Stroke
is the pervasive illness with the annual prevalence rate of 800,000 among
individual in the United States. Stroke increases the morbidity and mortality
on a high scale, but many patients also recover from the illness with the help
of appropriate health care facilities (Seymour, & Wolf, 2014). The
survivors experience substantial disabilities in multiple domains including
biological, psychological, social and emotional areas of life, mainly, the
dysfunctions in sexuality are very common among stroke survivors. The
Literature suggests that three-quarters of stroke survivors encounter sexual
dysfunctions and the most frequently accounted post-stroke sexual problems
among female are decline in coital frequency and libido, reduced orgasmic ability
and vaginal lubrication, and dysfunction of erection, ejaculation, satisfaction
has been reported by men (Akinpelu, Osose, Odole, & Odunaiya, 2013).
Numerous stroke survivor manifest fear of having a stroke attack again that
disturb their sexual functioning and intimate relationships with their
partners. Some studies signify the disturbed sexual relationship between a
post-stroke patient and their spouses (Rosenbaum, Vadas, & Kalichman,
2013).
The
stroke patient reported significant apprehensions and concerns regarding the
sudden attack of stroke during the sex. As a result, they avoid the intimate or
sexual relationship with their spouses. Like the sex, life is an imperative
component of healthy life, and the gap or disturbance further leads many psychosocial
and physical problems among post-stroke patient. Therefore, it is imperative to
address their apprehensions and concerns in rehabilitation centres with the
help of nurses and healthcare professionals. The studies indicated that the
rehabilitation centres do not provide proper facilities to address the sexual
problems of their patient. As a result of the patient QOF adversely affect.
The
rehabilitation and proper health care services assist the patient to control
their sexual problems and apprehension regarding the stork attack. The
Rehabilitation usually stressed upon achieving functional independence and
regaining mobility but ignored the psychological, behavioural and sexual
dysfunctions that occur after stroke (Schmitz & Finkelstein 2010). The
sexuality and Intimate relationships are an integral part of achieving a
quality of life standard. Despite recognition about the post-stroke sexuality
problems, most post-stroke rehabilitation programs ignore the need for
developing a consistent and reliable way of addressing sexuality post-stroke
(Nilsson, Lalos, Lindkvist, & Lalos, 2011).
Physicians
rehab centres and other health-care professional's only addressed such issues
when raised explicitly by the family members or spouses of the patients. They should
focus on the pre and post assessment regarding post stork sexuality problems to
enhance the quality of their lives. The sexual dysfunction after stroke is
widespread and needs special attention of the healthcare professional
specifically the nurses (NG, Sansom, Zhang,
Anatya, & Khan, 2017). In
rehabilitation centres, the role of psychologists is imperative in promoting
healthy sexual life among post-stroke patients. The psychologists provide their
best services to improve the quality of life of their patient following the
code of ethics and code of conduct.
Significant
knowledge gap has been found regarding the stroke and sexuality from the
perspective of the patient in health care.
Sexuality
is a vital aspect in patient health care, but the recent literature provides
significant evidence that the nurses avoid addressing sexuality unless the
patient asks for it. Some studies indicate that while practising
sexuality-related practices the nurses reported the feeling of discomfort, and
they acknowledge their responsibility to provide best services to their
patients in each area of health and refer the patients to psychologists
(Yilmaz, Gumus, Yilmaz, Akkurt, & Odabas, 2017). The psychologists
investigate their fear associated with fear to promote a healthy lifestyle.
Over
the past few decades, the epidemiological statistics signified that the
incidence of strokes has been rising considerably, claiming that in 2005, 5.7
million people suffered from stork, 6.5 million prevalence was recorded in
2015; an according to an estimate the ratio expected to raise up to 7.8 million
in 2030 (Yilmaz, Gumus, & Yilmaz, 2015). In the past, the stroke was more
prevalent among the elderly, but in the current times, Strokes prevalence are
higher among younger generations. The people age range of 55 and below found to
have 13% stroke rates rise from the 1990s to 2005 (Kissela et al., 2012).
The
stroke damage the overall functioning of the individual specifically the extent
of the damage fluctuate according to the kind of the strokes such as ischemic,
lacunars stroke, transient ischemic attacks and hemorrhagic (Kissela et al.,
2015). The literature is enriching with the evidence of the stroke
significantly impact the physical and psychological well being, but significant
gaps have been documented regarding the impact of strokes on sexual functioning
(Rosenbaum, Vadas, & Kalichman, 2013). No study comprehensively elaborates
the post-stroke effect on the sexual well being of the patients and how to
address such issues. The limited but available literature documented high rates
of sexual dysfunction among the stroke patients of both genders, which
significantly reduce the sexual satisfaction or sexual frequency and increases
the psychosexual problems among patients (Rosenbaum, Vadas, & Kalichman,
2013). It is quite imperative for patients who have recovered from a stroke the
need assistance in addressing the issue during the rehabilitation (Rosenbaum,
Vadas, & Kalichman, 2013; Ng et al., 2017).
The
literature signifies the importance of the rehabilitation process in improving
the Quality of Life for post-stroke patients concerning their sexual
functioning (Ng et al., 2017). Psychologists and Nurse’s plays a significant
role in addressing the sexual functioning among post-stroke patients, but
recent data elaborates that the nurses alone are failed to achieve the desired
goals regarding the post-stroke patient’s care. Therefore the collaboration of
psychologists is imperative to control the situation. The literature provides
the multiple reasons for nurse’s lack of support in promoting the healthy
sexual life among post-stroke patients. The lack of knowledge and comfort issue
is the most significant reason reported by Nurses to avoid the patient sexual
health care.
The
stroke attacks affect the psychological, physical, emotional and social aspects
of life, that; some descriptive investigated that the decreased sexual
activity, sexual satisfaction functions are frequent after stroke. Qualitative
research suggested that negative self-concept, distort body image and
dependency on a spouse leads to the negative alteration in sexuality Suffren,
Braun, Guimond, & Devinsky, 2011).
The
previous data highlight that sexual dysfunction as a most common disability
occurs after the stroke and more studies are needed to provide the in-depth
knowledge about the nature and level of sexual dysfunction that the post-stroke
patient’s encounter (Seymour, & Wolf, 2014). Furthermore, literature is a
lack of comprehensive studies on stroke survivors regarding their long-term
intimacy and sexuality oriented experiences. The rehabilitation centre ignores
the sexual therapies or treatment due to comfort and literacy issues
(Bugnicourt et al., 2014). The study indicated that stoke patient feels shyness
while discussing their sex-related issues with their therapist. In contrast,
some other studies indicate that the health care professionals do not discuss
sex life of their patient as they consider the patient must not be literate
about sex education (Clarke, & Forster 2015).
Another reason for avoiding the counselling
about sex life to post-stroke patients is lack of trained professional
regarding sex life. Instead of resolving the sexual dysfunctions and conflicts
of the patients the healthcare professional and nurses refers their patient to
the sex therapist. The multi diagnosis and referral to another therapist
mystified the client. As a result, the patient avoids taking the services of
the therapist (Akinpelu, Osose, Odole, & Odunaiya, 2013). The literature does not signify the
importance of rehabilitation centre focus on sexual problems of the patients.
According to literature, those post-stroke patients who received the
counselling regarding sexual problems reported more mental wellbeing and QOF as
compared to those patients who did not receive the counselling session (Genest,
Gerard, & Courtois 2017). Another study indicated that the Nurses have the
great responsibility to provide their best services to patients in each domain
of life, they must address all the possible issues that affect the QOF of the
patients (Dobkin, 2005).
The
PLISST model is widely used to overview the role of psychologists and nurses in
the health care settings concerning the treatment of sexual dysfunctions after
stroke. The PLISSIT model recommends a concise way for initiating the
sex-related conversation into a clinical setting, reducing the scope of a
patient's apprehensions and concern offering proper treatment plan through
counselling. The PLISST comprised of four levels of intervention: such as
permission, specific suggestions, intensive therapy and limited information
(Allen &Sheftel, 2017). The model suggests that the collaboration between
psychologists and nurses may probe the sexual health apprehensions of
post-stroke patients through open-ended questions. After the identification of
problems, the nurses and psychologists may provide associated etiological
information regarding concerns and apprehensions of sexual dysfunctions. The
specific suggestions for addressing sexual the problems may discuss with the
patient. The psychologists and nurses also aware the patient the other possible
alternative treatment options to solve their problems. In severe cases, the
patent may refer to the sex therapist or sexual health specialist, pelvic floor
specialist, to provide comprehensive guidance and support.