title: Sexual counselling of cardiac patients in Europe: culture matters.
abstract: BACKGROUND
  Sexual problems are common amongst cardiac patients, and concerns may arise when resuming sexual activities after a cardiac event. Sexual counselling is therefore indispensible. Culture is an identified barrier to talking about sex, but research is lacking on whether and how culture influences nurses in providing sexual counselling.
  
  
  METHODS
  This cross-sectional descriptive study assessed four areas related to sexual counselling provided by cardiovascular nurses. We investigated the impact of culture on these areas by surveying cardiovascular nurses living in Denmark, Norway and two regions of Belgium - Flanders, Dutch-speaking region and Wallonia, French-speaking region.
  
  
  METHODS
  Overall, 819 participants were recruited as they attended cardiovascular nursing congresses in Denmark, Norway and Belgium. Subjects completed the Undertaking Nursing Interventions Throughout Europe (UNITE) sexual counselling questionnaire, measuring practice, responsibility, confidence and perceived comfort of patients. Controlling for demographic, educational and professional covariates, we performed multiple linear regression analysis to determine the impact of culture on sexual counselling.
  
  
  RESULTS
  All four subscale scores were independently associated with culture. Danish nurses counselled patients significantly more often, reported feeling more responsibility and confidence and estimated more comfort in patients than Norwegian, Flemish and Walloon nurses.
  
  
  CONCLUSIONS
  This study showed that culture matters with respect to sexual counselling for cardiac patients. Interventions should be developed improving sexual counselling of cardiac patients. Educational courses and training of healthcare professionals on sexual counselling should be more sensitive to sociocultural differences. Cross-cultural perspectives may bias attitudes of professionals as they deal with concerns of cardiac patients about resuming sexual activity.
authors.affiliation: Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Goossens
authors.forename: T M
authors.initials: TM
authors.lastname: Norekvål
authors.forename: J
authors.initials: J
authors.lastname: Faerch
authors.forename: L
authors.initials: L
authors.lastname: Hody
authors.forename: S S
authors.initials: SS
authors.lastname: Olsen
authors.forename: M R
authors.initials: MR
authors.lastname: Darmer
authors.forename: T
authors.initials: T
authors.lastname: Jaarsma
authors.forename: P
authors.initials: P
authors.lastname: Moons
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003430:Cross-Sectional Studies; D003469:Culture; D004522:Educational Status; D005060:Europe / Q000208:ethnology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006331:Heart Diseases / Q000208:ethnology / Q000451:nursing*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009732:Nursing Care / Q000592:standards; D017060:Patient Satisfaction; D012731:Sex Counseling / Q000379:methods*; D012725:Sexual Behavior / Q000208:ethnology*; D012735:Sexual Dysfunction, Physiological / Q000208:ethnology / Q000451:nursing*; D011795:Surveys and Questionnaires