Recommendations for sexual expression management in long‐term care: a qualitative needs assessment

Abstract

Aims To conduct a qualitative needs assessment of Directors of Nursing regarding challenges and recommendations for addressing sexual expression and consent. Background Sexual expression management among long-term care residents is a complex issue for nursing home staff. Little guidance is available for those wanting to follow a person-centred approach. Policies and procedures are needed, and must be usable across long-term care settings. Design Qualitative design for in-depth exploration. Methods Semi-structured interviews were conducted with 20 Directors of Nursing in the spring and summer of 2013, representing a range of regions, facility sizes and resident populations. Interview questions prompted them to identify recommendations that address challenges to improving sexual expression management in long-term care settings. Results Comparative thematic analysis resulted in several codes, which were grouped into eight overall categories. Recommendation categories that addressed key challenges included: address the issue, make environmental changes, identify staff expertise, provide education and training, assess sexuality initially and recurrently, establish policies/procedures for sexual expression management, develop assessment tools for sexual expression and consent, and clarify legal issues. The recommendation to develop national guidelines was observed across categories. Discussion Directors of Nursing report several challenges to sexual expression management in their facilities, and perceive their current methods to be ad hoc. A proactive approach to policy and procedure development is needed.

Staff responses to residents exposing their genitals in public in long‐term care settings: The gap between common and perceived best practices

“…The perspective that is now accepted is that ISBs could be responses to contextual cues or unmet needs for intimacy that are innate, whether or not a person has dementia (Jones & Moyle, 2016;Kamel & Hajjar, 2003;Wiskerke & Manthorpe, 2018). Although there are few published and institutionally supported documents that include evidence-based behavioural recommendations for managing ISBs, some potentially useful strategies have been proposed as either stand-alone or supplemental interventions (International Longevity Centre -UK, 2011;Kettl, 2008;Syme, Lichtenberg, & Moye, 2016;Verdelho & Gonçalves-Pereira, 2017). As best practice, these proposals tend to recommend a careful assessment of the resident's sexual life story, how she/he relates to others (staff, relatives, other residents) and contextual cues that might trigger the ISBs.…”

Content analysis of public opinion on sexual expression and dementia: Implications for nursing home policy development

“…Unfortunately, sexual expression—behaviours ranging from intercourse to intimate behaviours (eg handholding, kissing)—remains largely ignored in nursing homes . This is due to barriers such as lack of knowledge, more restrictive/negative attitudes about older adult sexuality, and lack of resources to develop policy and train staff . However, experts highlight the need for proactive sexual expression policies for nursing homes that take a resident‐centred approach, in lieu of a more institutional approach where administrators and families are the only voice heard .…”

“…Although experts have posed various recommendations for sexual expression management, there is substantial room for growth in our understanding of public perspectives on sexual expression and dementia, and its impact on the development of a resident‐ or consumer‐centred policy. Policy discussions have often centred on accreditation and legal standards as well as nursing home rules and regulations; however, they have lost the consumer voice that is imperative to a truly resident‐centred approach to care. As nursing home care moves towards resident‐ or person‐centred approaches to care, our policies must reflect that.…”

The complexities of sexual behavior in residential aged care

“…As Villar and colleagues (2019) note, there are few published evidence-based guidelines and/or recommendations for managing sexual situations (including harassment and abuse) in long-term care. What is advocated as best practice when addressing resident sexual behavior is ensuring there is an assessment of the resident's medical and health condition, sexual life story, and relationships with others, and importantly, the resident's perspectives and unmet needs and how such needs can best be addressed (Bauer et al, 2014; International Longevity Centre -UK, 2011; Syme et al, 2016).…”

“…The situation is compounded by a workforce that is not educated to adequately address the sexual health and needs of older people living in LTCF. Despite nurses working in this setting reporting a desire for later-life sexuality training (Di Napoli et al, 2013), directors of nursing report that staff who are on the front line dealing with resident behavior are not supported by adequate training or education in order to deliver best care (Syme et al, 2016). In one of the few studies of staff education in this area, 40% of residential aged care staff reported never having received training in the area of older age and sexuality (McAuliffe et al, 2016).…”