Sextual health part 2;

Part 2 is to be your responses to Journal entries 10–18 from sections 5–7 of the Study plan. Please ensure that you number all of your journal entries. ( you will find the Journal entries in the study plan – answer each one of them with heading )

The response journal is a working document that you will compile as you progress through the Study plan. Your journal is an academic piece of work and needs to be chronological, word processed and appropriately referenced. It is expected that your journal will be legible, intelligible and must indicate critical thinking, exploration of issues and demonstrate wide reading around the subject matter. You must complete all of the responses.

NURS3906  Study plan
Section 5: Sexual health and the life cycle
Sexuality is evident throughout the stages of lifelong development and the life cycle
implies ‘a cyclic nature of development from conception to death and connotes not only
repetition but also progression in all areas of human development’ (Fogel & Lauver 1990,
p. 53). Physical, psychological and social factors of human sexuality are interwoven in
human development. If we consider the biologic basis of human sexuality then genetic
determination from the moment of conception begins this life-long development. The
psychosocial factors such as gender identity, gender role and sexual orientation have
already been identified in section 1.
Using developmental psychology and your prior learning in this area, this section will be
structured to reflect the theories of Freud and Erikson. You will recall that Freud:
conceptualised personality development as a series of age-related conflicts
between children’s primitive, hedonistic desires and the limitations imposed on
them by society for the sake of cooperative living. (Peterson 1996, p. 51)
He identified the id (unconscious reservoir of selfish instincts), the ego (an aspect of
personality which is reality oriented and mediates conflict between the id and superego),
and the superego (part of the unconscious personality which corresponds to the
conscience and motivates conformity to the dictates of society). Freud identifies five
stages of development: the oral stage (the first year of life), the anal stage (1-3 years),
the phallic stage (4-6 years), latency stage (6 years to puberty) and then the genital
stage (puberty onwards).
Erikson on the other hand saw ‘dialectical conflict as the basic mechanism of
development, and defined cumulative stages of personality growth in terms of the
unique forms of that conflict’ (Peterson 1996, p. 53). Erikson’s stages are: basic trust
versus mistrust (birth to 1 year), autonomy versus shame and doubt (1-3 years),
initiative versus guilt (4-5 years), industry versus inferiority (6-11 years), identity versus
role confusion (12-18 years), intimacy versus isolation (early adulthood), generativity
versus self-absorption (middle adulthood) and integrity versus despair (old age).
Other theorists to offer developmental theories are Piaget, Buhler and Maslow. The
following section is structured on the work of Freud and Erikson and follows a life cycle
approach. You are expected to undertake further readings in this section as it is
impossible to cover all of the stages comprehensively.
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NURS3906 > Study plan > Section 5: Sexual health and the life cycle
Childhood
Childhood development can be determined through seven developmental stages:
•  prenatal: conception to birth
•  infancy: birth through to one year
•  toddler: 1-4 years
•  preschool: 4-5 years
•  school age: 5-9 years
•  preadolescent: 10-11 years
•  adolescent: 12-21 years (early 12-14 years, middle 14-17, late 17-21 years)
These stages are defined using the theories of Erikson and Freud. Find a development
theory text or reading and define for yourself what you could expect in terms of behavior
related specifically to sexuality and sexual development during these stages.
Adolescence
Erikson refers to the stage of adolescence as ‘identity versus identity confusion’. This is
the time of rapid physical change which manifest as new body image perceptions. The
adolescent will need to develop an identity and consider the role that they will take in
society. There are many influences on this such as parents, peer groups and culture.
Adolescent sexual health is well covered in the literature, however much of it is
concentrated on sexual health education, HIV/AIDS, emergency contraception and
teenage pregnancies. The media focuses its attention on drugs, alcohol, drink driving
and the dangers. There is a need for the media to get the message across to the target
groups, however there is a fine line between supporting and shocking to get the
Journal entry 10
Make a list of the seven developmental stages of childhood and dot point what you
would expect to see in terms of behaviour related specifically to sexuality and sexual
development. (Referencing required)
Text reading
Rosenthall, D & Browning, C 2005, ‘Sexual wellbeing and life transitions: a focus on
adolescence and old age’, in M Temple-Smith & S Gifford (eds), Sexual health: an
Australian perspective, IP Communications, Melbourne, pp. 111-117.
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NURS3906 > Study plan > Section 5: Sexual health and the life cycle
message across. When you next see an advertisement in a magazine or on television
think about the message, who is the target group and is the message supportive or
shocking.
The inclusion of sexual health education in the school curriculum should be evident in
primary school. There is a need for multidisciplinary collaboration in the delivery of
sexual health education and services. The importance of evaluation of programs is
integral to the continuing and ongoing support they will receive.
There is another issue to consider in the sexual health needs of adolescents which
pertains to those who live in a rural or remote area. A study was undertaken in Australia
by the National Centre in HIV Social Research. Two main areas of concern arose from
the study and these pertained to the worry about being recognised in public venues such
as doctor’s surgeries and the local chemist shop and the informal mechanisms among
peer groups that appraise and regulate sexual behaviours and attitudes (Warr 1997).
The research was significant as there 1168 year 8 and year 10 secondary school
students living in small rural communities across Australia in the sample group. While
this study is now dated the same issues pertain to people living in rural and remote
areas.
Adulthood
Early adulthood
Early adulthood has been described by Zawid (1994) as an adventure in intimacy.
Erikson describes this stage of his theory as ‘intimacy versus isolation’. This is usually a
time of marriage, or deciding to stay single and pregnancy. Further it is a time for
making decisions about living arrangements and combining and managing a number of
roles. These factors bring many changes related to sexuality.
The following is an overview of early adulthood.
Object relations theory: The developmental tasks of this stage include distancing oneself
from family of origin, attachments and investments in a mate or significant others, and
children and career.
Journal entry 11
Visit a school in your local area (primary or secondary) and speak with a teacher
involved in sexual health education. In your journal describe the program, that is, when
is it taught, what is the content, what is the evaluation from the school’s perspective.
Describe the inter agency collaboration and identify the key stakeholders in the program.
(Referencing optional)

NURS3906 > Study plan > Section 5: Sexual health and the life cycle
Erikson/intimacy versus isolation: Young adults need to separate from their family of
origin and begin to develop new relationships based on commitments related to sharing
one’s adult life. These relationships will create a new family for the young adult.
Tasks of this stage: basic decision making regarding education, life mate, sharing of
mutual intimacy in marriage or in other relationships; and life style.
Sexuality: This is the stage of values. Sexual orientation becomes more consolidated.
Challenges may be the first pregnancy, abortion, the first use of contraception or for
some the first birth of a child, nursing and planned parenthood.
Sexual health and pregnancy
Pregnancy is a time of great change for the woman, her partner and family. Sexual
activity throughout pregnancy should continue, however this is often an area not
discussed. The first research about sexual activity in pregnancy was conducted in the
1960s by Masters and Johnson and since that time further studies have been done in
this field.
The next reading provides the opportunity to examine issues related to sexuality
throughout the pregnancy, childbirth and postnatal cycle.
Sensitivity is the essence for discussing sexual health during pregnancy and you may
wish to refer back to the PLISSIT model and the need to give clients permission to talk
about their sexuality.
Midlife
Middle adulthood according at Erikson, is a time of generativity and, assuming
the adult has made a commitment to a life goal, a time in which energy is
devoted to productivity, including work, family, relaxation activities, creative
endeavours, and assumption of a broader social role.
(Fogel & Lauver 1990, p. 73)
There are developmental issues that men and women still have to cope with in midlife
and while it is a time between young adulthood and aging much can happen. There are
family structure changes, perhaps more leisure time when children become more
independent, perhaps change in family with relationship breakdowns, the establishment
of new relationships, and the physical changes in both men and women. Women may be
faced with the issues of menopause and men may find that their sexual response slows
down.
Text reading
Brown, E 2005, ‘How sex works: the biological basics’, in M Temple-Smith & S Gifford
(eds), Sexual health: an Australian perspective, IP Communications, Melbourne,
pp. 78-79.
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NURS3906 > Study plan > Section 5: Sexual health and the life cycle
When one has survived the midlife the next stage is aging.
Aging
The concept of aging in society today and what constitutes an older adult will vary
according to social and cultural contexts. For a child, often 40 seems old! The physical
changes of aging vary with individuals and often ‘guessing’ the persons age can be
difficult. This is often a difficult time in a person’s life as they are faced with loss in many
forms. Loss of a significant other such as a lifelong partner with whom one has had a
healthy and active sex life can be devastating. Living arrangements may change and one
has only to look in the media to see that retirement villages have become a huge way of
life for older Australians. Further, there are those who have actively taken to the roads
as the ‘grey nomads’. For some there is loss of role status as they retire from
employment. It is the biological and psychological changes that occur during this phase
of life that create the challenges that people have to face.
From your own experiences think about how you see older people and their sexuality.
It is hoped that this section has provided you with some knowledge about the
developmental tasks that are achieved throughout the life cycle and how sexuality
impacts on each of these. You may have selected one of the stages of the life cycle for
your essay or you may have gained new knowledge about the stages or you may have
reflected over old knowledge. Knowing the developmental theories and stages provides
some awareness for our understanding. The next section will identify sexually
transmitted infections and sexual health inequalities, which can of course occur at any
stage of the life cycle.
Text reading
Rosenthall, D & Browning, C 2005, ‘Sexual wellbeing and life transitions: a focus on
adolescence and old age’, in M Temple-Smith & S Gifford (eds), Sexual health:
an Australian perspective, IP Communications, Melbourne, pp. 117-128.
Journal entry 12
Think of a time when you have been caring for a person over 70 years of age. How did
they express their sexuality? Make an entry in your journal and then return to the
literature and see whether their behaviour reflects what the literature says. (Referencing
required)

NURS3906  Study plan
Section 6: Sexual health—sexually transmitted
infections and sexual health inequalities
Medical issues
It is important that as nurses and midwives we are aware of the unique problems and
challenges that impact on the way that client’s with chronic illness express their
sexuality. There are so many conditions that can have an impact that it would be
impossible to examine them all. What is important is that you are informed about the
physiological influences of the disease process to give the information to the client to
cope with, and adapt to their illness.
There are myths about sexuality and illness and as care providers we need to be aware
of these as they may influence a client’s sexual expression and level of comfort with sex.
Illness will affect sexuality to some degree and therefore assessment is crucial in the
care of the client.
The emotional reaction to illness may have a negative effect on the client. Emotions such
as anger, confusion, denial, fear, shame, guilt, loss of control and depression need to be
diagnosed and addressed.
Some guidelines to consider when assessing threat to body image include:
•  Are the changes observable?
•  Are the changes to the body functional?
•  Is the loss symbolic?
•  Is the change temporary?
•  Is the loss permanent?
•  Is the illness socially acceptable?
Text reading
Aitken, S 2005, ‘Pathology and sexual function’, in M Temple-Smith & S Gifford (eds),
Sexual health: an Australian perspective, IP Communications, Melbourne,
pp. 146-155.
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NURS3906 > Study plan > Section 6: Sexual health—sexually transmitted infections and sexual
health inequalities
•  Is the client feeling dehumanised as a result of the hospital or medical experience?
•  What life cycle body images are occurring?
The physical side effects of illness such as pain and fatigue will also have an effect on the
relationship.
Sexually transmitted infections (STIs)
In the text these are referred to as biological and psychological threats to sexual health.
There are a number of sexually transmitted infections and while it is not reasonable to
expect that you recognise them all, it is reasonable to expect you know what to do. The
first earliest recorded account of an STI was in China in 6237 BC and it is thought that
this was probably syphilis. While we have come a long way in the treatment of infections
such as syphilis there is a need to ensure that the community does not become
complacent.
When a client presents to clinic (or the hospital) suspicious that they may have an STI it
is crucial that they are carefully assessed and a correct diagnosis made to ensure that
the appropriate treatment can be commenced. The first aspect is the management of
any of the STIs infection and this will depend on whether it is viral, bacterial or a
parasitic infection. The prevention of the infection spreading is critical and for some that
may mean a change in their sexual practices as well as counseling and adhering to a
treatment regime. The practitioner must keep an open mind and be non-judgmental
when presented with a client with an infection. When the client has a sexually
transmitted infection it is important that you know whether it is a notifiable disease
under section 30 of the Public and Environmental Health Act 1987.
Text reading
Rosengarten, A 2005, ‘Sex and sex-ability: sex, illness, and disability’,
in M Temple-Smith & S Gifford (eds), Sexual health: an Australian perspective,
IP Communications, Melbourne, pp. 198-212.
Journal entry 13
Write an account of an experience that you have had with a client whose sexuality was
challenged. You may like to use the headings presented for ‘assessing threat to body
image include’ as a structure for this response. (Referencing optional)
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NURS3906 > Study plan > Section 6: Sexual health—sexually transmitted infections and sexual
health inequalities
As there is social stigma and often psychological sequelae it is important that the person
with the STI knows where to go for treatment and you may like to see what is available
in your community. Give some thought to the adolescent with an STI who lives in a
small community. The only practitioner is best friends with their parents. The person
needs a safe environment where they will not be judged, where they know they will get
treatment, contract tracing will be initiated in a sensitive way and they will be followed
up.
Journal entry 14
Visit www.health.sa.gov.au and find the Report of notifiable disease. Make a list of
the sexually transmitted infections that have to be notified in South Australia.
Now visit www.stdservices.on.net and identify the four most common STIs in South
Australia. What is the incidence of each of these diseases?
Then go to www.sti.health.gov.au and list the four most common STIs in Australia.
What is the incidence of these? How does South Australia compare to Australia?
What is Confidence with Condoms? Can you find information about Snake condoms?
Why might these be valuable community activities?
(Referencing required)
Text reading
Aitken, S 2005, ‘Sexually transmissible infections’, in M Temple-Smith & S Gifford (eds),
Sexual health: an Australian perspective, IP Communications, Melbourne,
pp. 131-145.
Activity
Go to http://www.tuneinnotout.com/topics/sex/sti/chlamydia.
Have a look around this website. You should have identified Chlamydia as the most
common STI in Australia. There are some great YouTube visions.
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NURS3906 > Study plan > Section 6: Sexual health—sexually transmitted infections and sexual
health inequalities

NURS3906  Study plan
Section 7: Family planning
Couples and indeed single people have the capacity to plan their family. The issues to be
considered are delaying childbearing, spacing children, and limiting the number of
children. Unintentional pregnancy may occur. The use of contraception has given women
and men freedom to enjoy a healthy sexual relationship without the risk of pregnancy.
For effective contraceptive behaviour the following conditions may be important:
•  motivation to use the method
•  acceptance of and satisfaction with the method
•  accurate knowledge base of reproduction and the contraceptive method of choice
•  partner support
•  ready availability and accessibility of the method.
The factors that influence contraception are social, cultural, psychological and
developmental. Some of these have already been alluded to in other readings. The
individual beliefs, attitudes and values may also have an influence.
Patient education is crucial once a contraceptive method has been selected to ensure
that the client has the correct information. The most crucial teaching is with the oral
contraceptive pill. There are a large variety of pills on the market from monophasic and
triphasic to combined and progesterone only and the ‘morning after pill’. Knowing how to
take the prescribed pill and the side effects that may be experienced will assist with
compliance. It is always a useful strategy to check that the client has understood your
teaching and especially the seven day rule.
Text reading
Brown, E 2005, ‘How sex works: the biological basics’, in M Temple-Smith & S Gifford
(eds), Sexual health: an Australian perspective, IP Communications, Melbourne,
pp. 78-79.
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NURS3906 > Study plan > Section 7: Family planning
Congratulations!!! You have made it to the end. I hope that you have had the
opportunity to examine some of your feelings, beliefs and attitudes towards sexual
health. The section on the law and religion as they relate to sexual health has, hopefully,
strengthened your understanding of the cultural differences in this area of health. I hope
that you have had the opportunity to undertake some sexual health assessments and
that you feel quite comfortable performing this role. You will have completed you
response journal and your essay. Undertaking these activities would have given you the
opportunity to explore areas of sexual health and undertake an in depth study in your
area of interest. I hope that you have enjoyed the topic and that you are now more
knowledgeable about sexual health.
The following text reading is like a conclusion that will provide you with some thoughts
about the next 20 years for a sexually healthy Australia. It would be good to revisit this
in 20 years and see whether the suggestions have eventuated.
Journal entry 16
Select one method of contraception and write in your journal the following:
• use effectiveness of method selected
• availability
• cost
• popularity usage rate
• mode of action
• advantages and disadvantages
• effects on sexuality.
List the references of any research you could find on the chosen method in the last three
years. (Referencing required)
Journal activity 17
Now I would like you to complete the following sentence:
Sexuality means …
Return to what you wrote when you started the topic. Is there any difference in your
statement? I hope that there is and that you now have a deeper understanding of your
own sexuality and the sexuality (as an activity of daily living) of your clients.
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NURS3906 > Study plan > Section 7: Family planning
Happy work and safe sex!!!
Text reading
Moodie, R 2005, ‘Conclusion: sexual health for all: strategies for action in the twenty
first century’, in M Temple-Smith & S Gifford (eds), Sexual health: an Australian
perspective, IP Communications, Melbourne, pp. 317-324.
Journal activity 18
Having now completed the learning activities for this topic reflect on your learning, and
discuss how you might change your practice with this new knowledge.

Sexual health inequalities
There are many examples of sexual health inequalities in Australia, minority groups such
as Aboriginal and Torres Strait Islanders, sex workers, gay men and lesbian women,
those in prison, homeless people and so the list goes on.
The text readings cover these areas well and you are invited to read them all to give
yourself an overview or you can select just one or a couple. These may assist with your
essay if you have chosen one of these areas to explore further.
This reading is interesting when you see that brothels are illegal in South Australia. In
March 2006 police closed 15 known brothels in the Adelaide metropolitan area, and while
they state that they are closed, a simple Google search finds many ‘hits’ advertising their
services. This is an area that we will keep a watch on as the prostitution bill becomes
clearer. You may like to look at http://www.scarletalliance.org.au/laws/sa/ for more
detail.
Text reading
Senior, K 2005, ‘Men’s business and women’s business: Indigenous sexual health’,
in M Temple-Smith & S Gifford (eds), Sexual health: an Australian perspective,
IP Communications, Melbourne, pp. 159-169.
Text reading
Harcourt, CS 2005, ‘Occupational hazards: sex workers and their sexual health’,
in M Temple-Smith & S Gifford (eds), Sexual health: an Australian perspective,
IP Communications, Melbourne, pp. 170-178.
Text reading
Levy, M 2005, ‘Behind bars: sexual health in Australian prisons’, in M Temple-Smith &
S Gifford (eds), Sexual health: an Australian perspective, IP Communications,
Melbourne, pp. 179-186.
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NURS3906 > Study plan > Section 6: Sexual health—sexually transmitted infections and sexual
health inequalities
Text reading
Mallett, S 2005, ‘On the streets: the sexual health of homeless young people’,
in M Temple-Smith & S Gifford (eds), Sexual health: an Australian perspective,
IP Communications, Melbourne, pp. 187-197 & 131-145.
Journal entry 15
Select one of the readings from the ‘Sexual health inequalities’ section above and
summarise the key points. How do these key points fit with your own declared
values and beliefs from journal entry 6? (Referencing required)
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structure as following:

1-    The words count must not be more than1500 words total for all journal entries – so 100-300 words for each question ), So please try to stay in word count

2-    Use a heading for each journal entry- Do not want nor need essays for each entry response. The nature for the questions lends itself to brief individual responses.

3-    References must be accessed and not less than 10 references.

4-    The essay structure is to response to journal entry 10-18.( please see the attach files ) .
5-    You will find in the study plan some required reading to answer the question please get access to these books or sources  and get the answer from these books .
6-    This is the required reading book for this topic
(Temple-Smith, M & Gifford, S (eds) 2005, Sexual health: an Australian perspective, IP Communications, Melbourne.)

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