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

Having Reliable Support: A Prerequisite to Promote Sexual and Reproductive Health in Young Women with ADHD

Living with attention deficit hyperactivity disorder (ADHD) may influence sexual behaviors and intimate relationships in young women, resulting in a higher risk of unwanted pregnancy, sexual victimization, and sexual dysfunction. To develop adequate support, the study aimed to describe conceptions of how to promote sexual and reproductive health (SRH) in young women with ADHD. A secondary analysis using phenomenography was performed on qualitative interview data exploring variations of support. The study involved 15 young women with ADHD, aged 15-29 years, and 16 health care professionals, with various professions, working in the fields of gynecology, youth health, and psychiatry. Having reliable support was conceptualized as fundamental for promoting SRH. Access to information concerning SRH and living with ADHD as well as early support from health care contributed to a reliable support enabling self-knowledge and management of sexual relationships. Trustful relationships in health care were perceived as important because of previous experiences of feeling misunderstood and criticized in life, making them feel comfortable discussing SRH. Clinical encounters with a clear structure were further perceived to make information more accessible and clinics that provided appropriate organizational conditions and collaborated with other clinics were described to enhance the availability of support. This study reveals the need for clinics to provide conditions that ensure SRH support is available, accessible, and free of stigmatization. Early intervention programs for young women with ADHD may be considered, offering guidance on SRH issues in both psychiatric and sexual health clinics.

Stigmatizing intimate relationships in schizophrenia: a study comparing mental health professionals, health students and the general population

BACKGROUND

Discrimination in intimate relationships (IR) is frequently reported among persons with schizophrenia. Despite ongoing effort of international organizations to combat mental illness stigma, there remain a limited understanding of specific IR-related stereotypes.

AIMS

The study aimed to i) identify the stereotypes related to IR of persons with schizophrenia held by Mental Health Professionals (MHP), health students and the general population, and ii) explore the effects of several factors associated with these stereotypes.

METHODS

This study used a mixed-methods approach. A survey developed collaboratively with persons with lived experience of mental health conditions (PWLE) was disseminated among MHP, health students and the general population.

RESULTS

The majority of the nine IR-related stereotypes previously identified by PWLE were endorsed by the participants (N = 532). PWLE were perceived as particularly incompetent in the domain of IR (e.g. to achieve couple project). Stereotypes endorsement varied among the groups. Continuum beliefs, perceived similarities and recovery beliefs were negatively associated with stereotype endorsement.

CONCLUSIONS

The general population, MHP and health students endorsed several stereotypes regarding IR of persons with schizophrenia. The results provide support for the role of theoretical beliefs in IR stigmatization, suggesting they may be relevant targets for evidence-based stigma reduction programs.

The Mastery of Competencies for the Care of LGBT+ People by Different Health Professionals

This study aims to compare the mastery of competencies in assisting the LGBT+ population of Brazilian health professionals. Data collection occurred in a face-to-face and virtual manner, in the first semester of 2018. The health professionals answered a socio-demographic and functional questionnaire, in addition to the questionnaire Measurement of Training Needs for Health Care for the LGBT+ Public. The data was analyzed using Mann-Whitney and Chi-square tests. The project research was submitted to and approved by the IMED Research Ethics Committee (CAAE 69116917.6.0000.5319). The sample (n= 380) was made up mostly of psychologists (42.3%), female (81%), heterosexual (73.2%), aged between 26 and 35 years (36%), Catholic (41%), living in the south region (36.9%), and working in the profession for ten years or more (34.3%). Skills gaps on the LGBT+ theme was identified, especially in topics such as "approach to the patient's sexuality," "interference of religious beliefs in care," "care with the genitalia and breast of the trans individual," among others. Professionals trained in psychology and non-heterosexuals had a greater mastery of the theme than the others. The fragmentation of knowledge and skills hinders the full and equal access to the health system, and continued educational actions are recommended.

Effectiveness of a Sexual Health Care Training to Enhance Psychiatric Nurses' Knowledge, Attitude, and Self-Efficacy: A Quasi-Experimental Study in Southern Taiwan

BACKGROUND

Sexual health is a taboo issue in some societies. Limited assessments were conducted during nursing care in mental health services. It is unknown whether psychiatric nurses' competencies would be enhanced through short training courses.

AIMS

The present study employed a quasi-experimental design to evaluate the effectiveness of an 8-hour sexual health care training for psychiatric nurses to improve sexual health knowledge, attitude, and self-efficacy in a teaching psychiatric hospital in southern Taiwan.

METHOD

Volunteered psychiatric nurses were randomly assigned to the experimental or control group. The 8-hour training program contained sexual health knowledge and attitudes, case discussion, role play, and sexual identity or harassment issues. Each nurse received a pretest and a posttest in the 1-month period between August and September 2019. Descriptive and multivariate statistical analyses were used to evaluate the effects.

RESULTS

Among the 75 psychiatric nurses, 43 were in the control group and 32 were in the experimental group. The two groups were not significantly different in the working year, gender, education, marriage, and other psychosocial variables. After the training, the overall performance of sexual health care knowledge, attitudes, and self-efficacy of the experimental group improved significantly than the controls.

CONCLUSIONS

The sexual health care training program enhanced psychiatric nurses' confidence and generally improved their sexual knowledge and attitudes. It is suggested that sexual health care needs to be highlighted during in-job training to augment the well-being and life quality of psychiatric patients.

Continuing education with a holistic approach to the Brazilian LGBT+ population through use of the m-health App

AIM

This article aims to discuss the development of a continuing education course for health care professionals to provide competent healthcare assistance to the Brazilian LGBT+ population and the implementation of this course using a m-Health solution.

BACKGROUND

There is a scarcity of continuing education courses in the Brazilian context that update provides evidenced-informed education to ensure health care professional competence in the delivery of health care to LGBT+ individuals.

METHODS

Based on Bloom's taxonomy, with a main focus on the cognitive domain, the course "Ally: A Holistic Approach to the LGBT+ Individual'' was developed in five months. This was based on the Nurse's Health Education for LGBT Seniors (HEALE), the Curriculum Implementation and Institutional Climate manual, Changes to Improve Healthcare for LGBT People, Gender Nonconforming or Born with DSD" and the National Comprehensive Health Policy for LGBT+ People, among others.

RESULTS

Comprising six modules: i) human sexuality; ii) equitable care and appropriate terminology; iii) public health policy for the LGBT+ population; iv) cultural skills for health professionals; v) aging and health care for the LGBT+ population; and vi) mental health of LGBT+ people. Content validity indexing was established using an expert panel and was Ally was supported by a m-Health Solution called "Over the Rainbow'' and totals of 60 h of education.

CONCLUSIONS

This m-Health solution and continuing education course for health professionals can be an opportunity to change health professionals' practice to offer more equitable health care for the LGBT+ population.

Hidden No More: Addressing the Health and Wellness of LGBTQIA+ Individuals in Nursing School Curricula

BACKGROUND

Lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual (LGBTQIA+) individuals face barriers to equitable health care access. During clinical encounters, LGBTQIA+ individuals interact with nurses and health care providers who often lack a thorough understanding of LGBTQIA+ cultures, terminology, and strategies for culturally affirming care. This article details the process undertaken to include LGBTQIA+ health elective courses.

METHOD

To outline LGBTQIA+ health education, a curriculum crosswalk was conducted. Course descriptions, objectives, and outcomes were crafted with faculty input. Priority LGBTQIA+ areas were analyzed, and textbook content was cross-referenced to identify topics for inclusion.

RESULTS

In Spring 2022, two LGBTQIA+ courses were launched. Undergraduate students at New York University Meyers (n = 27) and undergraduate and graduate students at the University of Pennsylvania (n = 18) comprised the inaugural classes.

CONCLUSION

LGBTQIA+ individuals experience poorer health outcomes due to longstanding health inequities. These disparities are partly fueled by the minimal exposure nursing students receive in their undergraduate education. Guidelines on the development of courses designed to highlight needs may address disparities, leading to better health outcomes. [J Nurs Educ. 2023;62(5):307-311.].

Sexual knowledge of Queensland forensic mental health patients: A cross-sectional quantitative study

Forensic patients with serious mental illnesses (SMI) encounter significant challenges including active symptomatology, associated social and interpersonal impairments, psychotropic medication side effects and institutionalization, all of which negatively affect sexual functioning and possibly their acquirement of sexual knowledge. Evidence shows an increased prevalence of high-risk sexual behavior by this group however, there is an absence of literature examining the sexual knowledge of forensic patients. This quantitative cross-sectional study enrolled N = 50 patients currently under the treatment requirements of a Forensic Order and utilized the validated General Sexual Knowledge Questionnaire (GSKQ) to quantify the participants' sexual knowledge over the domains of physiology, sexual intercourse, pregnancy, contraception, sexually transmitted diseases, and sexuality. Male forensic patients scored lower than females on all domains of sexual knowledge. All participants had reasonable knowledge of physiology, sexual intercourse and sexuality; of concern were poor scores on pregnancy, contraception and sexually transmitted diseases. Thirty-five (70%) of the respondents indicated that they had some limited sex education, mostly at school. Only six (12%) received any sexual education from a health professional despite extensive contact with the forensic mental health services across many years. There is a need to assess the deficit in sexual knowledge of forensic patients in order to develop sexual health education, intervention and rehabilitative programmes that cater to the specific needs of this group to improve their sexual knowledge, encourage safe and positive sexual experiences, and enhance their quality of life.

Behavioral Health Provider Attitudes and Beliefs about Sexuality and Intimacy: Findings from a Mixed Method Design

Recovery-oriented services overlook a crucial health domain for persons with severe mental illnesses (SMI): sexuality and intimacy. Though this aspect of social recovery correlates with improved life quality and treatment outcomes, behavioral health (BH) providers avoid such topics. The study's purpose was to obtain an updated snapshot of their attitudes and beliefs about sexuality and intimacy communication. Utilizing a community advisory board, we adapted the Sexual Attitudes and Beliefs Survey (SABS) and distributed it via survey link to a national listserv. We used independent samples t-tests to examine differences on SABS mean scores by gender, age group, educational attainment, and previous training on sexuality and intimacy. We asked open-ended questions and coded responses using content analysis. Participants with more education and previous exposure to training on sexuality and intimacy were more likely to hold open views on communication. Findings offer directions for addressing this neglected aspect of recovery.

Sexual health attitudes and beliefs among nursing faculty: A correlational study

BACKGROUND

Sexual health is an integral part of nursing care across the life span. Nurses internal and external factors influenced their knowledge, experiences, and competencies. These impact nursing education and professional practice. There was no known research regarding the nursing faculty's sexual health attitudes and beliefs and the relationship with predictive factors.

OBJECTIVES

The purpose aims to identify any statistical relationships between nursing faculty age, nursing educational level, nursing specialty, years of work, and years of teaching in nursing to predict their sexual health attitudes and beliefs.

DESIGN

This is nonexperimental and quantitative research of predictive correlational design with multiple linear regression statistical analyses.

SETTINGS

Data gathered from nursing faculty across the United States.

PARTICIPANTS

Nursing faculty teaching at the baccalaureate, master, and or advanced practice nursing programs.

METHODS

Online survey of sexuality attitudes and beliefs (SABS).

RESULTS

A convenience sample of 371 nursing faculty. The results showed a statistically significant and a moderate correlation (R = 0.35, R² = 0.12, F(9, 361) = 5.68, p < 0.01) of their sexual health attitudes and beliefs and the predictors. This indicated nursing faculty with a doctorate, women's health specialty, and increased years for age, nursing practice, and teaching showed lower SABS scores or barriers to addressing sexual health. The social cognitive theory and Benner's novice to expert model explained the relationship between predictors and sexual health attitudes and beliefs.

CONCLUSIONS

The findings of this study showed personal, educational, and professional factors as predictors affecting positively or negatively the faculty's sexual health attitudes and beliefs. Awareness of those findings should promote changes in nursing education, decrease sexual health barriers, and prepare faculty, students, and nurses to provide sexual health care across the life span.

Bringing sexuality out of the closet: What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?

INTRODUCTION

Sex has been recognised as an activity of daily living, and sexuality as an important part of our identity, with implications for our self-esteem and quality of life. Although this brings sex and sexuality within the scope of occupational therapy practice, empirical and anecdotal information suggests that neither are routinely included in therapy. The aim of this study was to investigate the experiences of therapists who are comfortable addressing sex and sexuality in practice, with a view to influencing future research and practice. The research question posed was as follows: "What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?"

METHODS

Interpretative Phenomenological Analysis (IPA) was used to explore the research question. Semi-structured interviews were conducted with 11 Australian occupational therapists who were purposively recruited. Interviews were audio-recorded, transcribed verbatim, and analysed following the guidelines for IPA data analysis.

RESULTS

Four master themes and five sub-themes emerged from the analysis and are discussed under the following headings: sexuality matters; know your boundaries; just do it; and seek support and mentoring. The themes provide insight into how occupational therapists successfully integrate sexuality into everyday practice.

CONCLUSION

According to the participants in this study, addressing sex and sexuality during therapy is part of providing holistic client-centred care. With clear personal and professional boundaries, occupational therapists can address sexuality within routine practice utilising core occupational therapy skills, such as communication, collaborative problem solving, pacing, positioning, and adaptive equipment. Furthermore, participants demonstrated that this can be done within a range of settings. It starts with a commitment and the motivation to find a way.

Medical and Health Care Professionals' Sexuality Education: State of the Art and Recommendations

Sexuality is considered an important aspect of holistic care, but research has shown that it is often not considered, as it should be, in health services. Addressing clients' sexuality requires a multidisciplinary approach and is not the responsibility of a single professional. The literature underlines that university students or those working in hospitals and other health care facilities are not adequately prepared to meet patients' needs regarding sexuality. The objective of this study was, therefore, to review the scientific literature addressing training courses for health professionals in sexuality between 2000 and 2020. Several studies have shown enhancement in health care professionals' ability to deal with patients' sexuality issues after participating in sexuality education programs, regardless of the course load and modality, even if the long-term effects have still to be proved. Health care professionals therefore require education in the area of sexuality, regardless of their discipline. According to the articles reviewed, in order to improve the performance and comfort level of health care professionals to deal with patients' sexuality, investments in training are necessary. Further evaluations of interdisciplinary sexuality education programmes should use larger samples and explore the differences across disciplines.

Initial psychometric evaluation of the physical health attitude scale and a survey of mental health nurses

WHAT IS KNOWN ON THE SUBJECT?: A clear association exists between serious mental illness (SMI) and poor physical health. Individuals with SMI have markedly higher risks for mortality and morbidity. Mental health nurses play an important role in enhancing service users' mental and physical well-being. The attitudes of mental health nurses towards physical health care have been explored in the western part of the world. However, cross-country differences should be determined to reveal the importance of this global issue. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study adds new data to the literature on the Physical Health Attitude Scale's (PHASe) validity and nurses' attitudes when working in acute mental health services in different cultures. Nurses in acute mental health wards mostly focus on the basic physiological indicators of patients' existing physical health problems, so health promotion practices such as sexual health and eye/dental examinations are neglected for individuals with SMI. Nurses' higher level of confidence about their delivery of physical health care is due to their familiarity with basic nursing practices (e.g. monitoring blood pressure and checking blood glucose levels). Differences that exist between countries in relation to smoking habits are probably due to different regulations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: To improve patients' physical healthcare outcomes, nurses should be provided with additional training and supervision to strengthen their skills and confidence. Nurses' perceived need for additional training reflects the importance of physical health care in mental health settings, in which training could substantially improve patient outcomes. Authors believe that standard protocols must be established in acute psychiatric care to eliminate obstacles to holistic patient care. Training needs of mental health nurses on health promotion practices should be considered by administrators of mental health settings. Abstract Introduction Nurses play an important role in improving the physical health of individuals with serious mental illnesses. The literature on the attitudes of mental health nurses towards physical health care provides a small amount of data. Assessing trends in nurses' attitudes through suitable surveys is important to ensure holistic care. Aim/Question This study sought to examine the Turkish version of the Physical Health Attitude Scale's (PHASe) validity and reliability and to survey Turkish mental health nurses' attitudes towards physical health care. Method The sample consisted of 174 nurses working in acute psychiatric wards. Firstly, the psychometric properties of the scale were analysed using factor analysis and measures of internal consistency and reliability. Then, the survey results of the attitudes of mental health nurses towards the physical health of patients with serious mental illnesses were determined using the Physical Health Attitude Scale (PHASe). Results The translated PHASe functioned best as a 24-item version and 4-factor solution that explains 51.3% of the variance. The internal consistency value was 0.83. The respondents' attitudes were generally positive about their role. There was less agreement for the involvement of nurses in practices of health promotion, such as sexual health, eye and/or dental examinations. The nurses surveyed also tended to use smoking for therapeutic purposes. Implications for practice Mental health nurses' knowledge and attitudes should be enhanced by additional training in the ways of meeting patients' biopsychosocial needs. Obstacles to physical health care can be removed by implementing standard protocols nationwide.

Sexual violence and mental health services: a call to action

People who experience sexual violence are highly likely to experience psychological and/or mental health (MH) problems as a result. People who use MH services often have a history of sexual assault and are also likely to be revictimised as an adult. Yet despite there being a very clear association, MH services are not yet performing routine enquiry, and even if they do, are not confident about how to record and manage disclosures. There is some emerging evidence that people with MH problems are exposed to sexual violence in inpatient MH settings, perpetrated by both other patients or members of staff. In this editorial, we explore the evidence to support a wider focus on sexual violence as a part of routine care, as well as some recommendations about how staff can more effectively discuss sexual issues including that of sexual victimisation.

Health professionals' experiences of providing care for women survivors of sexual violence in psychiatric inpatient units

Background

Survivors of sexual violence, who are predominantly women, commonly access mental health services. Psychiatric inpatient units in Australia are predominately mixed gender and may further retraumatise these women. Sexual violence is under-recognised by mental health professionals and there is a lack of adequate policy or direction for mental health service services. To date, only a small amount of research has focused on health professionals’ experiences of providing trauma-informed care to women in psychiatric settings, with most studies focused on specific practices or interventions. Qualitative data is particularly lacking on this topic. This is a critical gap in the knowledge given that health professionals are key to detecting and addressing victimisation. The aim of this study was to gain an in-depth understanding of healthcare professionals’ experiences and perceptions in providing care to women who are survivors of sexual violence in psychiatric inpatient units.

Methods

This qualitative study utilised semi-structured interviews with 40 health professionals recruited from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic analysis.

Results

Three main typologies were developed to describe participants’ experiences of the care provided to women; 1) Dismissing and denying; 2) Acknowledging but unprepared; 3) Empathising but despairing.

Discussion

Gender, professional training, adherence to the biomedical model, and level of experience influenced health professionals’ experiences.

Conclusions

Health professionals in this study held varying attitudes towards female consumers and responses to sexual violence. Our findings suggest the need to address individual staff perception and promote trauma-informed and gender-sensitive care across all disciplines, genders, and levels of experience.

Does a 2-Week Sexual Health in Rehabilitation Course Lead to Sustained Change in Students' Attitudes?-A Pilot Study

This pilot study aimed to explore if healthcare professional students participating in a 2-week elective course, Sexual Health in Rehabilitation (SHR), led to significant and sustained change in experienced competence and attitudes towards addressing sexual health in their future professions, when measured with the Students’ Attitudes towards Sexual Health-Danish version (SA-SH-D). Comparison-group design, using the SA-SH-D at baseline, after the 2 weeks course and 3 months after completing the course. Participation in the SHR course significantly changed the students’ attitudes; decreasing their fears of offending the patients and increasing their feelings of comfort in communicating about sexual health, and the results sustained during the follow-up period of 3 months. The results of the intervention suggest that a 2-week elective SHR course leads to sustained change healthcare students’ attitudes towards addressing sexual health in their future profession. Sexual health education positively changed the students’ attitudes, decreased their fears of offending the patients and increased their feelings of comfort in communicating about sexual health. The SA-SH-D is a useful tool to measure results of educational interventions aiming to change healthcare students’ attitudes towards addressing sexual health in their future profession. Future research is recommended regarding students’ attitudes towards addressing sexual health with persons living with disabilities. There is also a need to further research the effect of elective versus compulsory sexual health education in healthcare programs, to lessen the risk that healthcare students in their future profession will not be able to give equal care due to variation in competence and attitude.

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 NursEs lived Experience of Discussions about Sexual health, with kidney patients in Devon (NEEDS)

AIM

The aim of the study is to gain a better understanding about the complexities of discussing sexuality with patients.

DESIGN

The study will explore how nurses understand the phenomenon by using an Interpretive Phenomenological Approach; the technique encourages deep reflection and rich descriptions about lived experience.

METHODS

Six nurses will be interviewed using iterative, open-ended questions with prompts to illicit rich data.

PREDICTED RESULTS

Understand the support required to enable nurses to engage in deeper, more fulfilling conversations with patients about sexuality.

When holistic care is not holistic enough: The role of sexual health in mental health settings

AIMS AND OBJECTIVES

To explore the preparation that mental health nurses receive to address sexual health in practice.

BACKGROUND

People who use the mental health services often have complex sexual health needs. Mental health nurses are well placed to offer support. However, this rarely happens in practice, and therefore, people's sexual health needs are not being routinely addressed. It is not known why this is the case.

DESIGN

Systematic review and meta-ethnography.

METHODS

EBSCO, PsycINFO, MEDLINE and ASSIA databases were searched using Booleans with Mesh and key terms including "mental health nurse" and "sexual health". Date range was June 2006 to June 2016. Discursive papers were excluded. Included papers (n = 7) were synthesised using a meta-ethnographic approach.

RESULTS

The search yielded seven studies. Five key themes were identified: the (not so) therapeutic relationship; personal values dictating professional ones; institutionalised fear; being human; and education: the answer but where is it?

CONCLUSIONS

The findings illustrate the complexity of supporting people with mental health and sexual health needs. They show the discomfort many nurses have about broaching sexual health. Arguably more than with most issues, personal values impacted strongly on professional practice. Understanding the depth and multifaceted nature of these themes is important, because strategies can then be developed to mitigate the barriers to best practice. For example, the findings presented here offer a framework from which structured education and support can be built.

RELEVANCE TO CLINICAL PRACTICE

There is a need for Mental health nurses to be more responsive to concerns around sexual health and it should be routinely included in their practice. This study illuminates why this is not currently the case. By understanding this, remedial action can be taken by nurse educators. Implications are also discussed in relation to policy, research and practice.

Partners in Recovery program evaluation: changes in unmet needs and recovery

Objective Partners in Recovery (PIR) is an Australian government initiative designed to provide support and service linkage for individuals with complex needs living with severe and persistent mental illness. The aim of the present study was to examine whether consumers engaged in PIR programs in two large regions of Sydney experienced: (1) a reduction in unmet needs (either via self- or staff report); and (2) progress in their self-reported mental health recovery. Methods Unmet needs were measured using the Camberwell Assessment of Need Short Appraisal Scale and recovery was measured using the Recovery Assessment Scale - Domains and Stages. For individuals with initial and follow-up data, paired t-tests were used to examine change over time. Results At follow-up, individuals reported an average of two to three fewer unmet needs, and recovery scores increased by approximately 5% across each domain and the total score. At follow-up, the most common unmet needs were in the areas of 'company' and 'daytime activities'. Conclusions The results of the present study suggest that PIR services in these two geographical regions have achieved positive results. Individuals with severe and persistent mental illness engaged with PIR appear to have reduced their unmet needs and enhanced their mental health recovery. What is known about the topic? PIR services were established to support individuals with severe and persistent mental illness by creating service linkages to address unmet needs in order to facilitate recovery. Services were delivered through the new role of 'support facilitator'. What does this paper add? By examining routinely collected outcome measures, this paper shows the success of the PIR program. Individuals engaged with PIR reported fewer unmet needs and enhanced recovery over the time they were involved with the program. However, they still faced serious challenges in building successful social interactions, such as developing friendships, and participating in meaningful activities. What are the implications for practitioners? The support facilitator role developed as part of PIR appears to be a useful method of supporting individuals to reduce unmet needs and enhance recovery. However, further work is required to address the challenges associated with overcoming social isolation and participation in meaningful activities.

Sexuality education for health professionals: A literature review

Abstract The objective of this study was to review the scientific literature addressing educational actions related to the training of health professionals in sexuality between 2003 and 2013. The results obtained show that college seniors, recent college graduates, or those working in hospitals and other health care facilities are not adequately prepared to meet patients' needs regarding sexuality. Several studies have shown improvement in the health practitioners' ability to deal with patients' sexuality issues after participating in training programs in sexuality, regardless of the course load. According to the articles reviewed, in order to improve the performance and comfort level of health practitioners to deal with patients' sexuality concerns, investments in educational actions are necessary.

Supporting the Sexual Intimacy Needs of Patients in a Longer Stay Inpatient Forensic Setting

PURPOSE

To explore perceptions of nurses and patients regarding sexual intimacy in a long-term mental health unit.

DESIGN AND METHODS

Qualitative exploratory design including in-depth semi-structured individual interviews with 12 registered nurses and 10 long-term patients of a forensic mental health hospital.

FINDINGS

The theme of supporting sexual intimacy was identified and described in this paper and included the following subthemes for nurses: It depends on the setting, need for guidelines and consent, and for patients-it depends on the setting; and need for support.

PRACTICE IMPLICATIONS

The findings suggest that current guidelines regarding sexual intimacy in acute inpatient settings may not be appropriate in long-term facilities, with a need for guidelines to specifically address this setting. Furthermore, support for sexual intimacy needs of patients was identified as a strong need for patients and they believed not currently met. Nurses have an important role to play as part of their holistic approach to care and barriers to providing this aspect of care must be overcome to ensure patients' rights are respected.

The emancipatory potential of nursing practice in relation to sexuality: a systematic literature review of nursing research 2009-2014

Nurses play a key role in the provision of services in relation to sexuality in both primary and sexual and reproductive health-care. Given the intersection of sexualities with a range of social injustices, this study reviews research on nursing practice concerning sexuality from an emancipatory/social justice perspective. A systematic review of English articles published in nursing journals appearing on the Web of Science database from 2009 to 2014 was conducted. Thirty-eight articles met the inclusion criteria. Analysis consisted of a descriptive phase (types and location of studies, aspects of sexualities focused on, target health users and aspects of nursing practice focused on) and a critical/emancipatory phase. In terms of practice, our analysis revealed that: barriers exist to the integration of issues relating to sexuality in nursing practice; the social location of nurses and their personal feelings regarding sexuality influence their practice; content that addresses gendered norms and media that assist in communication underpin some emancipatory practices. Few studies locate analyses of nursing practice within gendered, cultural and social norms; consider advocacy as part of the practice of nurses; or analyse the promotion of health user participation in health services and structures. The implications for emancipatory practice are drawn out.

Perspectives on Sexual Health and Function of Recent Male Combat Veterans of Iraq and Afghanistan

Background

U.S. veterans of recent wars in Iraq and Afghanistan may be at greater risk for sexual dysfunction due to injuries, mental health conditions, medications used to treat those conditions, and psychosocial factors.

Objective

To explore the perceptions of recent Veterans about sexual health and dysfunction, contributing factors, its impact and solutions.

Design

Qualitative study.

Participants

Eight men who screened positive for sexual dysfunction at initial presentation to a postdeployment clinic at a Veterans Affairs medical center

Approach

Patients who screened positive for sexual dysfunction and indicated an interest in participating were contacted and scheduled for an in-person private interview with a researcher. Interviews were semistructured, utilizing open-ended and follow-up probe questions to elicit the individual's perspective about sexual dysfunction and its cause, impact and solutions. Interviews were recorded, transcribed and analyzed for themes.

Key Results

These heterosexual men discussed a range of sexual dysfunction in their activities including lack of desire, erectile dysfunction, delayed orgasm, premature ejaculation, and distraction. They also discussed the importance of setting or context and changes over time to their sexual health and function. The men shared their ideas about contributory factors, including normal aging, medication side effects, injury and a possible role for combat deployment more generally. Reported solutions for sexual dysfunction included medications, herbal remedies, and new positions and approaches to sexual activity. Participants reported discussing sexual dysfunction with their health-care providers and what was helpful. Finally, the men expressed in their own words the significant impact of sexual dysfunction on their self-perception, their partners, and their relationships.

Conclusions

Sexual dysfunction in recent combat veterans can have important negative effects on their health and relationships. Our findings elucidate perceived contributory factors and preferred solutions, which can be applied by health-care providers to improve the management of sexual dysfunction in these patients.

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.

Promoting HIV and sexual safety behaviour in people with severe mental illness: a systematic review of behavioural interventions

People diagnosed with severe mental illness (SMI) are at greater risk of HIV than the general population. However, little attention has been given to how best to reduce sexual risk taking in this group. The aim of the review was to evaluate the effectiveness of behavioural interventions to promote sexual safety behaviour in people diagnosed with SMI. A comprehensive search of relevant databases was undertaken, and studies were included if they were randomized, controlled trials; behavioural intervention related to sexual behaviour; included adults diagnosed with SMI; and if a behavioural outcome was reported. The Cochrane Assessment of Bias Tool was used. Of the initial 515 papers identified, 11 trials were included for quality assessment and data extraction. The studies were heterogeneous in content and dose of intervention, as well as outcome measure and follow-up periods, and all had some risk of bias. Four of the studies demonstrated significant improvement in safer sexual behaviour at follow up, but this effect diminished over time. The effect sizes were extremely variable. There is emerging evidence to suggest that a behavioural intervention has the potential to reduce sexual risks in people diagnosed with SMI. However, further high-quality research is needed in this area.

Is somatic health screening in patients with severe mental illness of added value?

PURPOSE

To evaluate the added value of somatic screening for patients with severe mental illness over regular care.

DESIGN AND METHODS

We compared the information on somatic health problems collected by screening with the general practitioner (GP) files (n = 118).

FINDINGS

The mean number of somatic health problems detected with somatic health screening was significantly higher than those noted in GP records (p < .01).

PRACTICE IMPLICATIONS

Somatic health screening is an addition to the care provided by the GP. Advanced mental health nurses can play a key role in somatic health screening and initiating further cooperation and communication of GP and mental health care.