Sexual Health Nurses Research Articles

(145) Health Practitioner Attitudes and Values Towards Problematic Sexual Behaviours

Abstract Introduction Sexuality is expressed through an individual’s sexual behaviours. Distinguishing “problematic” or atypical sexual behaviours from “typical” sexual behaviours depends on sociocultural conceptions of the norm. Perceptions of problematic sexual behaviour evolve in response to societal change. These perceptions influence and reflect the attitudes and vales of health practitioners. The attitudes and values of health practitioners directly affects clients with problematic sexual behaviours. Therapy approaches are not value-free. Practitioners are influenced by sociocultural norms which create and reinforce stereotypes. These social forces are especially pronounced in the context of problematic sexual behaviours. The nosological classification of sexual “disorders” risks pathologizing normal variants of sexual behaviours. Despite this, research examining health practitioner attitudes and values toward problematic sexual behaviours is scant. Existing measures of attitudes either focus on a broad range of sexual behaviours or on sexual health overall. We therefore sought to understand the themes underlying health practitioner attitudes and values toward problematic sexual behaviours. Objective To assess the themes influencing health practitioner attitudes and values towards problematic sexual behaviours. Methods An inductive qualitative approach provided the framework using in-depth, semi-structured interviews. An interview schedule was based on deductive domains gleaned from a review research exploring health practitioner attitudes and values toward problematic sexual behaviour, and the research team’s experience of the field. A case vignette of a distressed person reporting a problematic sexual behaviour was created to trigger discussion. A diverse range of health practitioners working with people reporting problematic sexual behaviours was recruited. This included five medical doctors (general practice, psychiatry, sexual health) and two sexual health nurses. A coding matrix was generated based on a priori review of the literature and a posteriori review of the interviews. Thematic analysis of interview transcripts was performed using the software program NVivo. Results Five themes emerged from the interviews. Two deductive themes were identified: methods of inquiry about sexual behaviours; discrepancies in defining problematic sexual behaviours. Myriad frameworks underpin a practitioner’s exploration of sexual behaviour issues. Interviewees also could not operationalise a consistent definition of the “problem”. Three inductive themes emerged: managing judgement in consultations; reflections on practitioner knowledge; the tension between fantasies and problematic sexual behaviours. Interviewees referred to “non-judgemental care” as essential in addressing sexual behaviour problems. There was consistent reference to a “limited understanding” of problematic sexual behaviours. A need to differentiate thoughts (fantasies) from actions (behaviours) for risk stratification was apparent. Conclusions The attitudes and values of health practitioners are influenced by sociocultural conceptions of normative sexual expression. These attitudes and values affect practitioner responses to people with problematic sexual behaviours. To better understand this, we propose three recommendations: the development of tailored supports to assist practitioners in managing judgements; an educational module to build understanding of problematic sexual behaviours; the development of a survey instrument to investigate the attitudes and values of health practitioners more broadly in responding to problematic sexual behaviours. Disclosure No.

‘I wouldn’t trust it …’ Digital transformation of young people’s sexual health services: a systems-informed qualitative enquiry

IntroductionDigital sexual health technologies for young people, such as websites, texting services and apps, could address some of the sexual health inequalities that many experience, since they have the potential...

Disruptions of sexually transmitted and blood borne infections testing services during the COVID-19 pandemic: accounts of service providers in Ontario, Canada

BackgroundSince the onset of the COVID-19 pandemic in March 2020 in Canada, the availability of sexual health services including sexually transmitted and blood-borne infection (STBBI) testing has been negatively impacted in the province of Ontario due to their designation as “non-essential” health services. As a result, many individuals wanting to access sexual healthcare continued to have unmet sexual health needs throughout the pandemic. In response to this, sexual health service providers have adopted alternative models of testing, such as virtual interventions and self-sampling/testing. Our objective was to investigate service providers’ experiences of disruptions to STBBI testing during the COVID-19 pandemic in Ontario, Canada, and their acceptability of alternative testing services.MethodsBetween October 2020-February 2021, we conducted semi-structured virtual focus groups (3) and in-depth interviews (11) with a diverse group of sexual health service providers (n = 18) including frontline workers, public health workers, sexual health nurses, physicians, and sexual health educators across Ontario. As part of a larger community-based research study, data collection and analysis were led by three Peer Researchers and a Community Advisory Board was consulted throughout the research process. Transcripts were transcribed verbatim and analysed with NVivo software following grounded theory.ResultsService providers identified the reallocation of public health resources and staff toward COVID-19 management, and closures, reduced hours, and lower in-person capacities at sexual health clinics as the causes for a sharp decline in access to sexual health testing services. Virtual and self-sampling interventions for STBBI testing were adopted to increase service capacity while reducing risks of COVID-19 transmission. Participants suggested that alternative models of testing were more convenient, accessible, safe, comfortable, cost-effective, and less onerous compared to traditional clinic-based models, and that they helped fill the gaps in testing caused by the pandemic.ConclusionsAcceptability of virtual and self-sampling interventions for STBBI testing was high among service providers, and their lived experiences of implementing such services demonstrated their feasibility in the context of Ontario. There is a need to approach sexual health services as an essential part of healthcare and to sustain sexual health services that meet the needs of diverse individuals.

Views and practice of abortion among Queensland midwives and sexual health nurses.

BackgroundA significant barrier to the access of safe abortion is the lack of trained abortion providers. Recent studies show that with appropriate education, nurses and midwives can provide abortions as safely as medical practitioners.AimsTo examine the attitudes and practices of registered midwives (RMs) and sexual health nurses (SHNs) in Queensland toward abortion.Materials and MethodsA cross‐sectional mixed‐methods questionnaire was distributed to RMs and SHNs from the Queensland Nursing and Midwifery Union. Data were described and analysed both quantitatively and qualitatively.ResultsThere was a 20% response rate (n = 624) to the survey from the overall study population. There were 53.5% who reported they would support the provision of abortion in any situation at all; 7.4% held views based on religion or conscience that would make them completely opposed to abortion. There were 92.9% who felt that education surrounding abortion should be part of the core curriculum for midwifery and/or nursing students in Australia. The qualitative responses demonstrated a variety of views and suggestions regarding the practice of abortion.ConclusionsThere was a wide variation in views toward induced abortion from RMs and SHNs in Queensland. While a proportion of respondents opposed abortion in most circumstances, a significant group was in support of abortion in any situation and felt involvement in initiating and/or performing abortion would be within the scope of RMs and SHNs.

Couples’ experiences with sexuality after spinal cord injury

Purpose To explore sexuality after spinal cord injury (SCI) from the perspectives of individuals with SCI and their romantic partners. Methods A sample of 8 Canadian adults with SCI (6 men, 2 women) and their partners participated in this study (N = 16). Semi-structured dyadic and individual interviews were conducted, discussions surrounding sexuality and intimacy were extracted, and a qualitative description of the interview data was performed using thematic analysis. Results Three major themes were identified: the changing definition of sex; emotions; and practical support. Couples’ conversations around the changing definition of sex after SCI addressed the taboo topic of sexuality and the importance of communication between couples, peers, and healthcare providers. Emotions included fears of losing intimacy, embarrassment in managing bladder and bowel interference, and acceptance in balancing being a romantic partner and a caregiver. Finally, couples reported challenges accessing practical support including medical interventions and sexual health nurses, but saw value in peer mentorship programs. Conclusion Couples explored a changing definition of sex following SCI that was complicated by the taboo nature of discussing sexuality, experienced a range of emotions throughout the recovery process, and had difficulties navigating the healthcare system for appropriate support. IMPLICATIONS FOR REHABILITATION Healthcare professionals should promote discussion and provide support for sexuality following SCI, but during initial rehabilitation may be too early. Healthcare providers should prepare people with SCI and their partners for the inevitable trial-and-error process involved in sexual rehabilitation. Rehabilitation professionals could direct couples to SCI peer mentorship programs to help normalize the experiences and emotions of sexual rehabilitation.

Rumination, risk, and response: a qualitative analysis of sexual health anxiety among online sexual health chat service users.

Anxiety is common among sexual health service users. Accessible, anonymous online sexual health services may offer opportunities to connect users with mental health services, but little is known about anxiety in these settings. We sought to characterise expressions of anxiety among chat users and nurse responses to anxiety. We conducted inductive thematic analysis of transcripts from an anonymous online sexual health chat service moderated by sexual health nurses. Among chat users, we identified: worry, anxiety, and emotional distress, particularly regarding HIV transmission risk, testing, and symptoms; exaggerated appraisal of HIV-transmission risk associated with sex-related shame and stigma; and patterns of anxiety that were unresolved by HIV education or testing interventions. Although nurses recognised and acknowledged anxiety, their responses to this anxiety varied; some provided anxiety management information, while others offered sexual health education and risk assessment. Targeted interventions addressing HIV-related stigma and anxiety among online sexual health service users are needed to facilitate connections to appropriate mental health supports.

Clinician imaginaries of HIV PrEP users in and beyond the gay community in Australia

Through the development and implementation of HIV pre-exposure prophylaxis (PrEP), the characteristics of PrEP users have been configured in a range of ways. Drawing on the concept of ‘imaginaries’, we consider how clinicians imagine PrEP users and related communities. We conducted 28 semi-structured interviews in 2019–2020 with PrEP-providing clinicians based in New South Wales and Western Australia. Participants included general practitioners, sexual health nurses and sexual health doctors. We inductively developed three themes through a reflexive thematic analysis: ‘PrEP users as 99% gay men/MSM’, ‘The informed and connected PrEP user’, and ‘Condom users in the PrEP era’. Participants imagined PrEP users primarily as gay men, and so we focused on how gay community was imagined in relation to PrEP users. Users were imagined as supporting one another to use PrEP effectively, but some were imagined as threatening norms of condom use amongst gay community. Analysing clinician imaginaries of PrEP users reveals insight into how clinicians speculate about and engage with changing community norms related to condom use and accessing PrEP. These imaginaries reveal ongoing tensions about who is believed to be best suited to PrEP, and PrEP’s impact on norms of conduct in imagined biosocial communities like gay men.

A Concept Analysis of Barriers to Sexual Health Nursing Care

A Concept Analysis of Barriers to Sexual Health Nursing Care

Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians.

In this qualitative study, we examine the challenges that have emerged for PrEP-providing clinicians after public subsidy for PrEP was introduced. We conducted 28 semi-structured interviews in 2019-20 with PrEP providers in two Australian states, and analysed data thematically. Participants included general practitioners (GPs), sexual health nurses and sexual health physicians. Sexual health services have been reconfigured to meet changing patient demand, with an emphasis on ensuring equitable financial access to PrEP. Restrictions to nurse-led PrEP frustrated some participants, given that nurses had demonstrated competence during trials. GPs were believed to be less effective at prescribing PrEP, but GP participants themselves indicated that PrEP was an easy intervention, but difficult to integrate into general practice. Participants expressed discomfort with on-demand PrEP. Our findings indicate that supporting ways for patients without Medicare to access PrEP inexpensively, advocating for nurse-led PrEP, and developing guidelines adapted to general practice consultations could ensure that PrEP is delivered more effectively and equitably. Additionally, PrEP providers require encouragement to build confidence in providing on-demand PrEP.

Social representation of reproductive biotechnologies among nurses working in sexual and reproductive health.

to compare the social representations of reproductive biotechnologies among sexual and reproductive health nurses, and their links with professional practice. an analytical, comparative, qualitative research, supported by the Theory of Social Representation, carried out in May/2014-February/2015, with 32 nurses from the city of Rio de Janeiro. Semi-structured interview, analyzed by ALCESTE® software. nurses not active in assisted human reproduction represent reproductive biotechnologies as unnatural methods of human reproduction, assessing the practice in this field as generalist and bureaucratic. Those who work represent as auxiliary and supporting nature for heterosexual couples, considering the innovative and specialized practice. each group presented specific contents and dimensions about reproductive biotechnologies. The representations are centered on moral, normative and ideological personal values, anchored in the traditional conceptions of human and family reproduction, but also collective, acquired in the professional routine, showing group identity and its distinct practices considering reproductive biotechnologies.

Issues Associated With Prescribing HIV Pre-exposure Prophylaxis for HIV Anxiety: A Qualitative Analysis of Australian Providers' Views.

HIV pre-exposure prophylaxis (PrEP) can alleviate anxiety about acquiring HIV, particularly for gay men and other men who have sex with men. However, research with PrEP providers has rarely examined HIV anxiety. We conducted 25 semistructured interviews in 2019-2020 with PrEP providers in New South Wales and Western Australia, and analyzed data thematically. Participants included general practitioners and sexual health nurses and doctors. Our analysis explores providers' views on providing PrEP to reduce HIV anxiety for gay men, serodiscordant couples where the partner with HIV has an undetectable viral load, and for "worried well" individuals who the providers speculated might have undisclosed risk. Although providers viewed PrEP as beneficial for many people's personal lives and relationships, they felt cautious about prescribing PrEP solely for HIV anxiety, while at the same time reporting that they prescribed PrEP if individuals insisted on it and had no medical contraindications.

P-04-20 Influence of the Interpersonal Relationship of the Organizational Climate in the Nurse Care of Sexual Health

Determine the influence of interpersonal relationships of the organizational climate on the care of sexual health nurses, in a hospital unit. Quantitative, descriptive, non-experimental and correlational transverse study. Non-probabilistic test, 73 nursing professionals from a second-level hospital unit in Mexico. The SPSS version 21 statistical program was used, applying descriptive statistics tests to understand sociodemographic and labor characteristics. About the type of correlationship between the main variables, Pearson test “r” was applied. The sociodemographic characteristics of the participants correspond to: under 35 years (55%), female gender (82%), single and married (36%), eventual hiring (45 %) and bachelor´s degree (73%). The majority as a general nurse "A” degree (91%), in the internal medicine and Toco surgery (27% respectively); with a salary between USD 560-1070 per month (64%) and an age of 1-10 years (73%). Was found a moderate and directly proportional relationship in the interpersonal relationships of the organizational climate and nurse care of sexual health (r= 0.724, p=0.012).

From silos to buckets: a qualitative study of how sexual health clinics address their clients' mental health needs.

To describe the current constraints, facilitators, and future prospects for addressing mental health and substance use (MHSU) concerns within sexual health clinics in two cities in British Columbia, Canada. We conducted in-depth interviews with 22 providers (14 nurses, 3 physicians, 3 administrators, 2 other health professionals) from six sexual health clinics. Providers consistently affirmed that MHSU-related concerns co-occur with sexual health concerns among clients presenting to sexual health clinics. Three factors constrained the providers' abilities to effectively address MHSU service needs: (1) clinic mandates or funding models (specific to sexually transmitted infections (STI)/HIV or reproductive health); (2) "siloing" (i.e., physical and administrative separation) of services; and (3) limited familiarity with MHSU service referral pathways. Mental health stigma was an additional provider-perceived barrier for sexual health clinic clients. The low barrier, "safe" nature of sexual health clinics, however, facilitated the ability of clients to open up about MHSU concerns, while the acquired experiences of sexual health nurses in counselling enabled clinicians to address clients' MHSU needs. In response to this context, participants described actionable solutions, specifically co-location of sexual health and MHSU services. Sexual health clinicians in British Columbia generally affirm the results of previous quantitative and client-focused research showing high rates of MHSU-related needs among sexual health clinic clients. Providers prioritized specific short-term (referral-focused) and long-term (healthcare re-organization, co-location of sexual and MHSU services) solutions for improving access to MHSU services for those using sexual health services.

Four-year overview of enrollment and participation in research studies conducted at the Prostate Cancer Supportive Care (PCSC) Program.

39 Background: The mission of the Prostate Cancer Supportive Care (PCSC) Program at the Vancouver Prostate Centre (VPC) is to provide clinical care focused on the needs of prostate cancer patients and partners. It is comprised of six modules that are administered by medical professionals in urology, radiation oncology, sexual health nurses, registered dieticians, certified exercise physiologist, male pelvic floor physiotherapists, and couples’ counselling. Incorporation of research into daily care provides evidence for these practices, identifies areas for improvement, and tests new approaches. In order to evaluate the interface between the clinical and research programs, we reviewed the metrics of our PCSC program. Methods: Research studies were grouped by type. Screening and enrollment logs were reviewed to tally the total number of patients approached versus enrolled. Reasons for non-participation based on data in our enrollment logs were categorized. Results: Between Feb 2015 and Mar 2019, PCSC Program participated in 22 research studies: 9 therapeutic or lifestyle intervention studies (3 RCTs), 3 observational studies, 2 registries, 1 survey, 1 genetic study, 1 databank , 2 collaborative programmatic studies, 3 “permission to contact” studies (referral to the study team only). 8 of the 22 studies included recruitment of dyads (both patient and their partner or caregiver). Of 1080 consenting patients, 760 (70.4%) enrolled in 1 study, 210 (19.4%) in 2 studies, and 110 (10.2%) in > 3 studies. 583 patients did not consent due to lack of interest (43.7%), not available (21.1%), time constraints (10.3%), travel distance (6.7%). Conclusions: Our data show that a subspecialty supportive care program can provide a rich environment in which to conduct clinical research. We believe that the integration of the research program and personnel into the clinical setting is key to our success. Current on-going studies are evaluating the impact of and patient satisfaction with all PCSC modules.

Assessing the Consultation and Relational Empathy (CARE) Measure in sexual health nurses\u2019 consultations

BackgroundIncreasingly healthcare policies emphasise the importance of person-centred, empathic care. Consequently, healthcare professionals are expected to demonstrate the ‘human’ aspects of care in training and in practice. The Consultation and Relational Empathy (CARE) Measure is a patient-rated measure of the interpersonal skills of healthcare practitioners. It has been widely validated for use by healthcare professionals in both primary and secondary care. This paper reports on the validity and reliability of the CARE Measure with sexual health nurses.MethodsPatient questionnaires were collected for 943 consultations with 20 sexual health nurses. Participating patients self-completed the questionnaire immediately after the encounter with the nurse. The questionnaire included the ten item CARE Measure, the Patient Enablement Index, and overall satisfaction instruments. Construct validity was assessed through Spearman’s correlation and principal component analysis. Internal consistence was assessed through Cronbach’s alpha and the inter-rater reliability through Generalisability Theory. Data were collected in 2013 in Scotland.ResultsFemale patients completed 68% of the questionnaires. The mean patient age was 28.8 years (standard deviation 9.8 years). Two of the 20 participating nurses withdrew from the study. Most patients (71.7%) regarded the CARE Measure items as very important to their consultation and the number of ‘not applicable’ and missing responses’ were low (2.6% and 0.1% respectively). The participating nurses had high CARE Measure scores; out of a maximum possible score of 50, the overall mean CARE measure score was 47.8 (standard deviation 4.4). The scores were moderately correlated with patient enablement (rho = 0.232, p = 0.001) and overall satisfaction (rho = 0.377, p = 0.001. Cronbach’s alpha showed the measure’s high internal consistency (Cronbach’s alpha coefficient = 0.95), but the inter-rater reliability could not be calculated due to the high achieved CARE Measure scores that varied little between nurses.ConclusionsWithin this clinical context the CARE Measure has high perceived relevance and face validity. The findings support construct validity and some evidence of reliability. The high CARE Measure scores may have been due to sample bias. A future study which ensures a representative sample of patients on a larger group of nurses is required to determine whether the measure can discriminate between nurses.

Listening for commissioning: A participatory study exploring young people's experiences, views and preferences of school-based sexual health and school nursing.

To explore the experiences, views and preferences of young people aged 11-19years regarding school-based sexual health and school nursing to inform commissioning and delivery for one local authority area in England during 2015. Promoting sexual health for young people remains a challenging, even controversial, but important public health issue. Concerns regarding accessibility, acceptability and efficacy in school-based sexual health and school nursing are evident in the literature. Additionally, a complex public health policy context now governs the funding, provision and delivery of sexual health and school nursing, which potentially presents further challenges. A qualitative, participatory design was used to explore sexual health and school nursing. Data were generated from 15 focus groups (n=74), with young people aged 11-19years, in educational-based settings in one local authority area in England. The resultant themes of visibility in relation to sexual health education and school nursing revealed both the complex tensions in designing and delivering acceptable and appropriate sexual health services for young people and the significance of participatory approaches. Our study shows the importance of participatory approaches in working with young people to clearly identify what they want and need in relation to sexual health. The findings also confirm the ways in which school-based sexual health remains challenging but requires a theoretical and conceptual shift. This we argue must be underpinned by participatory approaches. School nurses have always had a significant role to play in promoting positive sexual health for young people and they are exceptionally well placed to challenge the risk-based cultures that frequently dominate school-based sexual health. A shift of debates and practices towards the promotion of positive sexual health cultures though previously argued for now requires the active engagement and involvement of young people.

Designing a sexual health risk assessment for young people.

Sexual health nurses working with teenagers from the black and minority ethnic community reflect on fieldwork undertaken for a Mary Seacole leadership award aimed at reducing inequalities.

Increasing access to sexual health care for rural and regional young people: Similarities and differences in the views of young people and service providers.

This study aims to describe the views of sexual health service providers on access issues for young people and consider them together with the views of young people themselves. A cross-sectional mixed-methods study design involving semi-structured interviews with health service providers and an electronic survey with young people. Four towns in rural and regional Queensland, Australia. A total of 32 service providers: 9 sexual health nurses, 8 general practitioners, 6 school-based youth health nurses, 5 sexual health educators, 2 Australian Aboriginal health workers and 2 youth workers. There were 391 young people who participated in the Young People's Survey. Themes generated from interviews with service providers and quantitative data from young people addressing access to sexual and reproductive health (SRH) services for rural and regional young people. Service providers frequently identified structural barriers, confidentiality and lack of awareness of SRH services as barriers for young people seeking SRH care. Young people also reported that structural factors such as transport, cost and service operating hours were important; however, they placed greater value on personal attributes of service providers, particularly welcoming and non-judgemental attitudes. Health service policy and training focused on attitudinal qualities of individual service providers may improve access to SRH services for young people. Selective staff recruitment and professional development are important to increase sensitivity to youth issues. Promotion of non-judgemental and confidential care may also improve access for youth.

Nurse Leaders’ Experiences of Implementing Regulatory Changes in Sexual Health Nursing Practice in British Columbia, Canada

Most research about regulatory policy change concerning expanded nursing activities has emphasized advanced practice roles and acute care settings. This study is a contribution to the small pool of research concerned with regulatory policy implementation for nurses undertaking expanded nursing practice activities in a public health context. Using the regulatory changes in certified nursing practice in one Canadian province as our starting point, we investigated the experiences of nurse leaders in implementing this change. Using a qualitative interpretive descriptive approach informed by tenets of complexity theory, we examined the experiences of 16 nurse leaders as situated within the larger public health care system in which nurses practice. Two interrelated themes, (a) preparing for certification and (b) the certification process, were identified to illustrate how competing and contrasting demands between health care and regulatory organizations created substantial barriers to policy change. Implications for health service delivery and future research are discussed.

P75 Do cash incentives increase the uptake of chlamydia testing in pharmacies?

BackgroundChlamydia screening uptake rates in Australian and overseas pharmacies vary widely (11% to 58%).AimTo determine the effect on the uptake of chlamydia screening in community pharmacies when a cash reward...