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1 Nurses Health Education About LGBT Elders: Module 3 nurses heale module 3 SEX & SEXUALITY

2 Nurses Health Education About LGBT Elders: Module 3 This project is supported by funds from the Department of Health and Human Services (DHHS), Health Resources and Services Administration, the Bureau of Health Professions (BHPr), Division of Diversity and Interdisciplinary Education (DDIE), under grant number D62HP15057and title Comprehensive Geriatric Education Program for $160, The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the U.S. Government, DHHS, BHPR or the DDIE. 2

3 Nurses Health Education About LGBT Elders: Module 3 This 1 hour CNE program is being presented without bias and without commercial support. 3

4 SESSION OVERVIEW Role of Sex and Sexuality in the lives of LGBT Elders Conducting Sexual Histories and Providing Health Education for LGBT Elders Creating Safe, Sex Positive Environments for LGBT Elders Nurses Health Education About LGBT Elders: Module 3 4

5 SESSION OBJECTIVES At the end of this session participants will be able to: 3 health benefits sexual activity has for LGBT elders 3 core elements of conducting sexual history 3 prevention techniques that LGBT elders may use to reduce the risk of STI infection or transmission 3 ways to create safe, sex positive environments for LGBT elders Nurses Health Education About LGBT Elders: Module 3 5

6 SEX AND SEXUALITY IN THE LIVES OF LGBT ELDERS Nurses Health Education About LGBT Elders: Module 3 6

SEXUALITY MAY CHANGE OVER TIME AND CIRCUMSTANCE Sexual identity emerges throughout the life cycle Normalize sex among elders Sex is a life-long

7 SEXUALITY MAY CHANGE OVER TIME AND CIRCUMSTANCE Sexual identity emerges throughout the life cycle Normalize sex among elders Sex is a life-long basic human need Sex and intimacy among elders shouldn t be treated as a behavioral problem Nurses Health Education About LGBT Elders: Module 3 7

8 SEXUAL IDENTITY Penis, Testes, produce sperm Blue, Trucks, Pants, aggressive Natal/Biological Sex Intersex 1:1,500 GENDER Societal Construct Uterus, Ovaries, produce eggs Pink, Dolls, Dresses, timid Does this fit? Masculine GENDER IDENTITY Incongruence can cause anxiety GENDER EXPRESSION Outward expression Does this fit? Feminine Gay, Lesbian Sexual Orientation Spiritual, emotional, romantic attraction Hetero, Straight Nurses Health Education About LGBT Elders: Module 3 8

ageism and inaccurate beliefs about sexuality ending later in

9 SEX AND SEXUALITY Institute of Medicine It is likely that research in this field is largely undeveloped as a result of ageism and inaccurate beliefs about sexuality ending later in life. (IOM Report) Nurses Health Education About LGBT Elders: Module 3 9

10 SEX AND SEXUALITY research More then a quarter of people aged 65 to 85 report having an active sex life Of 250 LTC facility residents >> 8% reported sexual activity within the last month >> 17% expressed desire for sexual activity >> 90% reported having sexual thoughts or fantasies For people who were not sexually active, the most common reason why was because they lacked a sexual partner Continued sex with age is strongly correlated to self-reported healt Nurses Health Education About LGBT Elders: Module 3 10

SEXUAL EXPRESSION & INTIMACY Sexual expression does not always mean having penetrative sex Maintenance of physical attractiveness is the most common way elders express sexuality Handholding, kissing,

11 SEXUAL EXPRESSION & INTIMACY Sexual expression does not always mean having penetrative sex Maintenance of physical attractiveness is the most common way elders express sexuality Handholding, kissing, and masturbation are highly common amongst elders in nursing homes Intimacy can also be experienced by spending time with or caring for one another Nurses Health Education About LGBT Elders: Module 3 11

12 BENEFITS OF SEX FOR LGBT ELDERS Sex restores and enhances energy Sex can promote healing Sexual activity may prevent an additional feeling of loss Sex and intimacy reduce feelings of isolation Nurses Health Education About LGBT Elders: Module 3 12

13 WHAT AFFECTS SEXUAL FUNCTIONING? Poor Health Limited Mobility Adverse Side Effects of Medications Erectile Dysfunction Dyspareunia Nurses Health Education About LGBT Elders: Module 3 13

14 SEX & CONSENT If an older adult is able to make decisions about their own healthcare, they can consent to be sexually active. Cognitive Impairments Facility Approval Family Approval Nurses Health Education About LGBT Elders: Module 3 14

15 SEX & CONSENT MOST NURSING HOME RULES FAIL TO RECOGNIZE SEXUAL RIGHTS Nursing home regulations regarding conjugal visits State follow federal guidelines: No private room required Married couples have right to private visits Unmarried and married couples have right to private visits Nurses Health Education About LGBT Elders: Module 3 15

16 SEXUAL HISTORIES & HEALTH EDUCATION Nurses Health Education About LGBT Elders: Module 3 16

17 BENEFITS OF CONDUCTING SEXUAL HISTORIES Identifies sexual risk behaviors Creates an opportunity to provide sexual health education & risk reduction strategies Identifies sexual dysfunction Demonstrates openness between patient and provider Nurses Health Education About LGBT Elders: Module 3 17

18 ALLOWS PROVIDER TO BETTER UNDERSTAND A PATIENT S CIRCUMSTANCES & HEALTH CONCERNS Nurses Health Education About LGBT Elders: Module 3 18

19 TAKING A SEXUAL HISTORY: DO Ensure and maintain confidentiality Remind patient that information provided is confidential Discuss how or why information disclosed would be shared with care taker or others Inform patients that if they do not feel comfortable having full sexual history documented in progress notes that they can ask for some details to be excluded or coded Nurses Health Education About LGBT Elders: Module 3 19

TAKING A SEXUAL HISTORY: DO Be professional and provide assurance Always inform a patient why you are taking a sexual history and how it will be used Connect a patient s sexual

20 TAKING A SEXUAL HISTORY: DO Be professional and provide assurance Always inform a patient why you are taking a sexual history and how it will be used Connect a patient s sexual history to their overall health and well-being Normalize the assessment by telling patients that you conduct it with all patients Do so! Nurses Health Education About LGBT Elders: Module 3 20

21 TAKING A SEXUAL HISTORY: DO Ask appropriate questions: Ensure the appropriateness of questions being asked, making sure they are being asked for the purpose of gathering health information rather than pure curiosity Blend both closed and open-ended questions Ask sexual history questions on intake forms to normalize the conversation and to create a starting point for the conversation Avoid asking questions in a value ridden manner, instead ask them within a health framework Ask clarifying questions if you are uncertain about what a patient is saying When discussing sexual partners, use gender neutral language Nurses Health Education About LGBT Elders: Module 3 21

TAKING A SEXUAL HISTORY: DO Promote sex positivity Normalize sex and sexuality as a valued, lifelong part of human development Be open to discussing a patient s sex life and sexuality in a manner

22 TAKING A SEXUAL HISTORY: DO Promote sex positivity Normalize sex and sexuality as a valued, lifelong part of human development Be open to discussing a patient s sex life and sexuality in a manner that makes them comfortable Encouraging ongoing dialogue about sex and sexuality as it may change over the course of your relationship with the patient Nurses Health Education About LGBT Elders: Module 3 22

23 TAKING A SEXUAL HISTORY: DON T Express verbal or non-verbal judgment Recognize your own judgments about sex/sexuality and minimize the impact those judgments have on your patient Be aware of how judgment can be expressed through verbal and non-verbal cues, including body positioning, tone of voice, and facial expressions When a patient discloses a high risk behavior, ground your reaction in health education and behavior change, not judgment and stigma >> Don t describe a behavior as bad, instead describe it as high risk or describing its potential impact on one s health Nurses Health Education About LGBT Elders: Module 3 23

TAKING A SEXUAL HISTORY: DON T Make assumptions about sexual identity or behaviors Don t assume that someone s sexual orientation or relationship status defines their behaviors or identity Don

24 TAKING A SEXUAL HISTORY: DON T Make assumptions about sexual identity or behaviors Don t assume that someone s sexual orientation or relationship status defines their behaviors or identity Don t assume that seniors aren t having sex Don t assume that your definition of sex is the same as your patient s; establish a shared meaning Nurses Health Education About LGBT Elders: Module 3 24

TAKING A SEXUAL HISTORY: DON T Disclose information about your sexual history If patients ask you about your sex life or sexuality, maintain professional boundaries while not shaming them for asking

25 TAKING A SEXUAL HISTORY: DON T Disclose information about your sexual history If patients ask you about your sex life or sexuality, maintain professional boundaries while not shaming them for asking the question Rather than providing personal information, third person information or examples Instead of I really like using these condoms say Lots of people really like these condoms Nurses Health Education About LGBT Elders: Module 3 25

26 SEXUAL HISTORY: LET S ROLE PLAY Ask a presenter one of these questions Presenter will respond Now ask a follow up questions to gain more information >> Do you have sex with men, women, or both? >> Are you currently having sex with men, women, or both? >> When was the last time you were physical/sexual with a partner? >> What kind of sex are you currently having oral, vaginal, anal, digital, and/or other? Nurses Health Education About LGBT Elders: Module 3 26

27 SEXUAL HISTORY: LET S ROLE PLAY >> What safer sex or prevention techniques are you currently using? >> When was the last time you were screened for HIV and other sexually transmitted infections? >> Do you currently use any prescriptions or substances before or during sex? >> How would you describe your overall satisfaction with your sex life? Has your satisfaction changed over time? Nurses Health Education About LGBT Elders: Module 3 27

28 DOMAINS OF SEXUAL HISTORIES Relationship Status Sexual Orientation Protection & Risk Reduction Techniques Pregnancy History HIV/AIDS Status STI History Sex and Gender of Past & Present Sex Partners Number of Past & Present Sex Partners Frequency & Type of Sexual Behavior Substance Use During Sex Participation in Sex Work or Trade Debut of Sexual Activity Desire for Sexual Activity Cultural Influences on Sex Psychological & Physical Problems during Sex Sexual Assault/Abuse Nurses Health Education About LGBT Elders: Module 3 28

other risk factors Answer questions Identify risks Discuss risk reduction strategies

29 WHAT IS THE GOAL OF A SEXUAL HISTORY? TO PROVIDE HEALTH EDUCATION! Assess existing sexual health knowledge Educate on sexually transmitted infections and other risk factors Answer questions Identify risks Discuss risk reduction strategies Practice risk reduction techniques Encourage testing & screening Nurses Health Education About LGBT Elders: Module 3 29

30 Nurses Health Education About LGBT Elders: Module 3 CREATING SAFE, SEX POSITIVE ENVIRONMENTS 30

BENEFITS OF SAFE SPACE Prevents LGBT elders from going back into the closet Supports elders who are questioning their sexual orientation or gender identity Decreases

31 BENEFITS OF SAFE SPACE Prevents LGBT elders from going back into the closet Supports elders who are questioning their sexual orientation or gender identity Decreases isolation because it is safe to create community Creates safe spaces for everyone, not just LGBT people PHOTO BY MARKO ROSIC Nurses Health Education About LGBT Elders: Module 3 31

CREATING SAFE SPACE Promote visibility Offer LGBT-themed programming or events Affirm diverse gender presentations & expression Provide access to

32 CREATING SAFE SPACE Promote visibility Offer LGBT-themed programming or events Affirm diverse gender presentations & expression Provide access to condoms, lubricant, and sexual health information Develop, enforce and post inclusive policies Nurses Health Education About LGBT Elders: Module 3 32

33 CREATING SAFE SPACE Hire out LGBT staff Conduct staff training Create opportunities for privacy Interrupt and confront anti-lgbt attitudes, statements, and actions Nurses Health Education About LGBT Elders: Module 3 33

34 INTERRUPTING HARASSMENT Intervene immediately to end the harassment Follow up with people involved individually Acknowledge values Create consequences Support the bystanders Don t require mediation or an apology Nurses Health Education About LGBT Elders: Module 3 34

35 SUMMARY Sexuality of the LGBT Elder is a healthy part of the human experience Complete and accurate sexual histories are critical to the overall health of elder patients Following a routine normalizes the intake experience Nurses Health Education About LGBT Elders: Module 3 35

36 ACTION PLAN Explore personal misconceptions about sexuality of LGBT Elders Provide appropriate intake / screening for LGBT patients, use as an opportunity for education Initiate a policy for consent Create safe spaces for LGBT Elders Interrupt harassment Nurses Health Education About LGBT Elders: Module 3 36

37 HOWARD BROWN HEALTH CENTER GERIATRIC EDUCATION for more information please contact: Cecilia T. Hardacker, RN Director, Geriatric Education Program (773) Hector Saldago Bilingual Trainer Michelle Lemchuk, MSW Admin Nurses Health Education About LGBT Elders: Module 3 37

38 Nurses Health Education About LGBT Elders: Module 3 Thank you! 38

nurses heale module 3

Nurses Health Education About LGBT Elders: Module 3 nurses heale module 3 SEX & SEXUALITY Sexuality Nurses Health Education About LGBT Elders: Module 3 This project is supported by funds from the Department