Sexuality and consumers of mental health services: the impact of gender and boundary issues

The importance of sexuality to humanity is clearly acknowledged. However, for consumers of mental health services, it tends to be a neglected topic. Although nurses are at the forefront of mental health service delivery, evidence suggests they are reluctant to include sexuality as part of their care. This article describes the findings from a qualitative exploratory research project that examined mental health nurses' attitudes to discussing sexuality with consumers. Fourteen mental health nurses from a service in Queensland participated in this study. Data analysis revealed two main themes: the impact of gender, and professional boundary issues. In terms of gender, participants referred to the impact of sexual dysfunction experienced by young adult male consumers. For female consumers the discussion centred on vulnerability to sexual exploitation and the need to exercise protective measures to ensure safety. Participants indicated concerns about being professionally compromised when discussing sexuality with consumers of the opposite sex. These findings highlight the need for further exploration of mental health nurses' attitudes towards discussing sexuality with consumers as part of their practice.     

Sexuality of people living with a mental illness: A collaborative challenge for mental health nurses

This article is a review of the literature examining the sexuality of mental health consumers and the role of mental health nurses. A search identified 72 English articles on the topic. The evidence clearly indicates that sexuality is a critical aspect of who we are as individuals, and of how we view ourselves, but discussion of this topic is neglected by mental health nurses. Discussion focuses upon the wide acceptance of sexuality as a legitimate area for nurses to address in their care, and addresses mental health nurses' lack of knowledge about sexuality, conservative attitudes, and anxiety when discussing sexual issues. Consumer sexuality is poorly assessed in mental health, and is infrequently explored by mental health nurses. The result is that issues of sexuality for the consumer continue to affect many areas of their lives, including their relationships and ongoing commitment to treatment. The nurse–consumer relationship provides an opportunity to take sexual history into consideration, promote safe sexual practices, discuss sexual problems, and educate clients about sexual issues. This literature review identifies the need for further discussion of this topic and for research to point the way ahead for this important but neglected area of mental health nursing.     

Facilitators and barriers for nurses in providing sexual education to myocardial-infarction patients: A qualitative systematic review

BackgroundMyocardial infarction (MI) greatly impacts an individual’s sexual health. It is reported that almost 40 to 80% population with MI are not able to resume their sexual routine after the illness due to organic or psychological sexual dysfunction. To reduce the prevalence of sexual dysfunction after MI, cardiac nurses are required to provide sexual counselling to their stable patients. However, this responsibility is seldom fulfilled by nurses due to several barriers. These barriers are not explicitly explored from the nurses’ perspective, which is necessary to understand in order to promote sexual counselling in cardiac health care settings.ObjectiveTo explore the facilitators and barriers of cardiac nurses in providing sexual education to post-MI patients.Design and methodA qualitative systematic review was undertaken by performing a systematic search from six databases along with search from reference lists of related studies.FindingsFour studies revealed 49 findings, which formed 10 categories and yielded four synthesised findings. These are: (1) Institutional Barriers such as lack of education, guidelines and material resources can prevent nurses from providing sexual education to MI patients; (2) Personal barriers such as uncertainty about the nurse’s role in sexual education, giving least priority to sexual counselling and lack of comfort with discussing sexuality can affect how nurses provide sexual education to MI patients; (3) Socio-cultural and religious barriers such as contradictory beliefs and gender differences can challenge nurses when providing sexual education to MI patients and (4) Nurses consider different strategies for addressing sexual education with MI patients, in individual or group settings.ConclusionTo promote sexual counselling, strategies are proposed by nurses, which can help in limiting barriers and facilitate in conducting counselling sessions. These strategies need to be validated from extensive research before implementing them into nursing practice.     

Talking or avoiding? Mental health nurses' views about discussing sexual health with consumers

Mental health consumers are sexual beings; however, their sexual desire, capacity, and ability to maintain previous sexual patterns can be altered by their illness or by the effects and side-effects of medications. The sexuality of consumers has been poorly addressed, and the limited evidence suggests that mental health nurses remain ambivalent to including sexuality in their care. This paper presents the findings of a research project investigating the practices of mental health nurses in assessing and supporting the sexuality of consumers. A qualitative, exploratory approach underpinned individual interviews with 14 mental health nurses from inpatient and community settings. The participants acknowledged the importance of sexuality; however, most were reluctant to enquire about consumer concerns and tended to either ignore the issue or refer it to another clinician. Four themes were identified: talking about or avoiding sexuality concerns with consumers; sexuality is not an important priority; refer to others, as talking about sexuality is not 'my' job; and sexuality is poorly addressed by others. It is important that barriers to the assessment and discussion of sexuality are identified, and measures are taken to overcome them.     

Barriers and facilitators for oncology nurses discussing sexual issues with men diagnosed with testicular cancer

PurposeTesticular cancer occurs at a time in a man's life when major social life changes are occurring and when body image, fertility, sexual desire and performance can be central issues. Oncology nurses, as members of the multidisciplinary team, are in an ideal position to address men's concerns. The aim of this study was to investigate oncology nurses' self-perceived knowledge and comfort in relation to discussing sexuality concerns with men diagnosed with testicular cancer and to identify the barriers and facilitators to such discussions.MethodsThis study employed a self-completion, anonymous survey design with a sample of registered nurses working in five, randomly chosen, oncology centres in Ireland.ResultsIn total, 89 questionnaires (45% response rate) were included for analysis. Findings suggest that although nurses were open to addressing concerns, few informed patients they were available to discuss sexual concerns. Nurses reported lacking knowledge of, and discomfort in, discussing the more intimate aspects of sexuality, including: ejaculatory difficulties, erectile dysfunction, impotence, prosthesis options and testicular self examination.ConclusionsFindings reinforce the need for more comprehensive education on sexuality issues and testicular cancer. Nurses need to take a more proactive approach to sexuality care, as opposed to the ‘passive waiting stance’ that permeates the current culture of care. Education programmes need to include specific information on sexual issues associated with testicular cancer, and oncology nurses must subsume sexuality as an essential aspect of their role through changes in policies and nursing care planning.     

Understanding the current sexual health service provision for mental health consumers by nurses in mental health settings: Findings from a Survey in Australia and England

Nurses in mental health settings avoid talking to consumers about sexual health concerns. It is unclear whether this avoidance prevents the provision of sexual healthcare. The present study gathered information about how mental health nurses respond to sexual health issues within their routine practice, what issues they address, and their view on their role in promoting sexual health for consumers. A cross‐sectional study using an electronic survey questionnaire, originally generated from a previous study in the united kingdom, was employed. The study occurred in four National Health Service Trusts in England and a national call for participants in Australia. Participants were nurse clinicians (n = 303) who self‐selected by completing surveys available via email and newsletters containing links to the survey. The results demonstrated that mental health nurses do not routinely include sexual health in their practice and are poorly prepared in knowing what to do with a sexual health issue, and what services to assist consumers to use. In conclusion, it has been well established in the literature that mental health consumers experience high sexual health needs that potentially impact on health and recovery. Mental health nurses are ideally placed to promote sexual health and refer consumers to sexual health and family planning services. Training to improve the confidence and responsiveness of mental health nurses to sexual health is an urgent need.     

Exploring Sexual Risks in a Forensic Mental Health Hospital: Perspectives from Patients and Nurses

Patients utilising forensic mental health inpatient services experience a range of sexual risks, including vulnerability to sexual exploitation and exposure to sexually transmissible infections. However, there is a paucity of research exploring the issue of sexual risks from the standpoint of patients and the nurses who work closely with them in inpatient secure settings. This article presents findings from a qualitative exploratory study, which investigated the views of patients and nurses about sexual relationships in forensic mental health settings. Risk was a major theme arising from the data and is the focus of this article. Subthemes from nurse participants included sexual safety, sexual vulnerability, unplanned pregnancies, and male sexuality issues. Subthemes from patients included risks associated with sexual activity, access to information and sexual health care, unplanned pregnancies, vulnerability, and male sexuality issues. Knowledge about these sexual risks by patients and nurses were well articulated, however information and assistance were considered by patients to be less than satisfactory in improving their knowledge or in providing the support they considered important to reduce sexual risks. The issue of risk needs to be addressed, and nurses would be well placed to contribute; however they require education to improve their ability to provide sexual health education to patients along with strategies to ensure patients receive the support and services they require to reduce their exposure to sexual risks.     

Sexual health. 2: An overt approach to sexual health education

An individual's sexuality is not always understood and recognized by healthcare workers. Some nurses have conservative and rigid attitudes regarding sexuality and undertake nursing interventions that may have a detrimental effect on a client's sexual health. If nurses are to take a responsible approach to their nursing interventions they need to reflect upon their knowledge, skills and understanding in relation to their own sexuality and the sexuality of others, and identify ways of rectifying shortfalls. The first of this two-part article discussed issues relating to sexuality in health care (Vol 8(9): 601-6). This part will use a sexual health model to highlight nurses' learning needs. Nurse educators need to include sexual health more overtly within the curriculum. It is important that nurses do not try to be sexual counsellors. Nurses need to acknowledge their limitations and the harm that inappropriate interventions can produce. If sexual health is to be included in nursing curricula, it should not be trivialized. A planned progressive model is required which acknowledges that the human condition is diverse and individual.     

Neuroleptic medication and sexuality: the forgotten aspect of education and care

Discussing issues of sexuality is a challenging and difficult issue for many health care workers. When it comes to sexuality and people with mental health problems there seems to be a dual taboo. Mental health nurses are ideal members of the health care team to talk to service users about issues as sensitive as sexuality and the side effects of medication that impact on sexual health. However, in both clinical practice and the nursing literature, the side effects of medications that impact on sexual function are often ignored and unspoken about. This paper examines the impact of both conventional and atypical neuroleptic medication on sexual function and discusses the probable causes of such effects. The possible reasons why health care professionals are reluctant to discuss side effects impacting on sexual health with service users are explored and emphasis is placed on the need for mental health nurses to respond to requests from service users for more education and discussion in the area of sexuality and sexual health.     

Taking a sexual history and educating clients about safe sex

The importance for taking a sexual history cannot be overstated. In the general patient population, the goal of the history is to assess the impact of illness on a client's sexual health. This information provides the nurse with a baseline for educating the client about his or her sexual adaptation to illness or surgery. Further, the sexual history is a part of the holistic nursing framework for patient care. Nurses working in settings in which they routinely care for clients with STDs have the additional responsibility of utilizing data from the history to educate clients regarding risk factors, re-evaluation of lifestyle behaviors, and preventative measures. Education of clients is crucial to decreasing the incidence of STDs. Nurses need to confront their own values and attitudes regarding sexuality as the first step to overcoming barriers in discussing sexuality with their clients. Additionally, education regarding human sexual behavior is important in expanding nurses' knowledge in this area. I have outlined interview techniques that can be helpful in eliciting the sexual history, emphasizing open-ended questions and ubiquitous statements. These techniques can be useful in both ambulatory and in-patient settings. The format for taking a sexual history has been addressed, with specific questions relevant to clients exposed to STDs. I have pointed to the need for considering the sexual history within the context of the client's life situation and suggested that information regarding sexuality be thoughtfully gathered, taking into account variables such as culture and sexual preference. Finally, this article addresses educating clients for safe sexual practices and emphasizes the need for nurses to counsel all sexually active clients concerning the risk factors for STDs. As the incidence of STDs continue to increase, and particularly as AIDS becomes increasingly widespread, nurses must be in the forefront of educating the public. As a health care profession advocating caring and commitment to holistic care, nursing can contribute to health promotion activities through addressing clients' sexual health.     

Talking about sex as part of our role: Making and sustaining practice change

Sexual issues are common for consumers of mental health services and have many adverse consequences for quality of life as well as impacting negatively on the mental illness itself. Nurses in mental health settings are well placed to assess for the presence of and provide interventions for sexual concerns. To date, little research has been undertaken to explore nurses' attitudes and whether sexual issues would be accepted as part of their care. This paper presents findings from the third stage of a qualitative, exploratory research study with mental health nurses working in an Australian mental health service. The findings from the first two stages suggested that the participants had tended to avoid discussion of sexual issues, but a brief education intervention had produced a greater willingness to address sexual issues as part of care. The aim of the third stage was to determine the degree to which changes in practice had continued over time. Two main themes that emerged from this data were: (i) holism, from rhetoric to reality; and (ii) part of what I do. Addressing sexual issues became part of practice, a change sustained 2 years following the intervention, because participants recognized its importance for holistic nursing care.     

Exploration of personal recovery-oriented care on an acute mental health unit

BackgroundPersonal recovery should be the cornerstone of mental health nursing practice. Nursing interventions should build on consumers' strengths to provide hope, so consumers are empowered to achieve their own personal goals.AimThe aim of this study was to explore mental health nurses’ lived experience of their practice, understanding and knowledge of personal recovery-oriented care on acute mental health units.MethodVan Manen's methodology was utilised in this study. Data was gathered through semistructured conversational interviews with mental health nurses working on an acute unit.FindingsParticipants found personal recovery was difficult on an acute mental health unit. Factors that participants identified that impeded personal recovery-oriented care on acute mental health units included: the acuity of consumers in a low dependency area, lack of time to engage consumers, and loss of the therapeutic role for mental health nurses on acute units.DiscussionMental health nurses are expected to focus on the personal recovery needs of mental health consumers while managing clinical risks to consumers and others on the acute unit. This has the mental health nurse navigating a course between two worlds, and results in mental health nurses being confused between concepts of personal recovery and clinical recovery.ConclusionIf acute mental health nurses cannot define personal recovery, they will not be able to effectively implement interventions that support consumers in their personal recovery journey on acute units and will be drawn into the clinical recovery paradigm.     

Nurses' approaches towards sexuality of adolescent patients in Turkey

Aims and objectives. The purpose of this study is to determine the approaches regarding sexuality of nurses caring for adolescent patients in Turkey. Method. The sample includes nurses caring for adolescent patients in hospitals located in major cities of Turkey. There were 571 responses from the 783 nurses who were given the questionnaire. The questionnaire consists of three sections. The instrument used in this study was developed by Wall‐Haas. Multiple analyses of variance in SPSS version 11.5 was used in the comparison of the scores obtained from the instrument. Results. Approximately 69% of nurses stated that concerns about sexuality should be a routine component of nursing care; 70·5% of nurses stated that nursing interventions dealing with concerns about sexuality increases the patient's well being. About 70% stated that discussing sexual issues with children is the responsibility of their parents. Half of the nurses had difficulty in initiating a discussion about sexuality with their patients. Conclusion. The findings in this study point out that the nurses’ approaches towards adolescent sexuality are rather conservative. They were not comfortable talking about issues of sexuality with adolescent patients. The nurses were aware of the importance of sexuality for an adolescent patient; however, they were not able to reflect this awareness in their practice. Relevance to clinical practice. The aim of this study is to draw the nurses’ attention to adolescent sexuality and to review their attitudes towards sexuality. Hence, the nurses will be able to notice their difficulties related to sexual issues and cope with them. As a result, they will be able to give holistic care to their patients.     

Scratching Beneath the Surface: Influencing Factors on Nurses’ Attitudes Toward the Use of Seclusion

Reducing the use of seclusion is now widely identified as a quality issue for mental health services and reflects recognition of the detrimental impact of seclusion on consumers of services. Despite this, the research evidence suggests that nurses continue to support the use of seclusion in order to maintain a safe environment. The aim of this study was to consider how factors such as Therapeutic Optimism, Job Satisfaction, and Burnout might relate to nurses’ attitudes toward seclusion. The Heyman Attitudes to Seclusion Survey, Elsom Therapeutic Optimism Scale, Maslach's Burnout Inventory, and Minnesota Satisfaction Questionnaires were completed by 123 nurses employed in one of eight participating mental health services. Data analysis included Spearman's rho and independent-samples t-tests statistics. The findings suggested several significant relationships between attitudes toward seclusion and therapeutic optimism, job satisfaction, and burnout. Participants with higher optimism scores, high intrinsic motivation, low emotional exhaustion, and high personal accomplishment were more likely to respond negatively to the use of seclusion. This research enhances our understanding of attitudes toward seclusion and may assist in the development of interventions to influence more positive attitudes.     

'Veiling sexualities': a grounded theory of mental health nurses responses to issues of sexuality

Title. ‘Veiling sexualities’: a grounded theory of mental health nurses responses to issues of sexuality. Aim. This paper is a report of a study to develop a grounded theory explaining how mental health nurses respond to issues of sexuality in clinical practice. Background. The history of sexuality and people with mental health problems has largely been a history shrouded in misunderstanding, stigma, myth and negativity. However, individuals with mental health problems may experience sexuality and relationship difficulties related to their life experiences, mental illness, or its treatment. Methods. Grounded theory was the methodology used for the study. Interviews were conducted in 2005–2006 with 27 mental health nurses working an urban area in the Republic of Ireland. Data were analysed using the concurrent processes of constant comparative analysis, data collection, theoretical sampling and memo writing. Findings. The core category to emerge from the data was ‘veiling sexualities’. This refers to participants’ accounts of how they responded to the sexuality dimension of clients’ lives. Participants’ main concerns about sexuality were related to feelings of personal and professional vulnerability, due to a lack of competence, comfort and confidence in this area. The theory highlights the manner in which nurses perpetuate practices that marginalize, discriminate and socially exclude clients as ‘sexual citizens’. Conclusion. The theory of Veiled Sexualities may facilitate acknowledgement of the presence of sexuality in all nurse–client encounters, and promote a discourse on the sexual rights of people experiencing mental distress among mental health nurses and all involved in the delivery of mental health services.     

Sexuality,sexual health and older people: A systematic review of research on the knowledge and attitudes of health professionals

ObjectivesSexuality remains important to older people and should be recognised as an important part of their overall care. However, this appears to be poorly understood and addressed by many healthcare professionals. This systematic review reports on knowledge and attitudes of health professionals towards sexuality and sexual health of older people, including factors that impact knowledge and perceptions.Review methods and data sourcesThe review, conducted using Joanna Briggs Institute methods, included 23 studies of varied methodology published between January 2004 and January 2015.ResultsFindings indicated that healthcare professionals often consider older people's sexuality as outside their scope of practice and there is lack of knowledge and confidence in this area. Cultural norms and taboos, length of time spent working with older people, familiarity with the older person, previous training and degree of exposure to people who are not heterosexual were all identified as factors that impact knowledge and attitude.ConclusionsBetter role modelling and education are needed to improve knowledge and attitudes toward later life sexuality.     

Consumer sexual relationships in a Forensic mental health hospital: Perceptions of nurses and consumers

The management of consumer‐related risk is paramount in a secure forensic mental health facility. However, the consequent risk aversion presents a major barrier to consumers forming sexual relationships in a manner that is open and accepted. Investigation of the views of nurses working in forensic mental health settings on this topic is limited, and even more so for consumers of services. This qualitative exploratory study was undertaken to elicit the views of consumers and nurses about forming sexual relationships within this long‐term and secure setting. Individual in‐depth interviews were conducted with 12 nurses and 10 consumers. The benefits of, and barriers to, sexual relationships was identified as a major theme, and these findings are the focus of this paper. Nurse responses included the subthemes ‘supportive factors’ and ‘potential dangers’, reflecting their qualified support. Consumer responses included the subthemes ‘therapeutic’, ‘feeling normal’, ‘restrictions and barriers’, and ‘lack of support and secrecy’. The importance of sexual relationships was clearly articulated, as was the difficulties in forming and maintaining them within the forensic setting. More open discussion about this commonly‐avoided issue and the education of nurses and other health professionals is required.