New Zealand Rehabilitation Association, Inc.

Maria Low is a Clinical Nurse Specialist in Rehabilitation for the Burwood Spinal Unit, Canterbury District Health Board (CDHB).  Recently, Maria wrote a successful business proposal to CDHB for additional hours dedicated to addressing sexuality in rehabilitation and last month she was appointed to that role.

To begin with, could you outline your roles and responsibilities at Burwood Hospital?

Absolutely!  Well, I have a 0.5 FTE position as Clinical Nurse Specialist in Rehabilitation, and I job share with Lyn Stephens who’s the other Clinical Nurse Specialist in rehab, and, as of last month, I also have an additional 0.3 FTE role dedicated to sexuality rehabilitation.  Our role involves being a resource person providing clinical expertise regarding acute management, rehabilitation and reassessment.  We have a hands-on approach to working with the nursing team.  We also work closely with our clinical nurse manager, Ngaire Hunt, and the nurse educators to implement quality nursing care, policy, practice and procedures.  We communicate with all the members of the health team.  We see an integral part of the rehab process is aimed at the patients reaching their optimum function and social and mental wellbeing – obviously – so we aim to establish a therapeutic relationship with the patients by involving them in their own care, including choosing the goals of rehabilitation together.  I stay focused on the patients’ issues and provide the patients with opportunities to recognise their own needs, providing them with education, positive feedback, honesty and respect.  We also need to have a good understanding of coping mechanisms for patients in crisis.

An important part of our role is to organise the patients’ breaks away from the hospital and discharges, so to facilitate that we liaise with the patients, the family and whanau, members of the interdisciplinary team, the funding agencies (e.g. LifeLinks, ACC) as well as external agencies such as district nursing and care agencies.  We attend medical rounds, the multidisciplinary team meetings, and we advocate for our patients.  We also do a lot of external teaching to care agencies, to ACC, and presenting at conferences.  Part of my role also involves acting as a keyworker for some patients… and I’m the team leader for collecting our AROC data – that’s the Functional Independence Measure score on admission and discharge for the Australasian Rehabilitation Outcomes Centre.  I’m actually off to Adelaide in November for a workshop on that.  I’m a CPR instructor, an IV assessor, and I’m also trained as a clinical supervisor.

Phew! That’s a lot of work!

(Laughs) That’s the summarised version – the brief overview.

What about your role in sexuality rehabilitation?

Again, I’m a resource person.  I support and educate the staff across the Burwood Spinal Unit multidisciplinary team by facilitating workshops and inservice education.  When setting up the roll, I liaised with Susan Sliedrecht who is the counsellor in the Auckland Spinal Unit, and who was an amazing help, giving me support and assistance with setting up the structure of my workshops.  I’m now running my sixth workshop in November.

What has the response been like from the Burwood staff regarding the workshops on sexuality rehabilitation?

The feedback has been very positive.  The staff all say that this kind of training has been long overdue, that this is finally a chance to discuss sexuality issues; a chance to be given some opportunities to learn how to address some of these issues with the patients.  The staff have reported that the workshops have given them more knowledge and that they now feel more comfortable addressing sexuality issues with patients.  Historically it’s always been that everyone thinks someone else in the team is addressing sexuality - that the consultants are dealing with it perhaps – and so it’s been a subject that has not really been discussed that much with patients.

Who has attended your workshops?

The workshops have been interdisciplinary: the speech language therapists, physios, OTs, nurses, and doctors attend. Even though I’ve had this dedicated time allocated, it’s not solely my role to address sexuality issues.  I shouldn’t be the only person discussing sexuality, because patients will choose who they want to discuss these issues with.  But, yes, the feedback from the workshops has been very, very positive.

What are the others parts of your roles with regard to sexuality rehabilitation?

I also do sexuality counselling with patients on a one-on-one basis. I do patient group presentations.  I liaise with consultants, and assist with procedures for erectile devices and fertility.  I have also given presentations to care agencies, ACC and at conferences.

Did you have any specialist training, for example in the sexuality counselling?

Yes, I’ve done some training with Robyn Sainsbury, a sex psychologist.  I completed a sexual counselling course with her – two of those.  I’d also worked at Christchurch Women’s Hospital, and did a community sexual health course in the Sexual Health Clinic.  So I’ve previously had a real interest in the area.

What did you have to do to get the role set up?

A few years back, when the hospital was audited, they realised that sexuality wasn’t being captured, so I was asked by my Charge Nurse to look at doing some guidelines – which I did in 2006.  So because I had done a Postgraduate Certificate in Clinical Rehabilitation, I knew how to research and find what was out there, I was able to write guidelines for the organisation.  It took a long time to get the guidelines through I’d have to say, by the time they got circulated etc, but they were eventually approved and now they’re in our CDHB Policies and Procedures manuals.

Wonderful!

So in those guidelines I included a section on the importance of having staff education and that all people working in the rehabilitation environment should have an opportunity to have some training in sexuality rehabilitation.  That was my starting point.  Then I started running some patient group education talks, and it didn’t take long before people started identifying me as the one to discuss these issues with – but I was really restricted with my other role responsibilities.  The next step then was to put a business case forward to create a dedicate position to address this need, again with skills learnt from postgraduate study.  And that business case was signed off to get 0.3 FTE added to my current position to dedicate to the sexuality rehabilitation role.  So I pushed my own wheelbarrow really – because I had a real passion and a belief that this was something that needed to be addressed.

Do you think addressing sexuality issues in rehabilitation is a ‘nice to have’ or a ‘need to have’?

Oh, I absolutely think it is a need to have.  I absolutely believe that – obviously, since I’ve gone to all this trouble (laughs).  Rehabilitation covers all life domains, and therefore a holistic rehab service has to have opportunities to address sexuality issues.  The research also clearly indicated that sexuality should be broached during the inpatient rehab stay and should be introduced by the health professional.   Sexuality has an important role in maximising quality of life for people with spinal cord injury, so we need to legitimise the topic.  The research shows that patients do not always raise these issues first, but when the health professional does, it makes it ok to ask.  So it is important that the health professional broaches the topic first.  Of course not every patient will want to discuss this topic, but it is essential that they know that in this environment they have permission to do so.

What are the important components of a sexuality rehabilitation service at the Burwood Spinal Unit?

Well, I might not be the person that an individual patient wants to talk to, so it is important that all staff have some level of knowledge about sexuality in rehabilitation, and is able to redirect patients to other people where appropriate.  So all staff need to have access to the appropriate education and training.  It’s also important to have doctor consultations where sexual function and the appropriate investigations are looked at.  I also think it is really important to link in with peer supports from the same consumer group.  In this regard we’re very lucky – we have the Allen Bean Centre nearby to help.  Some of the staff there are already actively involved in addressing sexuality issues.  Also, this all should happen in an inpatient and outpatient basis as well.

How do you think this stuff would apply to areas of rehabilitation other than spinal cord injury?

I think in all areas of rehab it’s important – particularly in Older Person’s rehabilitation because ageism comes in there as well, and people make the mistake of assuming that patients over 65 aren’t interested in sex.  Because I think the thing people need to remember is that sexuality is not all about intercourse and orgasm – it covers a whole lot of things like self-image, body-image, cuddling, intimate relationships and all those sorts of things.  I think historically it has all been about erectile dysfunction and intercourse, when the view of sexuality should be broader.  So I think sexuality has a place to play in rehabilitation for the aged, following total hip replacement surgery, plastic surgery, getting colostomies, palliative care – anything like that really.

What advice would you give to someone who wanted to improve the way their rehabilitation service addresses sexuality issues?

I just think anyone who has a passion and can see a gap – regardless of if it is in sexuality or something else – you can make change happen.  For me, from where my nursing career started to now, I never would have dreamt that I would have had policies and procedures and guidelines written where I’ve been the main author.  It’s definitely a team approach, but you do need someone to lead sometimes.  Change happens if you’re innovative and you work to demystifying some of the myth out there.  If you really believe in it, any one of us can do it.

Thanks for your time.