Very intriguing question in mind

Katie71275 · Oct 30, 2012

In that situation I would post the benefits and risks. If I remember correctly, she just has the gene right? So really there's no true timeline at play correct? I have a friend who has the gene(strong family hx of mother/aunts with Breast cancer as well), and she chose to have her breasts remove(I don't recall if she had the hysterectomy/ovary removal as well though). I would also see if we could get some sort of referral to counseling so they could have an objective third party's assistance.

gomes.nelson · Oct 30, 2012

Sounds like a plan ! That suggestion does sound great .. Yes she does have the gene. Also, like you mentioned there is no true timeline at the play and the situation that I provided. The situation that I came up with does not even mention if she has the gene. In an instant, the young woman changes her mind to not have her mastectomy.. which she is scheduled to have implying that her husband won't love her no more. Then we as the nurse, how could we change her mind ? Also keeping in mind that we are supposed to act ethically here following clients values, ethics and beliefs ? We can only do so much as a nurse. But how would this be considered something ethical ? Aren't we as nurses supposed to advocate?

KelRN215, BSN, RN · Oct 30, 2012

Sounds like a plan ! That suggestion does sound great .. Yes she does have the gene. Also, like you mentioned there is no true timeline at the play and the situation that I provided. The situation that I came up with does not even mention if she has the gene. In an instant, the young woman changes her mind to not have her mastectomy.. which she is scheduled to have implying that her husband won't love her no more. Then we as the nurse, how could we change her mind ? Also keeping in mind that we are supposed to act ethically here following clients values, ethics and beliefs ? We can only do so much as a nurse. But how would this be considered something ethical ? Aren't we as nurses supposed to advocate?

It's not our job to change her mind and convince her to have an elective surgery.

If I were the nurse in a case like this, I would talk to the patient about her thoughts and fears and then refer to Social Work. The role of prophylactic mastectomy/hysterectomy in women with the BRCA genes is controversial. It is known to reduce the risk but there are other ways to proceed. It is our job to offer the patient the most accurate information and to then honor their decision. If she chooses to proceed with close surveillance monitoring or prophylactic chemotherapy, those are valid choices as well.

metal_m0nk, BSN, RN · Oct 31, 2012

My answer would be to educate both the patient and her significant other about the benefits and risks of having the surgery and not having the surgery and then refer them to a therapist if they felt like they wanted or needed to explore the issue in more depth before she makes a decision.

KelRN215 is right, it is not our job as nurses to convince patients to have elective surgery. Unless it is a life/limb emergency, she must be the deciding factor when it comes to her personal health management.

gomes.nelson · Oct 31, 2012

I find this very helpful. Thank You all for your replies. To be honest, this is my very first thread and post on "all nurses". As a new user, I feel that having comments and replies from RN's and students such as myself equally broadens my perspectives and horizons. Once again, thank you all very much :)

nurseprnRN, BSN, RN · Oct 31, 2012

Before you do anything, take a look at the PLISSIT model. While it was initially developed to help clinicians discuss sexual topics, it is generalizable to any topic. Note where it says as soon as you get to a level where you are personally not trained/expert, you must refer to someone who is. I would expect a conversation like this for this patient to be well beyond the capability of a nursing student once you get past the first "Permission" level (samples below).

PLISSIT Model of InterventionPLISSIT is an acronym for four levels of intervention that were developed by psychologist Dr Jack Anon: Permission, Limited information, Specific Suggestions, and Intensive Therapy.¹²

Permission, the most basic and general level of intervention, allows the patient to express concerns in this area. Patients are reassured that their feelings are normal, acceptable, and a sign of recovery.² (says it all)

Limited information relates to patient concerns regarding the impact of their specific condition on sexual expression abilities and may consist of dispelling myths.² This level of intervention is often provided in a group setting, includes patients and their sexual partner (if desired), and offers factual information via pamphlets, handouts, and resource lists.²

Specific suggestions are aimed at solving an individual patient's problem and requires advanced knowledge and skill, but may be within the realm of OT service provision. A detailed sexual history is obtained, specific problem(s) identified, and goals collaboratively established that address improved function in the targeted area.² Intervention approaches may include problem solving, education, and compensatory strategies.

The highest level, intensive therapy, requires formal training and documented competence in sex therapy, sexuality counseling, or psychotherapy.² This level of intervention is beyond the scope of typical rehabilitation intervention and indicates the need for referral to a specialist.

Annon JS. The PLISSIT model: a proposed conceptual scheme for the behavioral treatment of sexual problems. J Sex Educ Ther. 1976;2:1-15.

Examples of questions broaching the subject of sex (the "permission" level in the PLISSIT15 model)

Routine questioning

"I always ask whether patients are having any relationship or sexual problems. Your sexual health is an important part of your life. Sometimes an illness or medication can affect your sexuality. How has your relationship been going lately?"

Generalising

"People with chronic renal failure often experience sexual difficulties, such as loss of desire or problems with enjoyment. How have you been affected?"

Normalising

"When a woman receives a diagnosis of breast cancer it's normal for her to be concerned about how treatment might affect her sex life. What worries have you had?"

Using statistics

"Over 80% of men with peripheral vascular disease report problems with sex, such as difficulty gaining and keeping an erection. What changes have you noticed?"

Other open ended questions

"What kinds of sexual problems have you had?"

"What happens when you and your partner try to make love?"

"How is your health affecting your relationship?"

Also: never mistake anything you see on TV as related to actual practice. Gray's Anatomy, House, and others are to real nursing as Cinderella is to real dancing.