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.

Addressing clients' sexual health in occupational therapy practice

BACKGROUND.

Sexuality is an important dimension of one's health and well-being. Studies show that occupational therapists regard clients' sexual health as a legitimate domain of practice but do not adequately address it in their clinical work.

PURPOSE.

This study aims to describe occupational therapists' perspectives regarding clients' sexual health.

METHOD.

This exploratory study surveyed Canadian occupational therapists using an online questionnaire that collected information on beliefs, knowledge, comfort, barriers, and facilitators with regard to addressing sexuality. Descriptive analysis was conducted on questionnaire data, and content analysis was used to organize respondents' comments.

FINDINGS.

While most respondents believed that addressing sexuality was within their scope, few actually did so in practice. Participants reported comfort with sexuality but identified lack of knowledge as a barrier to addressing clients' sexual health.

IMPLICATIONS.

This study provided a greater understanding of factors that require consideration for occupational therapists to effectively meet clients' sexual health needs.

Addressing Sex in Occupational Therapy: A Coconstructed Autoethnography

Occupational therapy practitioners generally agree that sex is a meaningful occupation and should be part of the rehabilitation process; however, there has been reluctance to include clients’ sexual concerns in practice. To explore how occupational therapy is addressing clients’ sexual concerns, we (one author with a professional background in occupational therapy and the other who is a consumer of occupational therapy services) used a coconstructed autoethnographic approach that involved shared reflection between us. We discuss insights discovered through the coconstructed process, including the potential health risks involved in sexual activity, the importance of sexuality as a core aspect of identity, the ways that rehabilitation currently excludes sexuality, and the potential role of occupational therapy in addressing sexuality.

Secondary health conditions experienced by people with spinal cord injury within community living: implications for a National Disability Insurance Scheme

BACKGROUND

Australia's National Disability Insurance Scheme (NDIS) provides supports for individuals, delivered through a personalised participant planning process, to influence choice and goal attainment.

AIM

This study aimed to use both quantitative and qualitative methods to examine the impact of secondary health conditions on the experiences of people with spinal cord injury (SCI) who have returned to community living, in the context of Australia's National Disability Strategy and recently launched NDIS. Exploration of lived experience of health conditions following SCI utilising this mixed methods approach may offer important insights for effective planning within an NDIS.

METHODS

A cross-sectional survey using the Spinal Cord Injury Secondary Conditions Scale (SCISCS), demographic questionnaire and in-depth interview was undertaken with 33 people with SCI living in the community. Demographic and SCISCS data were reported using descriptive statistics. Interviews were audio-taped, transcribed and analysed thematically.

RESULTS

Participants were on average 58.5 years of age and 20 years post-injury. Five key themes emerged relating to (i) spasm and pain; (ii) sexual dysfunction; (iii) pressure areas; (iv) fatigue; and (v) the impact of secondary health conditions on life role participation and choice of supports and equipment.

CONCLUSION

Secondary health conditions can significantly impact occupational participation following SCI. Appropriate intervention, including customised equipment and direct support, if delivered as part of an effective NDIS, may prevent or reduce the severity of these conditions and offer the potential to influence health and participation outcomes of people who have returned to community living.

Ethical tensions in occupational therapy practice: A scoping review

Introduction

Ethical tensions are an unavoidable part of occupational therapy practice. Given the significance of this, and the divergent nature of the literature, a need was identified for a systematic examination of the published literature on this topic. The purpose of this scoping review therefore was to identify, summarize, and describe existing literature on ethical tensions in occupational therapy practice.

Method

A comprehensive scoping review was conducted. In the initial search, 459 articles, spanning a 13-year time frame, were retrieved from six databases; 32 articles met the criteria for full review.

Results

Seven themes were identified that highlighted ethical tensions related to: (a) resource and systemic issues; (b) upholding ethical principles and values; (c) client safety; (d) working with vulnerable clients; (e) interpersonal conflicts; (f) upholding professional standards and (g) practice management.

Conclusion

This scoping review highlights a breadth of ethical tensions that have implications for practice, education, policy and research. It represents an important first step in mapping knowledge about ethical tensions in occupational therapy practice, and lays a foundation for future research directions.

"Don't Think Paralysis Takes Away Your Womanhood": Sexual Intimacy After Spinal Cord Injury

Sexuality and intimacy are important components of health and well-being. Issues surrounding sexuality and intimacy are equally important for men and women living with physical disabilities, including spinal cord injury (SCI). Yet, women's sexuality after SCI remains largely unexamined. This article presents the findings from an in-depth qualitative investigation of the sexual and reproductive health experiences of 20 women with SCI in or around Detroit, MI. Findings echo existing literature documenting the sexual consequences of life after SCI and suggest new areas of inquiry important for better addressing sexual concerns across the lifespan. Specifically, findings suggest a need to consider the variable effects of SCI on sexual intimacy in relation to a person's developmental trajectory, the appropriate timing of sexual education, the need to expand conceptualizations of sexual intimacy, and the ways SCI may affect sexuality in later life.

The Impact of Assistive Equipment on Intimacy and Sexual Expression

Introduction:

Sexuality is a holistic concept that involves more than the sexual act. Despite being a quality of life domain that promotes meaningful existence, it is an aspect of life that is often avoided by health care practitioners.

Method:

In this Heideggerian phenomenological study, conversational interviews were conducted with 13 people with motor neurone disease, and 10 of their partners, in order to understand their experiences of sexuality and intimacy.

Findings:

The findings provide evidence for the value of touch in people's lives and shed light upon the impact that assistive equipment has on intimacy, sexual expression and maintaining emotional and physical connection between couples. None of the people interviewed had previously been given the opportunity to discuss these issues with their occupational therapist.

Conclusion:

There is a place in occupational therapy practice for discussing the value of emotional and physical connection for individuals in the context of any equipment provided.

Occupational Therapy Students' Choice of Client Activities: Does Patients' Gender Matter?

Aim:

In order to achieve a fairer system of health care, it is important that the research and education of health professionals, as well as the organisation of health care, takes into account the gender perspective. The gender order influences women's and men's lifestyles and living conditions and, through this, their health, quality of life and daily activities. The aim of the present study was to explore the perceptions of gender in occupational therapy students in their choice of activities: do students choose activities according to traditional roles?

Method:

The method was a fictional case study containing 16 activities. Each student was given a copy of one of the versions of the case, Eric or Erica. The students were told to underline the three activities regarded as being of most benefit for the actual patient. Eight male and 99 female students participated.

Results:

The most chosen activities were cooking, visits to cafeterias and gardening, and the least chosen were spinning, laundry and computer work. The results showed that the students made choices based on traditional gender roles.

Conclusion:

Extended knowledge is needed about how gender is constructed in occupational therapy, and about whether gendered choices contribute to a prolonged period of treatment or rehabilitation, or the opposite.