Specific Situations

1. Masturbation
1. Definition-act of achieving sexual arousal and orgasm through manual or mechanical stimulation of the sex organs.
2. Characteristics
   1. Can be an interpersonal as well as a solitary activity.
   2. “It is a healthy and appropriate sexual activity, playing an important role in ultimate consolidation of one’s sexual identity.”*
   3. Accompanied by fantasies that are important for:
      1. Physically disabled.
      2. Fatigued.
      3. Compensation for unreachable goals and unfulfilled wishes.
      4. Rehearsal for future sexual relations.
      5. Absence or impersonal action of partner.
   4. Can help release tension harmlessly.
3. Concepts and principles related to masturbation
   1. Staff’s feelings and reactions influence their responses to client and affect continuation of masturbation (that is, negative staff actions increase client’s frustration, which increases masturbation).
   2. Masturbation is normal and universal, not physically or psychologically harmful in itself.
   3. Pleasurable genital sensations are important for increasing self-pride, finding gratification in own body, increasing sense of personal value of being lovable, helping to prepare for adult sexual role.
   4. Excessive masturbation-some needs not being met through interpersonal relations; may use behavior to avoid interpersonal relations.
   5. Activity may be related to:
      1. Curiosity, experimentation.
      2. Tension reduction, pleasure.
      3. Enhanced interest in sexual development.
      4. Fear and avoidance of social relationships.
4. Nursing care plan:
   1. Long-term goals
      1. Gain insight into preference for masturbation.
      2. Relieve accompanying guilt, worry, selfdevaluation.
   2. Short-term goals
      1. Clarify myths regarding masturbation.
      2. Help client see masturbation as an acceptable sexual activity for individuals of all ages.
      3. Set limits on masturbation in inappropriate settings.
5. Nursing implementation:
   1. Examine, control nurse’s own negative feelings; show respect.
   2. Avoid: reinforcement of guilt and self-devaluation; scorn; threats, punishment, anger, alarm reaction; use of masturbation for rebellion in power struggle between staff and client.
   3. Identify client’s unmet needs; consider purpose served by masturbation (may be useful behavior).
   4. Examine pattern in which behavior occurs.
   5. Intervene when degree of functioning in other daily life activities is impaired.
      1. Remain calm, accepting, but nonsanctioning.
      2. Promptly help clarify client’s feelings, thoughts, at stressful time.
      3. Review precipitating events.
      4. Be a neutral “sounding board”; avoid evasiveness.
      5. If unable to handle situation, find someone who can.
   6. For clients who masturbate at inappropriate times or in inappropriate places:
      1. Give special attention when they are not masturbating.
      2. Encourage new interests and activities, but not immediately after observing masturbation.
      3. Keep clients distracted, occupied with interesting activities.
   7. Health teaching: explain myths and teach facts regarding cause and effects.
6. Evaluation/outcome criteria:
   1. Acknowledges function of own sexual organs.
   2. States sexual experience is satisfying.
   3. Views sexuality as pleasurable and wholesome.
   4. Views sex organs as acceptable, enjoyable, and valued part of body image.
   5. Self-image as fully functioning person is restored and maintained.