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

Approaches for improving sexuality and sexual health care in mental health settings: A qualitative study exploring clinicians' own perspectives

There is an acknowledged professional practice gap regarding sexuality and sexual health related needs within mental health settings in Australia and internationally. Yet little is known about how clinicians can be best supported or enabled to improve sexuality-related practice, from their own perspective. This is important, given the sensitive and complex nature of sexuality and sexual health within the context of mental distress and service provision. This article reports a follow-up study, where mental health clinicians who participated in an initial study were invited to reflect on and discuss the (finalized) results and recommendations generated. The aim was to generate insights into the tools, strategies, and approaches participants felt would best equip and support clinicians to better incorporate sexuality and sexual health into their work. Six clinicians from three disciplines (mental health nursing, psychology, and psychiatry) participated in in-depth interviews to reflect on a plain language summary of the initial study. Three interconnected themes were generated via reflexive thematic analysis: (1) access to knowledge and information; (2) support from peers, senior colleagues, and workplaces; and (3) enacting a focus on sexuality-related care. These findings provide valuable insights into how clinicians may want to be supported in relation to (improving) their sexuality-related practice. The analysis also demonstrates the importance of a multifaceted approach to improving sexuality-related care in mental health and other health settings. This knowledge will contribute to directing future research and development of interventions, tools, strategies, or other approaches to this end.

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.

Sexual risk behavior among individuals seeking outpatient mental health services: Associations with childhood emotional neglect and identity dysfunction

This study was developed to examine sexual risk behavior among patients seeking community-based mental health services, including associations with psychological distress, identity dysfunction, and childhood emotional neglect. A mediation model was examined regarding identity dysfunction mediating the link between emotional neglect and sexual risk behavior. A total of 245 outpatients completed questionnaires regarding perceived risky sexual behavior, psychological distress, identity dysfunction, and emotional neglect. Sexual risk behavior was found to be a prevalent issue among individuals seeking outpatient mental health services, with 13% reporting engagement in unsafe sexual practices at least some of the time. Mediation analysis revealed that childhood emotional neglect was indirectly linked with sexual risk behavior through the mediating effect of identity dysfunction. Thus, findings suggest a pathway to sexual risk behaviors through perceived childhood emotional neglect and identity dysfunction. Clinical attention to identity-related vulnerability among this population may be warranted in aiming to mitigate risk-taking associated with sexual practices.

Exploring the wider societal impacts of sexual health issues and interventions to build a framework for research and policy: a qualitative study based on in-depth semi-structured interviews with experts in OECD member countries

OBJECTIVES

Sexual health is a complex public health challenge and can generate wide-ranging health, social and economic impacts both within and beyond the health sector (ie, intersectoral costs and benefits). Methods are needed to capture these intersectoral impacts in economic studies to optimally inform policy/decision-making. The objectives of this study were (1) to explore the different intersectoral costs and benefits associated with sexual health issues and interventions, (2) to categorise these into sectors and (3) to develop a preliminary framework to better understand these impacts and to guide future research and policy.

DESIGN

A qualitative study based on in-depth semi-structured online interviews.

SETTING

OECD (Organisation for Economic Co-operation and Development) member countries.

PARTICIPANTS

Professionals with expertise in the field of sexual health including clinicians, medical practitioners, sexologists, researchers, professionals working for international governmental or non-governmental health (policy) organisations and professionals involved in implementation and/or evaluation of sexual health interventions/programmes.

METHODS

Sampling of participants was undertaken purposively. We conducted in-depth semi-structured online interviews to allow for a systemic coverage of key topics and for new ideas to emerge. We applied a Framework approach for thematic data analysis.

RESULTS

28 experts were interviewed. Six themes emerged from the interviews: (1) Interconnections to other areas of health (ie, reproductive health, mental health), (2) Relationships and family, (3) Productivity and labour, (4) Education, (5) Criminal justice/sexual violence, (6) Housing, addiction and other sectors. The findings confirm that sexual health is complex and can generate wide-ranging impacts on other areas of health and other non-health sectors of society.

CONCLUSION

These different sectors need to be considered when evaluating interventions and making policy decisions. The preliminary framework can help guide future research and policy/decision-making. Future research could explore additional sectors not covered in this study and expand the preliminary framework.

A Qualitative Study on Sexuality and Sexual Experiences in Community Forensic Mental Health Patients in Queensland, Australia

This qualitative study reports on the sexuality and sexual experiences of community-based forensic mental health participants. The findings indicate that these participants feel the need for intimacy and want to engage in sexual activity more often than their neurotypical Australian peers. Participants identified their mental health and the side effects of compliance with prescribed psychotropic medications were barriers to achieving their desired level of sexual activity. Participants supported the notion that mental health teams were positioned to assist patients navigate the psychological, cultural, education and physical barriers to achieving sexual health and wellbeing. We propose several interventions to support these participants and other community forensic mental health patients in attaining healthy relationships, understanding their sexual health, and gaining more fulfilling sexual experiences. These interventions, which include sex education, upskilling in socialization and communication, and regular medication reviews, could be delivered as part of the holistic care provided by mental health teams. Mental health clinicians should be offered appropriate training to assess patients and have discussions related to sexuality, sexual experiences and sexual health needs.

The Core Nursing Interventions in Adult Psychiatric Outpatient Care Identified by Nurses, a Delphi Study

PURPOSE

To define the core nursing interventions identified by nurses in the adult psychiatric outpatient care setting.

METHODS

A two-round Delphi study. The panel consisted of nurses and nurse managers.

FINDINGS

Nurses identified 53 core interventions, 50 of which are described in the Nursing Interventions Classification (NIC). Altogether, two thirds of these interventions were in the NIC domain 'Behavioral' and the emphasis was on NIC classes 'Coping Assistance' and 'Behavior Therapy,' suggesting that nurses define providing psychosocial support as the core in their work.

CONCLUSIONS

The findings indicate that the main role of nurses in the psychiatric outpatient care is to deliver psychosocial care for their patients. The lack of family interventions among the core interventions and the need to add the missing three interventions into the classification need more research in the future.

IMPLICATIONS FOR NURSING PRACTICE

This study helps to define nurses' role in the psychiatric outpatient care. The findings can be used in developing nursing education programs.

Correlation Between Needs Satisfaction and Behavioral Intentions of Sexual Health Care

BACKGROUND

This study aimed to evaluate correlations between female nurses' needs satisfaction and behavioral intentions for providing sexual health care and to assess moderating effects of learning needs on that correlation.

METHOD

A total of 300 female RNs were enrolled. Two validated instruments were used to collect information on participants' learning needs, needs satisfaction, and behavioral intentions for providing sexual health care.

RESULTS

Adjusted multivariable regression analysis revealed significant moderating effects of medium and low learning needs on correlations between needs satisfaction and behavioral intentions (medium learning needs: β = 0.282, 95% CI = 0.075, 0.490; p = .008; low learning needs: β = 0.293, 95% CI = 0.033, 0.553; p = .027), while no moderating effect was observed in those with high learning needs.

CONCLUSION

Needs satisfaction was significantly correlated with behavioral intentions of sexual health care in medium and low learning needs groups. [J Contin Educ Nurs. 2020;51(10):457-464.].

The Relationship Between Gender Role Orientation and Sexual Health Care in Taiwanese Nurses: A Structural Equation Model

Introduction

Patients’ sexual concerns are private, sensitive issues, and providing sexual health care (SHC) is a legitimate area of concern for the nursing practice.

Aims

This study tests a structural equation model for factors that affect SHC among Taiwanese nurses.

Methods

A cross-sectional study was performed between August 2014 and July 2015. A total of 471 registered nurses from a medical center in Taiwan were enrolled in this study. All nurses participated anonymously and completed 3 questionnaires: Nursing Attitude in Sexual Health Care scale, Nursing Intervention in Sexual Health scale, and Gender Role Orientation scale. The Permission-Limited Information-Specific Suggestions-Intensive Therapy model based on scale was application, and theory of planned behavior was used to examine the relationship of these 3 scales in nurses.

Main Outcome Measures

SHC surveys were developed for nurses. These valid and reliable instruments included Nursing Attitude in Sexual Health Care, Nursing Intervention in Sexual Health, and Gender Role Orientation.

Results

The fitted structural equation model was valid. The construct reliability of latent variables ranged from 0.730 to 0.942, which met the requirement of 0.70. The attitude about SHC (β = 0.182, P < .001), subjective norms on SHC (β = 0.146, P < .001), and confidence about SHC (β = 0.583, P < .001) had significant effects on the behavioral intention to provide SHC. Subsequently, the behavioral intention to provide SHC had a significant, direct effect on the behavioral frequency of providing SHC (β = 0.356, P < .001). However, gender role orientation was not significantly associated with behavioral intention and behavioral frequency to provide SHC.

Conclusions

The good fit for the structural equation model suggests that the predictors of behavioral intention and behaviors of providing SHC include attitude, subjective norms, and perceived control. The stronger behavioral intention of providing SHC resulted in a higher frequency of providing SHC. However, the relationship between gender role orientation and SHC had no significant effect.

Huang C-Y, Liou C-F, Lee S-H, et al. The Relationship Between Gender Role Orientation and Sexual Health Care in Taiwanese Nurses: A Structural Equation Model. Sex Med 2020;8:565–573.

Navigating and negotiating meanings of child abuse and neglect: Sociocultural contexts shaping Australian nurses' perceptions

Nurses who work with children have the opportunity to make a difference by identifying and responding to child abuse and neglect. Little is known about the ways that nurses define, assess and respond to child abuse and neglect and how this subsequently affects children. This paper reports one of four themes identified through inductive analysis of a qualitative study exploring nurses' perceptions and experiences of keeping children safe from abuse and neglect. The aim of this paper was to report on how nurses understand and interpret child abuse, is found to be shaped by their own sociocultural contexts. A qualitative research design underpinned by social constructionism framed the study. Data were collected in 2016 and 2017 through 21 in-depth, semi-structured interviews with nurses who work with children in Australia. Key findings showed that nurses working with children had difficulty defining child abuse and drew upon multiple sources to construct a working definition. In addition to drawing from official legislation and guidelines, nurses compared and contrasted the level of abuse with their own personal and professional experiences of parenting. Nurses described the challenges of making assessments when faced with cultural practices different from their own. Nurses' descriptions of how they defined abuse showed that their assessments of child abuse and neglect were inextricably linked to their personal values and beliefs. As such, nurses were often working from their own value systems rather than consistently taking a child-focussed approach. There was an absence of consistent and explicit critical reflection on ways that values and beliefs might shape practice at individual and system levels. We propose this is a missing aspect of child safe practice. Reflection on how personal and professional values and beliefs interact with the implementation of evidence-informed approaches will increase nurses' capacity to maintain a child-focus.

'It's just a peripheral issue': A qualitative analysis of mental health clinicians' accounts of (not) addressing sexuality in their work

Sexuality, relationships, and intimacy are integral parts of many peoples' lives, not negated by mental distress and illness. Yet typically, these needs are not addressed adequately in mental health settings. In-depth interviews were conducted with mental health clinicians with an aim of exploring their perceptions and understandings of sexuality and sexual concerns within mental health settings. Participants were 22 mental health nurses, psychologists, and psychiatrists working with people across a range of settings in four Australian cities. Sexuality or aspects of this were often not addressed in clinical practice, and this was common across participants' accounts. A critical thematic analysis was conducted to explore how participants made sense of or explained this silence in relation to sexuality. Two key themes were 'Sexuality is hard to talk about' and 'Sexuality is a "peripheral issue"'. In positioning sexuality as a peripheral issue, participants drew on three key explanations (sub-themes): that sexuality rarely 'comes up', that it is not pragmatic to address sexuality, and that addressing sexuality is not part of participants' roles or skill sets. A third theme captured the contrasting perception that 'Sexuality could be better addressed' in mental health settings. This analysis indicates that, beyond anticipated embarrassment, mental health clinicians from three disciplines account for omissions of sexuality from clinical practice in similar ways. Moreover, these accounts serve to peripheralize sexuality in mental health settings. We consider these results within the context of espoused holistic and recovery-oriented principles in mental health settings.

Nursing interventions for sexual dysfunction: An integrative review for the psychiatric nurse

Sexual dysfunctions are prevalent disorders in psychiatric patients that too often are not addressed by psychiatric-mental health nurses. An integrative review was conducted using PubMed, Joanna Briggs Institute, SCOPUS, PsycINFO and CINAHL databases to evaluate the evidence for independent, nursing interventions for sexual dysfunction across all nursing literature that could be implemented by psychiatric-mental health nurses. Out of 2448 articles, nine papers met inclusion criteria and were synthesized. Best available evidence was found for sexual teaching interventions for female sexual dysfunction. The implications for psychiatric-mental health nursing practice and recommendations for future research are discussed.

Supporting the intimate relationship needs of service users with psychosis: what are the barriers and facilitators?

Background: Mental health services aim to provide holistic care, but the intimacy needs of clients are neglected. Currently there is limited understanding of the challenges mental health professionals (MHPs) face when considering supporting the relationship needs of people with psychosis.Aim: This study investigated the views of community-based MHPs from a range of disciplines regarding the barriers and facilitators to supporting clients with their romantic relationship needs.Method: Semi-structured interviews were conducted with 20 professionals and analysed from a realist perspective using thematic analysis.Results: Barriers identified were: (1) "They will never be able to form close attachments." (2) "Modern social care teaches us reduce risk, reduce risk, reduce risk." (3) "You're only relying on what you've picked up over the years". Facilitators were: (1) "If they could find a partner they would progress a lot more". (2) "It's all to do with the relationship you've got between you and your client". (3) "It's having the resources".Conclusions: Results highlight areas for service improvement and will help inform the development of future interventions.

Who decides when people can have sex? Australian mental health clinicians' perceptions of sexuality and autonomy

Sexuality is a central aspect of human experience but there is evidence that this is largely constrained, pathologised or ignored in mental health settings. We conducted in-depth interviews with 22 psychologists, psychiatrists and mental health nurses working across a variety of settings in four Australian cities. Sexuality was most often perceived as relevant in the mental health setting when it was simultaneously constructed as dangerous. Participants located this danger in sexual expression itself or within individuals who, because of mental illness, lacked the autonomy required to successfully engage in 'safe' sex. We discuss these findings and their implications for research and professional practice.