2. Homosexuality
   1. Definition-alternative sexual behavior; applied to sexual relations between persons of the same sex.
   2. Theories regarding causes
      1. Hereditary tendencies.
      2. Imbalance of sex hormones.
      3. Environmental influences and conditioning factors, related to learning and psychodynamic theories.
         1. Defense against unsatisfying relationship with father.
         2. Unsatisfactory and threatening early relationships with opposite sex.
         3. Oedipal attachment to parent.
         4. Seductive parent (incest).
         5. Castration fear.
         6. Labeling and guilt leading to sexual acting out.
         7. Faulty sex education.
      4. Preferred choice as a lifestyle.
   3. Nursing care plan/implementation:
      1. Nurse needs to be aware of and work through own attitudes that may interfere with providing care.
      2. Accept and respect lifestyle of gay (male homosexual) or lesbian (female homosexual) client.
      3. Assess and treat for possible sexually trans mitted diseases and hepatitis.
      4. Health teaching: assess and add to knowledge base about alternatives in sexual behavior.
   4. Evaluation/outcome criteria: expresses self confidence and positive self-image; able to sustain satisfying sexual behavior with chosen partner and avoid at-risk behaviors for STDs.
3. Sex and the disabled person
   1. Assessment parameters:
      1. Previous level of sex functioning and conflict.
      2. Client's view of sex activity (self and mutual pleasure, tension release, procreation, control).
      3. Cultural environment influence on body im age).
      4. Degree of acceptance of illness.
      5. Support system (partner, family, support group)
      6. Body image and self-esteem.
      7. Outlook on future.
   2. Analysis/nursing diagnosis: Sexual dysfunction associated with physical illness related to:
      1. Disinterest in sexual activity.
      2. Fear of precipitating or aggravating physical illness through sexual activity.
      3. Use of illness as excuse to avoid feared or undesired sex.
      4. Physical inability or discomfort during sexual activity.
   3. Nursing care plan/implementation:
      1. Approach with nonjudgmental attitude.
      2. Elicit concerns about current physical state and perceptions of changes in sexuality.
      3. Observe nonverbal clues of concern.
      4. Identify genital assets.
      5. Support client and partner during adjustment to current state.
      6. Explore culturally acceptable sublimation activities.
      7. Promote adjustment to body image change.
      8. Health teaching:
         1. Teach self-help skills
         2. Teach partner to care for client's physical needs.
         3. Teach alternate sex behaviors and acceptable sublimation (touching, for example).
   4. Evaluation/outcome criteria: attains satisfaction with adaptive alternatives of sexual expressions; has a positive attitude toward self, body, and sexual activity.
4. Inappropriate sexual behavior
   1. Assessment: public exhibitions of sexual behav iors that are offensive to others; making sexual advances to other clients or staff.
   2. Analysis/nursing diagnosis: onflict with social order related to:
      1. Acting out angry and hostile feelings.
      2. Lack of awareness of hospital and agency rules regarding acceptable public behavior.
      3. Variation in cultural interpretations of what is acceptable public behavior.
      4. Reaction to unintended seductiveness by person's attire, posture, tone, or choice of terminology.
   3. Nursing care plan/implementation:
      1. Maintain calm, nonjudgmental attitude.
      2. Set firm limits on unacceptable behavior.
      3. Encourage verbalization of feelings rather than unacceptable physical expression.
      4. Reinforce appropriate behavior.
      5. Provide constructive diversional activity for clients or patients.
      6. Health teaching: explain rules regarding pub lic behavior; teach acceptable ways to express anger.
5. Evaluation/outcome criteria: verbalizes anger rather than acting out; accepts rules regarding behavior in public.