Let's talk about sex, occupational therapist saysOccupational therapist Kathryn Ellis meets with a patient at Walter Reed National Military Medical Center in Bethesda, Maryland. (Courtesy photo) by: Military Health System Communications Office
FALLS CHURCH, Va. — Even under the best circumstances, talking about sex can be difficult. Imagine, then, how service members who’ve experienced a physical or psychological injury might feel about the topic. Helping wounded warriors address sex and intimacy is the mission and – pardon the expression – the passion of Kathryn Ellis.
“The cultural stigma that it’s not OK to talk about sex runs really deep,” said Ellis, an occupational therapist at Walter Reed National Military Medical Center in Bethesda, Maryland. Health professionals may avoid the subject because they don’t feel either competent or confident to deal with it, she added.
“Maybe they feel like they’re not allowed to bring it up, or it’s not appropriate, or the patient doesn’t want them to,” she said. “But we need to treat sex and intimacy as any other valued conversation we have with service members.”
Ellis has been working at Walter Reed Bethesda since 2011. “She’s very knowledgeable on this topic,” said Laurie Lutz, chief of training, education, and simulation at the Extremity Trauma and Amputation Center of Excellence (EACE) at the Defense Health Headquarters in Falls Church, Virginia.
“She’s the one we reach out to for clinician education,” Lutz said.
EACE was the primary sponsor of this year’s Federal Advanced Amputation Skills Training symposium, which brought together health and wellness experts throughout the Department of Defense and Veterans Administration to communicate best practices in caring for wounded warriors and others with limb loss. Amputation is a catastrophic event causing impaired mobility and possibly secondary health and psychological issues, Lutz said.
Ellis was one of the featured speakers at the symposium. During her presentation, she paraphrased pioneering sex researchers Masters and Johnson: “Absence of sensation doesn’t mean absence of feelings. Inability to move doesn’t mean inability to please. Inability to perform doesn’t mean inability to enjoy. Loss of genitals doesn’t mean loss of sexuality.”
Along with holding a master’s degree in occupational therapy, Ellis is certified in sexuality counseling from the American Association of Sexuality Educators, Counselors, and Therapists. But this certification isn’t required for OTs to address intimacy, she said.
“Occupational therapy focuses on the physical, cognitive, and emotional components of the activities humans find meaningful,” she said. “Successful rehabilitation is resuming satisfying experiences in valued life occupations, including sexual activity and intimate social participation.”
At Walter Reed Bethesda, sex and intimacy is addressed in occupational therapists’ standard evaluation of clients. “We bring it up to identify particular concerns and needs, and then get clients connected with the services they might need,” Ellis said.
Other professionals may be brought in, including physical therapists, urologists, and behavioral health providers. Wounded warriors may face physical and psychological issues that can impact intimacy and sex, including bowel and bladder dysfunction, decreased energy, loss of sensation, memory problems, and poor self-image.
“A key focus is to improve our clients’ self-awareness and confidence so they can communicate more effectively what they desire in an intimate relationship or during a sexual encounter,” Ellis said.
And that’s important, she said, because positive intimate and sexual experiences lead to an overall better quality of life.
“I always encourage OTs and other health care providers to look at intimacy and sex from a wellness promotion point of view,” she said.
Ellis said sex and intimacy after physical or psychological injury may be more complicated than before the injury, and it’s certainly different.
“But I do think it’s possible that it can be better,” she said. “Our goal as occupational therapists is to give wounded warriors skills they can utilize as they recover to help them maintain positive sexual encounters and intimate relationships throughout their lifespan. And that’s the true success of OT intervention.”
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NCR Quality Symposium engages patients and care teamsTiffany Christensen, Vice President of Experience Innovation at The Beryl Institute, discusses her experiences with cystic fibrosis and the overall patient perspective in the health care experience. (Courtesy photo) by: Military Health System Communications Office
Diagnosed with cystic fibrosis halfway to her first birthday, Tiffany Christensen says that struggles with her health, and with the health care system, lent purpose to her life at a young age. Decades of illness, hospitalizations, and two double lung transplants later, she has taken her history – her “Ph.D. in being a patient” – and applied it to improving the care experience of others. Today she is a patient advocate, author, and speaker, and the vice president of experience innovation at the Beryl Institute, a global community of practice dedicated to improving the patient experience.
Quality symposium host Army Lt. Col. Downing Lu, Chief Quality Officer, National Capital Region Medical Directorate, joins panelists for “The Patient and Staff Experience in the NCR.” Panelists (left to right) include Navy Capt.Mark Kobejla, Director, Walter Reed National Military Medical Center; Jennifer Blake, MD, Deputy Chief of Clinical Services, Andrew Rader U.S. Army Health Clinic; Army Lt. Col. Kathy Spangler, Commander, Andrew Rader U.S. Army Health Clinic; and Air Force Lt. Col. Walter Singh, Chief Nurse, 11th Medical Squadron Joint Base Anacostia-Bolling. Joined at right by Rear Adm. David Lane, Director, National Capital Region Medical Directorate. (Courtesy photo)When Christensen shared her story with the health care providers, staff, patients, and family members at the National Capital Region Quality Symposium at Joint Base Andrews Nov. 9, she acknowledged the challenges facing everyone in the room. “I was in health care for just two minutes and I got burned out,” Christensen said of her initial experience as a patient advocate for Duke Health System. “I had such high expectations of the impact I was going to make on people’s lives, and I don’t feel like I was able to carry through on that impact.”
To achieve impact, Christensen urged providers to enlist help. “When I see organizations talking about high reliability, I think there is one resource not being utilized – patients and family members,” she said.
Presenters throughout the day touched on the theme of patient and care team engagement in improving the high-reliability experience. They offered tactics for achieving this transparency, including:
- Implementing Leadership Staff Rounds. Navy Capt. Mark Kobejla emphasized that his participation in leadership staff rounds enabled him to tap the collective experience of 7,000 lifetimes of work — from the 7,000 staff at Walter Reed National Military Medical Center, where Kobejla is the director of the medical center. Practicing leadership staff rounds gives leaders “presence, discovery, the ability to reinforce priorities, and (the chance to model) the behaviors you expect of leaders in the organization,” he said.
- Hiring Chief Experience Officers. Army Lt. Col. Kathy Spangler, commander of the Andrew Rader U.S. Army Health Clinic at Joint Base Myer-Henderson Hall, and Dr. Jennifer Blake, deputy chief of clinical services there, discussed the benefits of engaging a chief experience officer at Rader, the first facility in the NCR to implement this role. “When bridging the gap between experience and expectations, you need to understand what those expectations were — what’s important to our team members, what’s important to our patients?” Blake said. Since adding a chief experience officer, Rader has seen improved satisfaction among patients and care team members alike. For example, in July 2017, the facility scored 100 percent for the first time on the Joint Outpatient Experience Survey question 23: Satisfied with Healthcare. They achieved a score of 99.5 percent Satisfied with Healthcare for the month of September. Additionally, the team has gained a new mechanism for gathering team member comments and utilizing that input to improve experience (e.g., making changes to the break room, offering healthier snack options).
- Using a One-Question Survey. Air Force Lt. Col. Walter Singh, chief nurse, 11th Medical Squadron Joint Base Anacostia-Bolling, described how his team distributed a one-question survey to all adult patients at check-in to learn what one thing each patient would like to change about their care experience. He reported that most respondents, at 22 percent, were looking for improvements in the area of access.
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