Care Staff’s Sense-making of Intimate and Sexual Expressions of People with Dementia in Dutch Nursing Homes

Abstract

Objectives:The Person-centered Care (PCC) philosophy emphasizes close care relationships to enable care professionals to recognize the needs of nursing home residents with dementia. This study explored how care professionals make sense of resident behavior with regard to intimacy and sexuality. Methods: 26 nursing home care professionals (15 Nurses, 9 Health Care Professionals and 2 Managers) completed in-depth interviews that were subjected to an Interpretative Phenomenological Analysis (IPA). Results: Three thematic layers were identified. 1. Care Professionals pursue a "true" understanding of intimate and sexual behavior that underpins a resident's expression. 2. When care professionals feel the need to protect themselves, they can reframe a specific care relation in order to continue care. 3. The social context around the resident, from family to professionals (i.e. peers), influences interpretation of behavior and, consequently, the provision of care. Conclusions: Intimate and sexual expressions of residents can put care relations under pressure. Care relations that lack professional distance may compromise care professionals' judgments, impede their natural boundaries and decrease their well-being. Clinical implications: Along with implementing PCC principles, organizations should empower staff to develop, discuss and include self-reflection skills and personal boundaries within their work.

Losing hope or keep searching for a golden solution: an in-depth exploration of experiences with extreme challenging behavior in nursing home residents with dementia

“…Striking a balance between delivery of personal care while maintaining boundaries has been found to be difficult for many nursing assistants [35]. Indeed, an optimal balance between personal intimacy and maintaining a professional attitude is lacking in the literature on person-centred care, although the nursing literature stresses the importance of boundaries and a good balance between distance and involvement [36,37]. Too little attention on this balance could result in person-centred care being misinterpreted by care staff members and may lead to a serving attitude and culture of over-acceptance of challenging behavior as 'part of the job' [38], ultimately compromising the wellbeing of nursing staff [37,39].…”

“…Indeed, an optimal balance between personal intimacy and maintaining a professional attitude is lacking in the literature on person-centred care, although the nursing literature stresses the importance of boundaries and a good balance between distance and involvement [36,37]. Too little attention on this balance could result in person-centred care being misinterpreted by care staff members and may lead to a serving attitude and culture of over-acceptance of challenging behavior as 'part of the job' [38], ultimately compromising the wellbeing of nursing staff [37,39]. Probably suboptimal professional behavior of nursing home staff is less relevant in cases with less severe challenging behavior and is especially required in residents with extreme challenging behavior.…”

Live and let live: Residents' perspectives on alcohol and tobacco (mis)use in residential care facilities

“…Each organisation provided a contact person who enabled the researcher to recruit participants. Participants living in two types of units were included, because these residents are largely dependent on formal caregivers to facilitate and fulfil in their needs, habits and wishes: first, psychogeriatric units, in which care is provided for people with dementia in a moderate to severe stage (Waterschoot et al, 2021 ). These units are small (8–10 residents) mostly closed wards, designed as group homes with a communal space and individual bedrooms; second, units for people with severe physical disabilities and comorbidities, which are larger (15–20 residents) and are designed as individual apartments, sometimes with a communal space or living area.…”

How older adults with physical impairments maintain their autonomy in nursing homes

“…Paramedic professionals such as occupational therapists or physiotherapist provide treatment and can be consulted by nurses. An elderly care physician is responsible for the entire care process (Waterschoot et al, 2021). Nursing homes have separate units for older adults with physical impairments and for older adults with dementia (Custers et al, 2011).…”