{
  "abstract": "Introduction Intimacy, body image, and relationship concerns are well recognised consequences of stoma formation in IBD, yet they remain inconsistently addressed in routine clinical practice. Shame, seen as failure to be the person we are expected to be, has been identified as a key but under-examined mechanism shaping these clinical interactions.Methods A secondary analysis was conducted across interviews with 10 nurses working in IBD and specialist stoma services in the United Kingdom, Ireland, Canada and Australia. Analysis explored how shame influences patient–nurse interactions, and how this, in turn, relates to nurses’ training and preparedness to provide SWB care for ostomates. Data was analysed with reflexive thematic analysis.Results Six interrelated themes were identified with an overarching theme Silence as Practice: Education, Shame, and Clinical Interaction., where silence around intimacy-related concerns functioned as a patterned feature of nursing interactions shaped by shame and lack of educational preparation. Training influenced whether silence was sustained or transformed into meaningful dialogue. Across all interviews, shame most manifested as silence rather than overt distress, with patients rarely disclosing intimacy-related concerns unless explicitly invited. Shame was co-produced within interactions: patient discomfort intersected with nurses’ fear of ‘saying the wrong thing’ resulting in mutual avoidance and bidirectional embarrassment. Shame was identified as a possible influence on consent processes, with patients frequently accepting or postponing consideration of stoma formation without providing further explanation, which was understood to reflect shame-related avoidance. Routine clinical contexts, such as time pressure, lack of privacy, and information overload, amplified shame by limiting opportunities to discuss sexual wellbeing concerns. Lack of sexual wellbeing training for most nurses sustained these patterns, reinforcing avoidance. Equally, where nurses reported sexual wellbeing related education and routinely normalised these discussions, shame was reduced, perceived safety and trust increased, and disclosure occurred more frequently and with less difficulty when discussion was explicitly invited.Conclusions Shame is not an inherent feature of stoma in IBD care but a predictable outcome of unstructured communication and limited training. These findings highlight the need for education that prepares nurses with routine, context-sensitive strategies, and clear role boundaries. Shame competence practice should be included in training aimed at nurses involved in sexual wellbeing care in gastroenterology and stoma care. Training interventions should treat silence as a signal, and position conversations about sexual wellbeing as a standard component of care, rather than an optional add-on.",
  "authors": [
    {
      "affiliations": [
        "University of Oxford, Oxford, United Kingdom"
      ],
      "name": "Simona Fourie"
    }
  ],
  "title": "O33 When no one asks: shame and training in nursing conversations on sexual wellbeing in inflamatory bowel disease and stoma",
  "uid": "5f5d6be4-3570-5500-bfff-5086ab27d642"
}