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Commentary: The Acute Care for Elders Unit: Taking the Rehabilitation Model into the Hospital Setting
Sexuality is nursing’s last frontier. Kautz has provided us the sort of detailed language that rehabilitation nurses can use to teach patients as the method to break through this frontier. In spite of the holistic claims of our discipline, the one area we shy away from is sexuality. And yet, our sexual identity is formed early in life and is a fundamental expression of who we are. So, if this is so important to our identity, why is sexual counseling or even a sexual history something we don’t attend to, at least with the same vigor as, say, we do our patients’ bowel habits?
Now, it is not that our official taxonomies do not address sexuality in some form. The NANDA Taxonomy, for example, has “sexuality” as Domain 8, with the definition: Sexual identity, sexual function, and reproduction (North American Nursing Diagnosis Association, 2001). The sanctioned nursing diagnoses are Sexual Dysfunction, and Sexuality Patterns, Ineffective. Most textbook nursing health histories address sexuality, but hospital health histories usually reduce sexuality to a reproductive history.
Perhaps there are two conflicting notions that keep us from assisting patients with disabilities as they attempt to reclaim their sexual lives. Foremost is our society’s paradoxical attitudes toward sexuality. It is at once permissive, as seen in popular culture, but at the same time, restrictive, as seen with attitudes toward even discrete breast feeding in public. Secondly, is our understanding of sexuality as primarily what Tiefer (1995) calls a natural act, meaning a physiological act. Likening sexuality and sex to a physiological or biological analogy, she believes, has several consequences. One is that if considered natural (as digestion), one doesn’t need to be taught. The range among humans thus is considered fairly limited, and those who are experts are those who understand the physiology. So, Tiefer points out that in the fundamentals of sexuality “you’ll find the physiology of arousal but not of pleasure, of performance but not of fantasy” (p. 6).
Another analogy for sexuality is music (Tiefer, 1995). While playing piano requires anatomy and physiology of hands, arms, eyes, and ears, piano books do not begin with this. Importantly, one is not expected to know how to play without guidance, and everyone expects that abilities, desires, and styles vary greatly among people. A love of music transcends ages, but different aged people enjoy different styles, at different times, and different volumes. And certainly if someone sustained neurological injury, retraining to play again would be expected. So, this is where we are with stroke survivors and others in rehabilitation. They need help getting the music back—perhaps not in the same way, but in some way.
Some of our collective discomfort with frank sexual discussions with patients is a lack of knowledge and language. Kautz has given us the gift of both knowledge and specificity of language—resources. Nurses play such an important integrative role in rehabilitation; this is certainly one aspect of care that nurses must address. The author writes that he “cannot think of a higher rehabilitation goal than assisting our patients to love”—and many patients surely agree.
North American Nursing Diagnosis Association. (2001). Nursing diagnosis: Definitions and classification. 2001-2002. Philadelphia: NANDA.
Tiefer, L. (1995). Sex is not a natural act & other essays. Boulder, CO: Westview Press.