Orientation about sexuality for nursing students

Abstracts

OBJETIVO: Identificar a percepção de estudantes do Curso de graduação em Enfermagem sobre atividades voltadas à orientação sexual; estabelecer a forma de desenvolvimento destas atividades junto aos estudantes. MÉTODOS: Trata-se de um estudo descritivo em que se utilizou a análise de conteúdo, realizado junto a uma população constituída por 193 estudantes do Curso de graduação em Enfermagem da Universidade Federal de São Paulo. RESULTADOS: 93% dos entrevistados concordaram com atividades voltadas à orientação sexual, e 80% justificaram a necessidade por meio das categorias: contribuição para formação profissional (9%), estereótipos (1%), necessidade de informação (26%), prevenção (4%), cuidar de si para cuidar do outro (13%), autoconhecimento (8%) e dificuldades com o assunto (19%). CONCLUSÃO: Existe interesse dos estudantes de enfermagem por atividades voltadas à discussão da sexualidade humana no espaço acadêmico.

Estudantes de enfermagem; Sexologia; Sexualidade

ORIGINAL ARTICLE

Orientation about sexuality for nursing students

Orientación sobre sexualidad para estudiantes de enfermería

José Roberto da Silva Brêtas^I; Conceição Vieira da Silva Ohara^I; Isis Distrutti Querino^II

^IAssociate Professor at Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brazil

^IISpecialist in Surgical-Medical Clinic at Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil

Corresponding Author

ABSTRACT

OBJECTIVE: To identify the perception of students at the Nursing undergraduate course about sexual orientation activities; to establish how these activities should be developed towards the students.

METHODS: This is a descriptive study using content analysis, performed with a population consisting of 193 students of the Nursing undergraduate course of Universidade Federal de São Paulo.

RESULTS: 93% of the respondents agreed with sexual orientation activities and 80% justified the necessity through the following categories: contribution for professional education (9%), stereotypes (1%), necessity of information (26%), prevention (4%), taking care of oneself in order to care for the other (13%), self-knowledge (8%) and difficulties with the topic (19%).

CONCLUSION: Nursing students are interested in activities focused on the discussion of human sexuality within the academic universe.

Keywords: Students of nursing; Sexology; Sexuality

RESUMEN

OBJETIVO: Identificar la percepción de estudiantes del Pregrado en Enfermería sobre actividades dirigidas a la orientación sexual; establecer la forma de desarrollo de estas actividades junto a los estudiantes.

MÉTODOS: Se trata de un estudio descriptivo en el cual se utilizó el análisis de contenido, realizado junto a una población conformada por 193 estudiantes del pregrado en Enfermería de la Universidad Federal de Sao Paulo.

RESULTADOS: el 93% de los entrevistados concordaron con actividades dirigidas a la orientación sexual, y el 80% justificaron la necesidad por medio de las categorías: contribución a la formación profesional (9%), estereotipos (1%), necesidad de información (26%), prevención (4%), cuidar de sí para cuidar del otro (13%), autoconocimiento (8%) y dificultades con el asunto (19%).

CONCLUSIÓN: Existe interés de los estudiantes de enfermería por actividades orientadas a la discusión de la sexualidad humana en el espacio académico.

Descriptores: Estudiantes de enfermería; Sexologia; Sexualidad

INTRODUCTION

In a general way, care refers to acts of assistance, support or facilitation for or towards another individual or group that shows evident or anticipated needs, in order to improve a human condition or way of living. And caring refers to direct (or indirect) activities, processes and decisions of sustenance, skilled in aiding people, so as to reflect on behavioral attributes that are emphatic, supportive, compassionate, protective, helpful, educational and others, dependent on the necessities, problems, values and goals of the individual or group receiving care⁽¹⁾.

In nursing, the act of caring establishes a very close relationship, often intimate, with intense physical contact and permeated by several feelings and sensations. These actions, performed directly on the patient's body, put the nurse in direct contact with the excrements, pains and feelings of the patients⁽²⁾.

The individual is materialized and relates with the world through the body, organizing their stay in the world. It is also through the body that the nurses become aware of their history, their relations with the other and with the world, perceiving and comprehending that the meaning of their own existence cannot be apprehended or unveiled without mediation, and that this is offered to our comprehension and interpretation through the body itself⁽³⁾.

We believe that the nurse's body is the mediator of the care provided to the client, and, due to the proximity established between both in the act of caring, both the body and the corporeality become one in this profession.

For this practice, the nurses or the nursing students surround themselves to fulfill the healthcare necessities of the client, providing an inter-relational process through physical contact, which occurs by touching.

Techniques are important when caring for the client, but, conversely, are often used by the nurse as a defense mechanism. In this sense, an observation can be added: there is no technique that will protect one from oneself⁽⁴⁾.

Based in these assumptions and understanding that sexuality is an individual and social psycho-affective manifestation that transcends its biological base (sex), and whose expression is regulated by the current social values⁽⁵⁾, we note that, although it is present in every moment experienced by the nurse, it is, still, kept silent, hidden or invisible⁽⁶⁾. This invisibility and the occultation of some of the themes stemming from this context bring, by themselves, a special meaning. This happens in relation to sexuality in the nurses' education and practice.

In the nursing practice, a sign showing that sexuality is treated as a taboo is the lack of academic studies, discussions and reflections about it, and also in the professional practice itself. Besides, when feasible, they are shown in a biologist perspective, limited to family planning and the sexual act as a source of risk, not pleasure^(6-7).

Overall, sexuality is still a very repressed theme in our society, and repression in sexual education, since childhood, yields a series of "knots" that become more and more entangled, crushing our sexual development and behavior. Usually, such a situation demands a certain amount of time to be absorbed and is not always spontaneously reversible, and/or releases the individual from negative feelings that were incoherently repressed. As such, nursing is inserted into this social-cultural context, and, therefore, does not differ about beliefs, myths and taboos⁽⁸⁾.

Thus, we cite a study performed with American nurses, where their perceptions about sexuality related to patient care were explored, and the findings expose the difficulties towards the subject. It also proposes the introduction of the sexuality theme in the nursing curriculum so that they can acquire knowledge and integrate it to their practice⁽⁹⁾.

Motivated by the proposal of making the students of the Undergraduate Nursing Course at Universidade Federal de São Paulo (UNIFESP) aware about this theme, we elaborated this study with the goal of gathering subsidies to organize activities focused on orientation about sexuality.

OBJECTIVE

The purposes of this research were: to identify the perceptions of the students of the Undergraduate Nursing Course about activities focused on sexual orientation and establish how these activities should be established with the students.

METHODS

This is a descriptive study, with a quanti-qualitative approach. The choice for this type of study was made with the intention of describing the characteristics of a given population or facts and phenomena of a given reality. The study provides an outline of reality, since it describes, registers, analyzes and interprets the current nature or processes of the phenomena. The focus of this method in the dominant conditions of reality, or how a person, group or thing acts or works in the present, employs comparison and contrast to this end. It conveys the current conditions, necessities and how to achieve results for the resolution of problems⁽¹⁰⁾.

This project was approved by the Review Board of UNIFESP, complying with all the standards set by Resolution #196/96, which deals with the norms for research involving human beings⁽¹¹⁾.

The study population consisted of 193 students, with 176 (91%) females and 17 (9%) males, regularly enrolled in the four semesters of the Nursing Undergraduate Course at UNIFESP, who spontaneously decided to participate in the research.

Once we had the participation of the subjects who signed the term of consent, a semi-structured interview method was chosen for data collection, since it provides an atmosphere of interaction and reciprocity between the interviewer and the interviewee. The greatest advantage of the interview over other techniques is that it allows for the immediate and continuous apprehension of the desired information, with practically any type of respondent and about several topics. When the interview is successful, it can allow for the treatment of strictly personal and intimate topics, as well as complex themes and individual choices, which allows to further delve in the researched topic⁽¹²⁾.

In order to execute this stage of the research, we used some variables to characterize the population studied: age range, gender, religion and marital status, in addition to the study variable "activities focusing on sexual orientation", contemplated by questions based on the individuals' agreement or disagreement with the activities mentioned, the justification of the answers and the best way of performing them, thus allowing for a free conversation between the researcher and the interviewee.

After the interview, we used the Content Analysis technique to interpret the collected material. Content Analysis can be defined as a group of techniques of communication analysis, which aims to obtain, through systematic and objective description of the contents in the messages, indicators that allowed for the inference of knowledge related to the conditions of production/reception of messages⁽¹³⁾.

Among the Content Analysis techniques, we decided for category analysis, which allowed for the execution of data analysis through integrally reading the reports of each interviewee, where we tried to comprehend their interest (or lack thereof) about the theme. They were read so that a general idea could be obtained from each report. Next, each report was read a second time, attempting to identify structuring elements of the adolescents' testimonies about the researched topic, so that these could be decomposed into categories, yielding an axis for their analysis.

Two charts were elaborated for the presentation of results, considering the differences in the students' level of interest. By analyzing the descriptions of each category, they were also expressed in figures.

RESULTS

As for the age range, 24% of the female population were between 17 and 20 years old; 55% between 21 and 23 years old, and 21% between 24 and 29 years old. For the male population, 24% are between 17 and 20 years old, 35% between 21 and 23 years old, and 41% between 24 and 29 years old.

According to the data collected, the predominant religion was Catholicism, with 56%, followed by Spiritism with 15%, Evangelical with 9%, others (messianic, protestant, Adventist, Lutheran, Jewish) with 8%, 2% stating having no religion and 9% did not answer this question. Regarding marital status, 94% were single, 3% were married, 2% were in stable unions and 1% was divorced.

The data obtained with the content analysis revealed the perceptions of the study subjects, who were divided in two groups: those who agreed and those who disagreed with the activities focused on sexual orientation.

In the interviewed population, 93% agreed with activities focused on sexuality orientation. The justifications stated for the necessity of such orientation were grouped in the following categories: contribution for professional education (9%), stereotypes (1%), necessity of information (26%), prevention (4%), taking care of oneself in order to take care of the other (13%), self-knowledge (8%) and difficulties with the topic (19%). Twenty percent of the subjects did not justify their answers.

The students (7%) who did not agree with the activities focused on sexual orientation justified their opinion with the following categories: something unnecessary (4%); exposure (1%); enough information (2%).

Regarding the distribution of preferences about how the activities should be executed, 76% of the students were seen to prefer that sexual orientation would happen individually and in groups, followed by individual strategies (13%) and by group orientation alone (11%).

As for the distribution of the population's opinion about the strategy for the orientations, the highest preferred option was group discussion (32%), followed by workshops with a specific theme (30%), interviews (18%), expositive classes (15%) and other strategies (5%). Among these other strategies, the students mentioned dynamics that allowed body contact (both ours and the other's); group dynamics; studies of current themes, based in texts read by the students themselves; interviews and discussions with more than two people; each day a person of the group brings a doubt, which then develops into a discussion, with its eventual explanation by the teacher or monitor.

Distribution according to the place where these meetings could occur yielded most respondents (50%) mentioning the classrooms of the Nursing Department as the place of choice for the meetings, followed by 40% who chose the Nursing Assistance Center and 10% who preferred other places.

Regarding the period for the development of activities and service, the population chose late afternoon (47%), followed by lunch time (33%), afternoon (13%), and finally, morning and evening, both with 7% of the answers.

As for the opinion of the population about who would be responsible for developing the activities, 71% chose to have the teacher and the monitor (student) developing the activities together, followed by the teacher, individually (24%) and the student, individually (5%).

Chart 1

Chart 2

DISCUSSION

The category contribution for professional education unveiled, in the essence of the justifications, that an orientation service focused on sexuality is important for the education of the nurse as professional, since we constantly educate others when we provide care, educational activities, which often include sexual orientation. We also know that the theme is not adequately discussed in the undergraduate environment, given the importance it has within the current nursing theories. Such is the case of the Basic Human Necessities, which cover integral care for the individual, including sexuality.

Sexuality has been treated in the nursing theoretical fields as one of the basic human necessities, therefore considered as deserving attention in activities focused on fulfilling the healthcare necessities of the human being. However, in practice, the attention given to it is anchored in its reproductive function and clinical and pathological problems. There is no critical or contextualized discussion contemplating issues of the social-cultural sphere of human sexuality. This silence does not exist only in the theoretical discourse, since we identified that sex and sexuality are still considered taboo subjects in nursing practice and education^(6,14).

Helping another person grow is, at least, helping him/her to care for something or somebody besides him/herself. This involves encouragement and support so that this person may be able to provide care. As such, by helping individuals take care of themselves, fulfilling their own necessities of care and making them responsible for their own life. Thus, we understand that, by starting at the individuals' sexuality-related education and care, we will provide them with subsidies to care for themselves, developing autonomy and build a healthier sexual life⁽¹⁾.

In nursing care practice, the professional is always in contact with the body and the sexuality of the other, as it is the case in procedures such as bed bathing, oral hygiene, intimate hygiene, gall bladder tubing and others. In view of this reality, better education in the sexuality theme would contribute for the knowledge of the nursing students, the client who is the subject of their care, thus minimizing some difficulties in the student-patient relation, and contributing for better professional education.

Some of the students justified the importance of the service, since "there is no information about sexuality in the school curriculum" and "the topic is not often discussed in college" and that not discussing the question and the difficulties faced in undergraduation does not exempt the nurse of facing it during her professional life. On the contrary, it becomes more aggravated, making situations more difficult to be solved in the daily practice⁽¹⁴⁾.

There are also those who believe that the orientation service should not be provided only to the nursing students, but also to students of other courses of the Vila Clementino Campus of UNIFESP, which offers five courses in the Healthcare area (Medicine, Nursing, Speech Pathology, Biomedicine and Ophtalmic Technology).

We consider that this justification is very important, since the nurse is seen in society in ambiguous ways – sometimes as an asexual angel, stripped of any type of pleasure, or a sexual object. This happens because the woman has been considered an object deserving veneration – a fragile being, who must be protected, guided, defended, a sublime, angelical being, an erotic, dangerous, desirable and feared object, with a seductive and demonic nature. Angel and demon are two stereotypes that reflect two of the universally widespread myths about the women: the myth of female goodness and evil⁽¹⁵⁾. Therefore, both women and nurses, and this one doubly so, carry stereotypes that become intermixed and added together – especially in the latter case, because females are a vast majority in the profession⁽¹⁶⁾. Also, there is the fact that the media collaborates for the perpetuation of the figure of the nurse as sexual object, using this image in scenes that denigrate her image and do not reflect the professional reality, such as the use of inadequate clothes at the workplace, exchange of affection and relationships with patients and other healthcare professionals.

The media has a strong effect in the perspective of the population, and they state that this constant and untrue representation of the nurses results in the negative image that the genera public has of them^(16-17).

In the category necessity of information, the essence of most justifications is the lack of clarification and doubts about the sexuality theme, and, as such, the service would be important because it would clarify the students' doubts, offering them better orientation, and, eventually, to the patients as well.

In this category, we obtained justifications focused in the professional future, which we considered pertinent, since the healthcare area is being constantly developed and updated. Therefore, the students would be better prepared to deal with this theme.

There are also justifications based around the lack of a family figure to talk about this topic and the lack of freedom with the parents, and even friends, to clarify doubts. Therefore, the service would help them, since we understand that the student may feel better under the guidance of an experienced professional of the sexuality area, and a person towards whom they have no affective bonds.

Within the prevention category, we obtained justifications saying that even when the healthcare professionals have information, they are subjected to the risks of becoming contaminated, transmitting sexually transmitted diseases (STDs) or even the occurrence of an unplanned pregnancy during a sexual relation. Thus, we observed that these students would like to have activities focused on the orientation, so that they could learn to prevent STDs and unwanted conception adequately.

In the category caring for oneself before caring for the other, we understand that the essence of the students' justifications is that, in order to be able to care for someone, it is first necessary to take care of themselves, i.e., the students have the necessity of knowing and understanding the issues of their own sexuality, so that they can later provide orientation about it to someone. In this sense, building oneself as an ethical subject, caring for oneself, ontologically, is the first relation; next, and even as a consequence, comes care towards the other, since those who know how to care for themselves adequately, know how to lead themselves, can lead themselves in the relation with and for the other⁽¹⁸⁾.

In the self-knowledge category, the students justified the importance of the sexuality orientation service only as a way to know themselves better, not necessarily mentioning that knowing themselves would influence their care and orientation. According to Polak⁽³⁾, nurses believe that it is indispensable to know who they are, how their bodies and minds act, and also, that they need to know themselves first, and later know what their bodies and their profession mean, and which characteristics their work has, for themselves and for the others.

With their testimonies, we understand that the sexual orientation activities can be a type of self-knowledge, which is often hampered by the overload of activities to which the students are submitted to during a full-time course. However, we understand that, when the students become aware of their own sexuality and have adequate information to educate someone about this topic, they will be better prepared and safe to orient someone, providing better care for themselves and their clients.

Salvage⁽¹⁹⁾ says that sexuality is an integral part of the individual, and any disease has the potential of affecting it. This author outlined examples of factors that affect sexuality, such as the disease process, drugs, surgeries and radiotherapy. Any of these can have a profound effect in a patient. The effects of the alterations in sexuality may be overly complex because of the interrelated biological, sociological and psychological aspects involved. This complexity can bring difficulties to estimate the effects of the disease, but may not prevent the nurses from considering sexuality while they care for their patients. This is strengthened with the finding that 93% of the students in the present study consider that the existence of a service of support and orientation about sexuality is important for the nursing students.

As for those who do not agree with the activity, we observed that in the category difficulties with the subject, several justifications were, in their essence, prejudiced in the same way that the sexuality theme is targeted, which often makes this theme become discussed in secrecy and surrounded by discomfort. Therefore, this difficult is extended towards the care provided, constantly making it an unpleasant and stressful activity for those performing it.

The testimonies about the nurses' education, practice and even the techniques used in healthcare exclude what is erotic, sensual, and are laden with prejudice, aggravating myths and taboos, creating an atmosphere of forbiddance about the topic, raising doubts and uncertainties, which overlap what is unsaid, what is not expressed verbally. This causes each person to act according to their pre-conceptions, resulting in embarrassment, feelings of shame, guilt and hostility, both for the nurse and for the other, in the inter-relation at the moment of care⁽²⁰⁾.

Unpleasant situations involve instances where privacy is broken, and they suggest that this is an important aspect in the construction of nursing about the concept of sexuality. Privacy breaches occur when nurses touch or approach their patients very closely, or when a taboo body part is exposed.

In the category something unnecessary, many justifications with varying meanings were obtained. We will analyze each of them separately.

It was observed that there are still students who, even though they are taking courses in the field of the healthcare sciences, believe that the concept of sexuality is limited to the sexual act, or sexual pleasure. Therefore, we understand that, for these students, the service would work not only as orientation about sexuality, but also as a way of unveiling the nursing profession, since we believe that, during the provision of nursing care, we are constantly dealing with the client's sexuality, and consequently, with our own.

In other justifications, we understood that the students considered the topic sexuality as something individual and reserved, and that what they learn in their life experience is enough. We know that several concepts about sexuality that we learned in our day-to-day routine are wrong, and the consequences of this wrongful learning appear in the STD, unplanned pregnancies and transmission of wrong concepts to other people. Especially for being future healthcare professionals, these students should look for accurate and reliable information to orient the other, and also, learn that the sexuality topic, even when very reserved, needs to be discussed so that it can become more natural and understandable in its wide senses (biological, psychological and social).

In the category exposure, he students were observed to feel exposed when attending a sexuality orientation service at the university, but we understand that, from the moment these students understand that sexuality is part of each individual and that it depends on their culture and formative processes of being human, their prejudices about the supporting service will be extinguished, and it can be then considered an important element for the personal and professional education.

In the category enough information, these students were observed to believe that they already have all the necessary information to orient themselves and the other, considering the service to be unnecessary.

CONCLUSION

A global analysis of this study allowed us to affirm that the inclusion of sexuality orientation activities for the nursing students would not simply contribute for professional education, but also to the personal growth of each student, by minimizing the existing taboos about sexuality or clarifying doubts or being a source of information.

We believe that, regardless of how sexuality was approached in the individuals' childhood and adolescence, the university cannot omit or marginalize the discussion of the process of human sexuality. If it is really objective and aims at educating the citizens/nurses so that they can have a holistic view of the human being, it is necessary to be concerned about the theme in the education of these young people as individuals who must know themselves and who will be professionals interacting with other people in the future.

We can also state that the current research will modestly contribute for the theme, since there are not enough academic studies, discussions and reflections. The results were clarifying and motivating, resulting in the organization of actions focused on the orientation about sexuality, such as: introduction of the theme in the content of the Psychology Applied to Health course; one elective course; distribution of condoms; and individual and collective orientation, based on the students' interest on the topic.

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Publication Dates

• Publication in this collection
  13 Jan 2009
• Date of issue
  2008

History

• Accepted
  06 June 2008
• Received
  25 Feb 2008