Journal of Nursing Education

Major Article 

Nursing Students’ Perceptions of Barriers to Addressing Patient Sexuality Concerns

Morris A. Magnan, PhD, RN; Diane M. Norris, PhD, RN

Abstract

Little is known about nursing students’ perceptions of barriers to addressing patient sexuality concerns. The twofold purpose of this study was to identify and describe attitudes and beliefs that might act as barriers to addressing patient sexuality concerns and to determine the extent to which these attitudes and beliefs are influenced by personal factors such as age, gender, and education. The Sexuality Attitudes and Beliefs Survey was used to assess students (N = 341) enrolled in either a traditional or accelerated second-degree baccalaureate program. Important barriers to addressing patient sexuality concerns reported by the majority of the students included not making time to address the concerns (67.9%) and believing that patients do not expect nurses to address the concerns (66.4%). Findings also revealed that accelerated second-degree students were more restrictive in their attitudes toward addressing patient sexuality concerns, compared with traditional students. Results of this study have implications for BSN program development and evaluation.

Abstract

Little is known about nursing students’ perceptions of barriers to addressing patient sexuality concerns. The twofold purpose of this study was to identify and describe attitudes and beliefs that might act as barriers to addressing patient sexuality concerns and to determine the extent to which these attitudes and beliefs are influenced by personal factors such as age, gender, and education. The Sexuality Attitudes and Beliefs Survey was used to assess students (N = 341) enrolled in either a traditional or accelerated second-degree baccalaureate program. Important barriers to addressing patient sexuality concerns reported by the majority of the students included not making time to address the concerns (67.9%) and believing that patients do not expect nurses to address the concerns (66.4%). Findings also revealed that accelerated second-degree students were more restrictive in their attitudes toward addressing patient sexuality concerns, compared with traditional students. Results of this study have implications for BSN program development and evaluation.

At the time this article was written, Dr. Magnan was Assistant Professor, and Dr. Norris is Associate Dean and Assistant Professor, Oakland University, School of Nursing, Rochester, Michigan.

This research was supported in part by an award from the Theta Psi Chapter of Sigma Theta Tau International.

Address correspondence to Morris A. Magnan, PhD, RN, 86 Cherokee Road, Pontiac, MI 48341; e-mail: morrismagnan@yahoo.com.

Received: June 06, 2006
Accepted: November 01, 2006

Nursing students are graduating into an increasingly complex environment of care. Marginalized areas of the human health experience related to human sexuality and sexual health have now become prominent areas of concern both nationally (aU.S. Department of Health and Human Services, 2000a, 2000b) and globally (World Health Organization [WHO], 2004). Sexual health has been defined, in part, as “a state of physical, emotional, mental and social well-being in relation to sexuality…” (WHO, 2005, p. 3), whereas sexuality refers to “a central aspect of being human throughout life that encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction” (WHO, 2004, p. 3). Public health problems, such as the emergence of the AIDS pandemic in the past 2 decades, increase in sexually transmitted disease, rise of teenage pregnancy, and problems of sexual violence against women and children, increase the expectation that nurses at all levels of practice recognize sexuality and sexual health as important components of human health, requiring nursing assessment and intervention. In addition, the sexuality concerns of patients with acute and chronic illnesses have been receiving increasing attention in the nursing literature.

Both sexuality and sexual health have been identified as important in the provision of nursing care by a number of professional organizations, including the American Nurses Association (2004), the Association of Women’s Health, Obstetric, and Neonatal Nurses (1994), the Oncology Nursing Society and American Nurses Association (2004), and the Rehabilitation Nurses Association (Gordon, Sawin, & Basta, 1995). The North American Nursing Diagnosis Association included sexual dysfunction on its list of nursing diagnoses in 1980 and added altered sexuality patterns in 1986 (Carpenito, 1989). The importance of nurses addressing sexuality and sexual health is further emphasized by the increasing number of nursing texts that now include discussion and, in some cases, full chapters on human sexuality and sexual health as an integral part of the knowledge base that informs nursing practice (Black & Hawks, 2004; Craven & Hirnle, 2003; Potter & Perry, 2005; Smeltzer & Bare, 2003). However, knowledge alone may not be enough.

Favorable dispositions and attitudes toward human sexuality and communication skills are needed to initiate and sustain one’s commitment to assess sexual health and address patient sexuality concerns (Guthrie, 1999; Webb, 1988). In a recent survey of RNs, Magnan and Reynolds (2006) reported that a major barrier to addressing patient sexuality concerns is nurses’ belief that patients do not expect them to discuss sexuality. If nurses or nursing students perceive that patients do not think sexuality is appropriate for nurses to address, they may be less inclined to assess sexuality, take a sexual history, or offer sexual counseling to patients even if adequately trained to do so (Webb, 1988).

Nursing students’ attitudes about sexuality assessment and counseling as a component of nursing care can present significant obstacles to the fulfillment of their professional roles. Unfortunately, little is known about the attitudes and beliefs that might keep nursing students from addressing patient sexuality concerns. Therefore, the twofold purpose of this study was to identify and describe attitudes and beliefs that might act as barriers to addressing patient sexuality concerns and to determine to what extent these attitudes and beliefs are influenced by personal factors such as age, gender, and education. It is expected that this knowledge will provide information needed to guide curricular enhancement to help students recognize and overcome barriers to addressing patient sexuality concerns.

Literature Review

Little attention has been given to examining nursing students’ attitudes regarding human sexuality. Attitudes about human sexuality are important in the education of health professionals because attitudes related to a particular subject are likely to influence an individual’s behavior. Historically, the study of nurses’ attitudes toward human sexuality has proceeded along two distinct lines of inquiry. One early line of inquiry focused on describing knowledge and attitudes related to specific sexual practices (e.g., masturbation, extramarital relations). A second and more recent line of inquiry has focused on explaining the relationship of personal characteristics (e.g., knowledge, comfort, confidence) and environmental features (e.g., kind of unit worked in, resource availability, staff reactions) on nurses’ engagement or non-engagement in sexuality-related nursing practices (Magnan & Reynolds, 2006). Nursing students have been included in studies regarding knowledge and attitudes about specific sexual behaviors but have not been included in studies predicting sexuality-related nursing practices.

The study of nurses’ attitudes about human sexuality issues began in earnest in the 1970s shortly after the Sex Knowledge and Attitudes Test (SKAT) (Miller & Lief, 1979) was developed. The SKAT assesses knowledge and attitudes related to the physical aspects of sexuality and specific sexual behaviors with little attention given to the non-erotic psychosocial areas of human sexuality, such as body image, the value of touch, or sex-role behavior. The SKAT yields five scores: one knowledge score and four attitude scores. The four attitude scores provide information about attitudes (conservative or liberal) regarding heterosexual relations (specifically, extramarital and premarital relations), sexual myths, abortion, and masturbation. SKAT results were used to demonstrate “the deficiencies of medical and nursing education in preparing health professionals to aid patients with sexual problems” and to evaluate the effectiveness of sexuality educational programs (Miller & Lief, 1979, p. 282).

A number of studies conducted in the 1970s and 1980s used the SKAT to measure the sex knowledge and attitudes of nurses and nursing students. Few studies looked exclusively at nursing students’ attitudes toward sexuality, but several included nursing students as a part of the sample. A premise underlying many of these studies was that nurses’ attitudes might be a significant obstacle to their effective functioning in the field of sexual counseling. However, protecting patients was emphasized more than promoting their sexual health. Thus, it was thought that if nurses could learn to acknowledge their own prejudices and adopt nonjudgmental attitudes, patients might be spared the discomfort of nurses’ punitive attitudes, careless statements, and inappropriate reactions (Fisher & Levin, 1983; Payne, 1976).

Lief and Payne (1975) used the SKAT to compare nursing students’ sexual knowledge, sexual myths, and attitudes about heterosexual relations (premarital and extramarital), homosexuality, masturbation, and abortion with those of RNs. The study found that nursing students were more knowledgeable about sexuality and more liberal in their attitudes, and both groups (students and RNs) were less knowledgeable and more conservative than any other group studied (e.g., medical students, college students, male or female graduate students).

In a follow-up study, Payne (1976) compared knowledge and attitudes of nursing students with those of family planning nurses. One might expect family planning nurses to be more knowledgeable about sexuality and to hold more liberal attitudes toward sexual behaviors because their work involves matters related to sexuality. However, the study found that nursing students were more knowledgeable about sexuality and more liberal in their attitudes toward heterosexual relations (extramarital and premarital relations), abortion, and masturbation but did not differ from the family planning nurses regarding adherence to sexual myths.

Nearly a decade after the study by Lief and Payne (1975), Fisher and Levin (1983) used the SKAT to examine knowledge and attitudes of nurses (N = 120) caring for oncology patients. When Fisher and Levin (1983) compared their results with those of Lief and Payne (1975), the nurses surveyed in the 1980s were found to be less knowledgeable about sexuality and more conservative in their attitudes toward heterosexual relations, masturbation, and abortion than were the nurses surveyed in the 1970s.

Webb (1988) studied British nurses (N = 50) in gynecological and nongynecological settings. Although the study included nursing students, the number of students in the study was not reported and student data were not separated from RN data. In the aggregate, Webb found that nurses, in general, do not appear to be equipped to discuss issues of sexuality with their patients because they lack the necessary social and communications skills, fail to see the relevance of discussing sexuality, or lack knowledge. In contrast, Wall-Haas (1991) found that even when nurses were theoretically capable of addressing issues of sexuality, they frequently reported feeling uncomfortable incorporating issues of sexuality, counseling, and education into their practice. Wall-Haas (1991) noted that despite having relatively liberal and accepting attitudes about sexuality, it was not uncommon (54%) for nurses to excuse not addressing sexuality by projecting onto their patients such thoughts as “the adolescent patient does not want sexuality counseling from a nurse” (p. 553).

In 1994, Lewis and Bor used the SKAT to evaluate registered general nurses (RGNs) (N = 161) working in hospitals affiliated with St. Mary’s Hospital in London, England. When Lewis and Bor compared results of their study with data obtained from nurses 2 decades earlier in the United States, they found that the RGNs scored significantly lower on knowledge about sexuality and attitudes about abortion and significantly higher on attitudes about heterosexual relations, but they did not differ on attitudes about sexual myths or masturbation.

Results from 2 decades of testing using the SKAT suggest that sexuality knowledge among nurses has not improved and that nurses tend to be somewhat conservative in their attitudes about sexual behaviors. Studies involving nursing students have been fairly consistent in documenting greater knowledge and more liberal attitudes among nursing students compared with RNs, but both nursing students and RNs have been shown to be less knowledgeable and more conservative than other college graduates.

In 2005, Reynolds and Magnan reported developing the Sexuality Attitudes and Beliefs Survey (SABS) specifically for the purpose of assessing nurses’ attitudes about patient sexuality concerns in clinical practice. Unlike the SKAT, the SABS does not elicit attitudinal information about the physical aspects of sexuality or specific sexual behaviors. Instead, the SABS elicits more general attitudinal information related to personal comfort, confidence, meeting patient expectations, and making time to address patient sexuality concerns (Reynolds & Magnan, 2005). To date, the results of three studies have been reported in the literature (Magnan & Reynolds, 2006; Magnan, Reynolds, & Galvin 2005; Reynolds & Magnan, 2005), but none of these studies included nursing students in the participant pool. These three studies uniformly reported that the two major barriers to addressing patient sexuality concerns included nurses’ belief that patients do not expect nurses to address sexuality concerns and failure to make time to address patient sexuality concerns. A troublesome question raised by these early studies is whether RNs’ attitudinal barriers to addressing patient sexuality concerns develop during the course of one’s professional career, or whether they are present while in nursing school. Thus, use of the SABS to survey nursing students’ attitudes about addressing patient sexuality concerns will provide not only direct information about nursing students’ attitudes toward patient sexuality concerns, but also insight into when barrier attitudes develop.

Method

A descriptive, correlational design was used to elicit information about nursing students’ attitudes and beliefs about patient sexuality and to examine these data in relation to factors such as age, gender, and educational level.

Sample and Setting

The sample consisted of 341 participants. All participants were first-time nursing students enrolled in a baccalaureate nursing program. Most (n = 294, 86.2%) were enrolled in the traditional nursing program, but 47 (13.8%) were seniors in the accelerated second-degree program. Among the traditional students, 1 student did not report class standing; the rest identified themselves as sophomores (n = 92), juniors (n = 103), or seniors (n = 98). Thirty-eight (11.1%) of the students were male, 294 (86.2%) were female, and 9 (2.6%) did not report gender. Participants’ ages ranged from 19 to 52 years (mean age = 25.16, SD = 6.61). Second-degree students (mean age = 30.79, SD = 7.18) were significantly older (t = −5.70, df = 52.8, p < 0.001) than traditional students (mean age = 24.3, SD = 6.09). Also, the number of male participants in the second-degree program exceeded what might be expected by chance alone (chi-square = 15.63, p < 0.001).

Procedure

Data collection occurred during a 2-month period from February to March 2006. Students were recruited either in person (N = 243) or online (N = 98; traditional seniors only). To ensure anonymity, all students recruited in person were instructed to place no personal identifying information on their survey booklets. Similarly, to maintain confidentiality, students were instructed to return questionnaires, whether completed or not, in the envelopes provided. The possibility of coercion was minimized by asking faculty to leave the room during data collection procedures. Students who provided online responses were given 4 weeks to complete the survey. Completed online surveys were electronically routed to a secured Web site.

Instrumentation

Nursing students’ attitudes and beliefs about patient sexuality in nursing practice were assessed using the SABS. The SABS elicits information about attitudes and beliefs related to addressing patient sexuality in nursing practice. Using a Likert-type response format, participants provide self-report information across 12 items, some of which are reverse coded. The theoretical range for the SABS is 12 to 72, with higher scores indicating a stronger barrier to addressing patient sexuality. Psychometric properties of the SABS, including internal consistency reliability, test-retest reliability, and construct validity, have been reported elsewhere (Magnan, Reynolds, & Galvin, 2005; Reynolds & Magnan, 2005). Internal consistency reliabilities for the SABS have ranged from 0.74 to 0.85 when administered to RNs. Internal consistency reliability of the instrument when pilot tested with senior nursing students attending a different midwestern university was 0.70 (Magnan, 2004). In the current study, the internal consistency reliability was acceptable (Cronbach’s alpha = 0.74).

When faced with questions about a sensitive topic, such as attitudes about human sexuality, some individuals provide answers they feel are more acceptable to others, rather than stating their honest opinion. This can result in a response bias, referred to as a social desirability response bias (Polit & Hungler, 1999). Crowne and Marlowe (1964) developed a social desirability scale to be used specifically for the purpose of determining the extent to which survey respondents were apt to provide socially desirable responses, rather than honest responses, to survey questions. To minimize the burden to nursing students of answering many questions, a shortened, 10-item version of the Marlowe-Crowne Social Desirability Scale (Strahan & Gerbasi, 1972) was used to assess social desirability response bias. In the current study, internal consistency reliability was marginal (Cronbach’s alpha = 0.60) but acceptable for a short-item test.

A demographic sheet was used to obtain information related to variables such as age, gender, current level within the nursing program, and prior exposure to sexuality educational programs.

Data Analysis

Data were analyzed using SPSS version 11.5 software. Both descriptive and inferential statistics were used to analyze the data. Inferential statistics included correlation, t tests, and the Kruskal-Wallis test.

Results

SABS total scores ranged from 12 to 61 (mean score = 33.56, SD = 8.01), with higher scores indicating stronger barriers to addressing patient sexuality. A nonsignificant correlation (r = −0.07, p = 0.23) between SABS totals scores and the Marlowe-Crowne social desirability scores suggests that the student participants provided honest, rather than socially desirable, responses. SABS total scores were unrelated to age. Further analysis showed that SABS mean scores differed by gender, exposure to sexuality instruction in nursing school, and level within the nursing program. Results of a Mann-Whitney U test (U = 4362.5, z = −2.17, p = 0.03) indicated that barriers to addressing sexuality concerns were greater for male students compared with female students. Average SABS scores (and therefore barriers) were significantly lower (t = 2.81, df = 333, p = 0.005) for students who reported receiving instruction on human sexuality in nursing school (mean score = 32.38, SD = 7.56) compared with students who reported no such instruction (mean score = 34.78, SD = 8.08).

Proportional responses to SABS items were examined to determine which of the potential barriers presented problems to the greatest number of students. These analyses were conducted by first dichotomizing each of the 12 SABS items into agreement (scale response, 1 to 3) and disagreement (scale response, 4 to 6) categories. Results of these analyses are reported in the aggregate and by level within the program (i.e., sophomore, junior, senior, second-degree senior) (Table). The preponderance of responses indicated that students understood how patients’ diseases and treatments might affect patient sexuality (item 2, 89.1% agreement), that giving patients permission to talk about sexuality concerns is a nursing responsibility (item 10; 86.1% agreement), and that discussing sexuality is essential to patients’ health outcomes (item 1; 77.6% agreement). In contrast, few students (12.1% agreement) thought that sexuality was too private an issue to discuss with patients (item 9), only 17% thought that patients were too sick to be interested in sexuality (item 5), and 24.9% thought that sexuality should be discussed only if the patient initiated the discussion (item 11). Still, less than one third of the students (32.1%) reported actually making time to discuss sexuality concerns with patients (item 6), and only one third (33.6%) thought that patients expect nurses to ask about their sexual concerns (item 12).

Agreement and Disagreement with Sexuality Attitudes and Beliefs Survey Items Across Educational LevelsAgreement and Disagreement with Sexuality Attitudes and Beliefs Survey Items Across Educational Levels

Table: Agreement and Disagreement with Sexuality Attitudes and Beliefs Survey Items Across Educational Levels

Kruskal-Wallis tests were used to determine whether the percentage of students endorsing SABS items varied significantly across levels of education. Within the traditional program, significant differences were found for two items (Table; items 6 and 12). Proportionately more sophomores, compared with juniors and seniors, reported making time to discuss patient’s sexuality concerns (item 6; chi-square = 12.88, p = 0.002). Also, proportionately fewer seniors, compared with juniors and sophomores, agreed that patients expect nurses to address sexuality concerns (item 12; chi-square = 6.79, p < 0.05).

When Kruskal-Wallis tests were used to compare endorsements of second-degree seniors with those of traditional seniors, statistically significant differences were found for six of the SABS items (Table; items 1, 6, 9, 10, 11, 12). Compared with traditional seniors, significantly fewer second-degree seniors agreed that giving patients permission to talk about sexual concerns is a nursing responsibility (item 10; chi-square = 9.01, p = 0.029); agreed that discussing sexuality was essential to health outcomes (item 1; chi-square = 20.66, p < 0.001); or actually made time to address patients’ sexuality concerns (item 6; chi-square = 33.97, p < 0.001). In contrast, compared with traditional seniors, a significantly greater proportion of second-degree seniors thought that sexuality was too private to discuss (item 9; chi-square = 14.66, p = 0.002) and should be discussed only if the patient initiates the discussion (item 11; chi-square = 42.30, p < 0.001). Finally, second-degree seniors were similar to traditional seniors in that, compared with sophomores and juniors, significantly fewer believed that patients actually expect nurses to address sexuality concerns (item 12; chi-square = 15.05, p = 0.002).

Discussion

Results of this study indicate that failure to make time to discuss patient sexuality concerns and believing that patients do not expect nurses to discuss their sexuality concerns are consistently among the top three barriers encountered by nursing students, regardless of level in the program (sophomore, junior, senior) or whether traditional or second-degree students. These results are similar to those of studies involving RNs (Magnan & Reynolds, 2006; Magnan, Reynolds, & Galvin, 2005), with the notable exception that the number one barrier for RNs was the nurses’ belief that patients do not expect nurses to address their sexuality concerns.

The fact that students do not make time to address patient sexuality concerns might be a consequence of their perception that patients do not expect nurses to address their sexuality concerns. Other researchers have reported that health professionals modify their behavior based on expected patient responses. For example, Schnarch and Jones (1981) reported that the likelihood of a physician discussing sexual concerns with a patient would be influenced by the physician’s perception of the patient’s probable response. Alternatively, it could be that students do not make time to discuss patient sexuality concerns because they perceive nursing work as a set of readily achievable psychomotor tasks that take priority over the psychosocial concerns of their patients. This may be especially true of the accelerated second-degree students who must acquire psychomotor and psychosocial skills in a very short time period. Pepa, Brown, and Alverson (1997) noted that it is not uncommon for such students to focus on acquiring a BSN degree to return to the workforce, rather than focusing on the process of learning how to deliver comprehensive nursing care that involves the use of critical thinking and interpersonal skills.

Many (77.6%) of the nursing students in this study indicated that discussing sexuality concerns was essential to patient health outcomes, and many (86.1%) believed that giving patients permission to talk about sexual concerns is a nursing responsibility. Still, as noted above, few students (32.1%) reported actually making time to address sexuality concerns, and many (66.4%) believed that patients do not expect nurses to address their sexuality concerns. Why students believed that patients do not expect nurses to address their sexuality concerns is difficult to explain. It may be that students are simply making wrong assumptions about patient expectations, given that past research has shown that patients actually believe that discussion of sexuality concerns with nurses is appropriate (Waterhouse, 1996; Webb, 1988). However, it should be noted that no recent surveys of patients’ perceptions have been reported in the literature. Additional research is needed to help dispel (what appears to be) the myth that patients do not expect nurses to address their sexuality concerns.

A surprising and unexpected finding of this study was that accelerated second-degree students differed substantially from traditional students on 6 of the 12 SABS items. Compared with traditional students, a greater proportion of second-degree students did not think discussing sexuality was a nursing responsibility or essential to health outcomes, thought patients were too sick to be concerned about sexuality, thought that sexuality was too private and should be discussed only if the patient initiated the discussion, and did not think patients expected nurses to discuss their sexuality concerns. This unevenness in the points of view expressed by student cohorts exposed to, essentially, the same curriculum is perplexing but not unique. Brown, Alverson, and Pepa (2001) reported an unevenness in the development of critical thinking skills of accelerated second-degree students compared with traditional students and suggested that the fast pace of accelerated programs may limit opportunities for critical reflection and application of newly acquired knowledge. Thus, it may be that in the current study, the pace of the accelerated second-degree program does not allow sufficient time for students to develop insights into the scope of nursing practice, acquire beliefs needed to shape positive attitudes about addressing patient sexuality concerns, reflect on value orientations toward holism, or acquire the communication skills needed to address sensitive psychosocial issues.

Recommendations

Research is needed to further understand nurses’ and nursing students’ perceptions of their role in relation to addressing patient sexuality concerns. Studies using the SABS have consistently shown that most respondents (whether nursing student or RN) do not think that patients expect nurses to address their sexuality concerns and rarely make time to do so. However, it should be recognized that these studies have failed to address important contextual elements such as environmental features (e.g., workload, cultural climate of care), personal characteristics of the nurse including value orientations (e.g., predominantly deontological and rule driven versus teleological and outcomes driven), patient characteristics (e.g., potential for sexual dysfunction, openness to communication), and characteristics of the nurse-patient relationship (e.g., length of time caring for patient, age differential, culture and gender differences). Research in which participants are given an opportunity to respond to contextually rich patient exemplars, while controlling for extraneous sources of variance, might yield a distinctly different picture of nurses’ views regarding their role in addressing patient sexuality concerns.

Helping students learn how to provide sensitive health assessment and counseling services is an important aspect of nursing education. Introducing sexuality as part of the nursing curriculum is of little use if students cannot integrate such theory into practice. Education should be geared not only toward providing nurses with knowledge about sexuality, but also toward helping them develop positive attitudes about addressing patient sexuality concerns and equipping them with communication skills to operationalize that knowledge (Duldt & Pokorny, 1999; Guthrie, 1999).

Attitude formation is a complex phenomenon mediated by factors such as personal experience, parental influence, group pressure, and cognitive information (Fishbein & Ajzen, 1975). However, both attitude formation and changes in one’s attitudes are possible through a variety of structured educational experiences. For example, Dixon-Woods et al. (2002) have reported success using multifaceted teaching-learning strategies to help medical students overcome anxiety and develop more positive attitudes toward addressing human sexuality concerns. The question of whether a transformation in attitude does or does not lead to desired changes in behavior and practice is an important one. Ongoing faculty support, involvement of clinical instructors, and the use of simulated patients are strategies that might help students translate newly acquired attitudes and skills into practice (Dixon-Woods et al., 2002).

Equipping students with sexuality communication skills may help them overcome the barrier of making time to address patient sexuality concerns and help dispel the myth that patients do not expect nurses to address their sexuality concerns. Encouraging students to make time in their daily assessments to ask patients “Do you have any concerns about how your illness or treatment might affect you as a woman/man?” is one way of giving patients permission to talk about their sexuality concerns while providing a safe and unobtrusive point of entry for the student.

Disparity in the data obtained from second-degree students, compared with traditional students, suggests that outcomes research is needed to determine the extent to which different pathways to the BSN yield similar levels of professional competency. Accelerated second-degree programs are mushrooming across the country as the nursing shortage worsens. These programs are intended to increase the number of BSN graduates by building on students’ previous degrees (Wink, 2005). Cangelosi and Whitt (2005) noted that most of the literature related to second-degree programs is anecdotal in nature, rather than research based. Very little research related to outcomes of these programs is found in the literature. Outcomes that have been studied include NCLEX-RN® pass rates (McDonald, 1995; Seldomridge & DiBartolo, 2005; Shiber, 2003), critical thinking scores (Brown, Alverson, & Pepa, 2001; Pepa, Brown, & Alverson, 1997), GPAs (Roberts, Mason, & Wood, 2001), and attitudes about nursing (Toth, Dobratz, & Boni, 1998). No studies were found related to clinical competence or performance.

Programs of research designed to evaluate the effectiveness of accelerated degree programs need to be developed. A comprehensive and effective program of research should be of sufficient breadth that the data provide information needed to describe student capabilities in areas known or thought to be important to professional practice, provide a basis for examining relationships among elements, and point to specific elements in the curriculum that, if modified, might lead to better student outcomes. Although this is a formidable task, it is one that must be undertaken. Broome (2004) noted that nurse educators:

must critically and systematically develop research programs that will evaluate the effectiveness of these new [accelerated degree] programs in creating a nurse who thinks critically, is a knowledge broker, and is capable of speaking up and out for both herself/himself and the patient! (p. 70)

However, questions of where to begin and how to proceed are daunting.

The Essentials of Baccalaureate Education for Professional Nursing Practice (American Association of Colleges of Nursing, 1998) offers a conceptual framework that could be used to guide program evaluation along three important dimensions: professional values, core competencies, and core knowledge. Moreover, the Essentials document has been developed in sufficient detail that it might be used further to identify or develop empirical indicators within these three identified dimensions. In the current study, for example, student attitudes about sexuality assessment and counseling might be understood as one indicator of the Essentials’ core competency related to communication, where it is expected that students are capable of “providing relevant and sensitive health education information and counseling” (p. 10).

When the results of the current study were analyzed in relation to competencies identified in the Essentials document, questions were raised about the relationship between professional values and communication competencies. The authors speculated that the accelerated pace of the program might curtail engagement in the reflective kind of thinking needed to develop professional value orientations toward nurse-patient interactions around socially sensitive subject matter. This position is similar to Rogers’ (1989) view related to perspective transformation. Perspective transformation is a process through which individuals gradually change how they view themselves and relate to others through awareness, reflection, and critical analysis of their values and beliefs (Rogers, 1989). Creating opportunities—in the classroom or during clinical conference—for student reflection and discussion of issues related to nurse-patient interactions around socially sensitive subject matter, such as human sexuality, might stimulate students to engage in the process of evaluating and transforming their own value orientations.

However, without program evaluation data related to acquisition of professional values, our position remains speculative. The next step in our program of research will seek to determine whether and to what extent accelerated second-degree students differ from traditional students in their professional values orientations, and whether these value orientations influence willingness and ability to address patient sexuality concerns.

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Agreement and Disagreement with Sexuality Attitudes and Beliefs Survey Items Across Educational Levels

Senior
ItemAggregatea(N = 340)Sophomore(n = 92)Junior(n = 103)Traditional(n = 98)Second-Degree(n = 47)
1. Discussing sexuality is essential to patients’ health outcomes.
  Agree77.6%85.7%74.8%81.6%58.7%
  Disagree22.4%14.3%25.2%18.4%41.3%
  Did not respond21001
2. I understand how my patients’ diseases and treatments might affect their sexuality.
  Agree89.1%87.9%92.2%89.8%82.6%
  Disagree10.9%12.1%7.8%10.2%17.4%
  Did not respond21001
3. I am uncomfortable talking about sexual issues.
  Agree36%36.3%41.7%35.7%21.7%
  Disagree64%63.7%58.3%64.3%78.3%
  Did not respond21001
4. I am more comfortable talking about sexual issues with my patients than are most of the nurses I work with.
  Agree42.9%43.5%38.8%44.9%47.7%
  Disagree57.1%56.5%61.2%55.1%52.3%
  Did not respond157503
5. Most hospitalized patients are too sick to be interested in sexuality.
  Agree17%23.9%17.6%8.2%19.6%
  Disagree83%76.1%82.4%91.8%80.4%
  Did not respond64101
6. I make time to discuss sexual concerns with my patients.
  Agree32.1%49.4%28.7%29.6%14%
  Disagree67.9%50.6%71.3%70.4%86%
  Did not respond1711204
7. Whenever patients ask me a sexually related question, I advise them to discuss the matter with their physician.
  Agree12.2%6.4%13%13.3%16.7%
  Disagree87.8%93.6%87%86.7%83.3%
  Did not respond2214305
8. I feel confident in my ability to address patients’ sexual concerns.
  Agree63.5%68.5%68%54.1%65.2%
  Disagree36.5%31.5%32%45.9%34.8%
  Did not respond43001
9. Sexuality is too private an issue to discuss with patients.
  Agree12.1%12.2%10.7%7.1%23.9%
  Disagree87.9%87.8%89.3%92.9%76.1%
  Did not respond32001
10. Giving a patient permission to talk about sexual concerns is a nursing responsibility.
  Agree86.1%83.3%88.3%90.8%76.1%
  Disagree13.9%16.7%11.7%9.2%23.9%
  Did not respond32001
11. Sexuality should be discussed only if initiated by the patient.
  Agree24.9%17.8%23.5%15.3%60.9%
  Disagree75.1%82.2%76.5%84.7%39.1%
  Did not respond42101
12. Patients expect nurses to ask about their sexual concerns.
  Agree33.6%41.6%41.2%24.5%21.7%
  Disagree66.4%58.4%58.8%75.5%78.3%
  Did not respond53101
Authors

At the time this article was written, Dr. Magnan was Assistant Professor, and Dr. Norris is Associate Dean and Assistant Professor, Oakland University, School of Nursing, Rochester, Michigan.

Address correspondence to Morris A. Magnan, PhD, RN, 86 Cherokee Road, Pontiac, MI 48341; e-mail: .morrismagnan@yahoo.com

10.3928/01484834-20080601-06

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