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Representations of Nurses Regarding Sexuality of Women Treated for Breast Cancer in Brazil

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Representations of Nurses Regarding Sexuality of Women Treated for Breast Cancer in Brazil ARTIGO ARTICLE 2049 Representations of nurses regarding sexuality of women treated for breast cancer in Brazil Representações das enfermeiras sobre a sexualidade de mulheres tratadas de câncer de mama Concepciones de enfermeras sobre la sexualidad de las mujeres tratadas por cáncer de mama Elisabeth Meloni Vieira 1 Nicholas John Ford 2 Manoel Antonio dos Santos 3 Lílian Cláudia Ulian Junqueira 3 Alain Giami 4 Abstract Resumo 1 Faculdade de Medicina de The development of new treatments has im- O desenvolvimento de novos tratamentos me- Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, proved survival and quality of life among can- lhorou a sobrevivência e a qualidade de vida dos Brasil. cer patients. Nurses are expected to answer pacientes de câncer. Espera-se que as enfermei- 2 University of Exeter, Exeter, questions and to provide orientation regarding ras forneçam orientações sobre a sexualidade United Kingdom. 3 Faculdade de Filosofia, patients’ sexuality since it is an important as- dos pacientes, considerada importante aspec- Ciências e Letras de Ribeirão pect of life. The main objective of this paper is to da vida. O principal objetivo deste artigo é Preto, Universidade de São to understand the representations of sexuality compreender as representações da sexualidade Paulo, Ribeirão Preto, Brasil. 4 Institut National de la Santé among nurses working with women who survive entre as enfermeiras que trabalham com as mu- et de la Recherche Médicale, breast cancer after diagnosis and during treat- lheres sobreviventes ao câncer de mama depois Paris, France. ment assuming that their representations may do diagnóstico e durante o tratamento, conside- Correspondence affect communication with the patient. This is rando que estas representações possam afetar a E. M. Vieira a qualitative study using an in-depth guideline comunicação com o paciente. Este é um estudo Departamento de Medicina which involved interviews with 28 nurses living qualitativo que entrevistou 28 enfermeiras que Social, Faculdade de Medicina de Ribeirão Preto, and working in the southeast of Brazil. The nar- vivem e trabalham no Sudeste do Brasil. As nar- Universidade de São Paulo. ratives were submitted to a content analysis and rativas foram submetidas à análise de conteúdo Av. dos Bandeirantes 3900, categories of representations were identified and e as categorias das representações foram identi- 2o andar, Ribeirão Preto, SP 14049-900, Brasil. are discussed here. Several representations of sex- ficadas e discutidas. Várias representações sobre [email protected] uality were found in the nurses’ discourses. Some sexualidade foram encontradas nos discursos of the nurses’ representations may be expected to das enfermeiras. Algumas delas podem ocultar a hinder their ability to provide helpful orienta- habilidade de transmitir orientação em relação tion regarding the sexual lives of these patients. à vida sexual desses pacientes. Breast Neoplasms; Sexuality; Nurses Neoplasias da Mama; Sexualidade; Enfermeiras http://dx.doi.org/10.1590/0102-311X00158512 Cad. Saúde Pública, Rio de Janeiro, 29(10):2049-2056, out, 2013 2050 Vieira EM et al. Introduction or even ignore some aspects of sexuality which may be important to patients. Such varied com- Breast cancer represents the most prevalent can- munication is likely to be based on nurses’ own cer in women in the world. Annually it consti- assumptions, concepts and beliefs pertaining to tutes 22% of all new cancer diagnoses in women the subject 14,15. In order to understand these im- and 7% of the 7.6 million cancer-related deaths portant representations we developed the pres- internationally 1. ent study having in mind the following question: Breast cancer has been the type of malignant how do nurses address sexuality as part of the neoplasm of greatest incidence and mortality health care for women recovering from breast among Brazilian women. In 2012 52,680 new cas- cancer? es were estimated, i.e., 52 new cases per 100,000 The objective of this study was to understand women 2. Over recent years, a significant increase the representations of how sexuality of women has been reported among young women up to undergoing treatment of breast cancer is under- 35 years of age 3. Similarly in the United States it stood by the nurses responsible for those patients is the most common cancer in women, but due after diagnosis and during treatment. to the advances of therapy and the participation in screening programs, mortality rates are now decreasing. The survival of women with breast Methods cancer is considered a process that begins at di- agnosis and does not cease, lasting until the end This is an exploratory qualitative study carried of life 4, so the rehabilitation of the survivors of out with 28 nurses living and working in the breast cancer takes place permanently and re- Southeast of Brazil. We identified all nurses work- quires attention in all spheres of daily life 5. Stud- ing in cancer clinics (ambulatories and hospitals) ies have shown that survival is associated with in Ribeirão Preto, a city in São Paulo State with several changes impacting upon different phases a population of half a million people, and con- in the lives of women, each phase with its specific ducted interviews. Only two nurses refused to demands 6,7. be interviewed. All but one nurses in the sample Sexuality is one of the areas potentially affected were women, aged between 23 and 60 years old, after breast cancer and because of its impact and with between two and 30 years of work experi- significance in the patient’s life, demands atten- ence with breast cancer patients. The majority, tion alongside that given to diagnosis and treat- 16 of them were married with children. Only one ment 8. Sexuality encompasses intimate feelings was cohabiting, nine were single and two were of individuality and is central to a person’s sense divorced or separated. Regarding sexual orienta- of wellness and health 9. The majority of research tion, one was homosexual. 20 of them had at- on breast cancer is focused on the period of di- tended a “specialization course” including 12 in agnosis and treatment and few publications are oncologic care, four had a Resident Certificate dedicated to investigating the impact of cancer and four had just a nursing degree. Only one upon sexuality and sexual life after treatment 5. reported she had cancer. We used a semi-struc- A literature review concerning the sexuality of tured interview guideline developed by a simi- women with cancer has identified important gaps lar collaborative study conducted in France 14. in the research of the subject. According to some A deliberately open and broad trigger question authors this has led sexuality-related breast cancer was used to start the interview: “How do you deal interventions to be based more upon anecdotal with sexuality in your professional practice?”. It experience and the predispositions of the special- is important to note that the interview explored ist than upon sound evidence from the social sci- both nurses general feelings about sexuality in ences 8. Some studies have reported that health their working practice, as well as its more specific professionals do not usually address sexual is- bearing upon dealing with the sexuality of pa- sues among breast cancer survivals 10,11. tients being treated for cancer (thus some quota- Among professionals of the health team, tions presented below include reference to male nurses are given an important role since they are patients). required to answer questions and provide orien- The research project was approved by the tation in several aspects of their patients’ lives in- Committee of Ethics in Research at the Escola cluding their sex lives. Some authors emphasize de Enfermagem de Ribeirão Preto, Universi- the need to improve communication on sexuality dade de São Paulo in August, 2009 (protocol n. between nurses and patients in order to deliver 1019/2009). All participants were asked to read better care 12,13. Representations about sexual- and sign a form detailing terms of consent and ity can affect communication since nurses can their free will in participating in the interview, put more or less emphasis upon different aspects in which confidentiality and privacy of informa- Cad. Saúde Pública, Rio de Janeiro, 29(10):2049-2056, out, 2013 REPRESENTATIONS OF NURSES ABOUT SEXUALITY OF WOMEN TREATED FOR CANCER 2051 tion were guaranteed, according to Resolution n. Holistic sexuality: sexuality as a basic human 196/96 of the Brazilian National Health Council. need for health and wellbeing The interviews were audio-tape recorded and transcribed in full. Afterwards they were subject- In this category representations of sexuality were ed to a content analysis and thematic categoriza- included that are similar to the World Health Or- tion in which the following range of representa- ganization (WHO) definition stated in 2002 17 (p. tions were identified and labeled. 4): “[Sexuality is] an integral part of the personali- In order to analyze the data, the following se- ty of everyone: man, woman, and child. It is a basic quence of content analysis was used: preparation need and an aspect of being human that cannot of the material through the interview transcripts, be separated from other aspects of life. Sexuality coding based on the previously defined thematic is not synonymous with sexual intercourse, it is script and data interpretation and description of not about whether we have orgasms or not, and it each category 16. After reading and identifying is not the sum total of our erotic lives. These may each category in the transcriptions of interviews be part of our sexuality but equally they may not. we organized similar narratives under each label. Sexuality is so much more: it is in the energy that We developed seminars for interpretation and motivates us to find love, contact, warmth and in- analysis, defining the meaning of each category, timacy; it is expressed in the way we feel, move, with the research team discussing each inter- touch and are touched; it is about being sensual pretation.
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