, barriers was revealed that prohibited nurses from assessing patients' sexuality. Nurses' practices regarding sexuality assessment occurred in a milieu that consisted of their conceptualization of sexuality, personal world-views, and individual efforts to search for a comfort level that would make discussing sexuality more feasible. Most nurses openly admitted they did not do a good job with sexuality assessment. Some of the nurses were able to offer ideas or suggestions to improve nursing practice with the sensitive topic of sexuality. Evidence derived from this study indicated that simple, short term educational programs will be ineffective in overcoming the major barriers that nurses identified regarding the opportunity and ability to initiate sexual assessment. Programs to increase sexuality assessment must address factors, such as nurses' personal comfort with sexuality, individual knowledge levels, and language skills to enable routine initiation of dialogues with patients about sexuality. Programs need to be ongoing in nature and nurses must be supported as they reframe their concept of sexuality and engage in a new skill. Research that identifies strategies to enhance perceived facilitators and decrease perceived barriers related to nurses' assessment of patients' sexuality concerns should continue to be an essential goal for nursing.