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

Strategies Used to Teach Professional Boundaries Psychiatric Nursing Education

Issues in understanding professional boundaries have been reported amongst student psychiatric nurses. Nursing students are at risk of crossing and violating professional boundaries as they are inexperienced in maintaining therapeutic relationships. Despite these challenges, there was a lack of literature regarding boundary instruction in psychiatric nursing education. Interpretative description was applied as method to answer: What strategies do psychiatric nurse educators utilize to teach professional boundaries to undergraduate students? Eleven educators and nine psychiatric nurses were interviewed. Data was analyzed using an inductive approach. Eight participants also attended a focus group to help refine analysis. Boundary instruction strategies included sharing stories, reflective activities, discussion in clinical settings, role modeling, and role play. Boundary instruction should be incorporated into psychiatric nursing curriculum in a deliberate manner to ensure students are exposed to the topic in meaningful ways throughout their academic career.

Sexuality and sexual dysfunctions in older people: a forgotten problem

This article considers sexuality in older adults and the associated stereotypes and stigmas that lead to this area being underappreciated. Normal physiological changes in ageing are discussed and how they can cause sexual dysfunction. The elderly population has a higher burden of comorbid physical illness and this review considers evidence on the interplay between physical health and sexual health. Mental illness is also strongly linked with sexual functioning and is discussed, as is the evidence on psychotropics and sexual side-effects. Attitudes on sexuality in long-term care settings are highlighted and approaches to managing sexual disinhibition are included.

A Real-World Study on Antidepressant-Associated Sexual Dysfunction in 2144 Outpatients: The SALSEX I Study

The objective of this cross-sectional study was to evaluate the frequency, impact, and management of sexual dysfunction associated with commonly prescribed antidepressants available in psychiatry outpatient clinics in Spain. We recruited 2163 adult patients who had undergone treatment with antidepressants for at least 8 weeks and had a history of normal sexual functioning before the prescription of the antidepressant, except for mildly impaired libido. We used the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) for evaluating the frequency and tolerance of sexual dysfunction and whether this side effect was spontaneously reported. Overall, 79% patients showed sexual dysfunction, as indicated by a total score ≥ 3 on the PRSexDQ-SALSEX; 64% showed moderate-severe sexual dysfunction, with no differences between men and women on these outcomes. In the multivariate logistic regression analysis, treatment with a serotonergic antidepressant and having a severe clinical state of psychiatric illness were the factors associated with the highest likelihood of presenting with sexual dysfunction. Sexual dysfunction was spontaneously reported by 838 (41%) of the 2066 evaluable patients for this outcome. Among patients with sexual dysfunction, this condition was poorly tolerated by 22% of the patients, with these frequencies being significantly higher in men than in women. The most frequently used strategies employed by the psychiatrists in our study for dealing with sexual dysfunction were switching to another antidepressant (34%) and waiting for spontaneous resolution (33%). In conclusion, our results indicate that despite being a well-known, long-standing side effect of antidepressants, sexual dysfunction continues to be extremely common in patients receiving antidepressants, especially serotonergic ones, potentially jeopardizing treatment success in a substantial proportion of patients. There are important sex differences in the reporting and tolerance of sexual dysfunction that require further investigation.

Coming In: Queer Narratives of Sexual Self-Discovery

Many models of queer sexuality continue to depict a linear narrative of sexual development, beginning in repression/concealment and eventuating in coming out. The present study sought to challenge this by engaging in a hermeneutically informed thematic analysis of interviews with eight queer people living in Western Australia. Four themes were identified: "searching for identity," "society, stigma, and self," "sexual self-discovery," and "coming in." Interviewees discussed internalized homophobia and its impact on their life; experiences and implications of finding a community and achieving a sense of belonging; the concept of sexual self-discovery being a lifelong process; and sexuality as fluid, dynamic, and situational rather than static. The article concludes by suggesting that the idea of "coming in"-arriving at a place of acceptance of one's sexuality, regardless of its fluidity or how it is viewed by society-offers considerable analytic leverage for understanding the journeys of sexual self-discovery of queer-identified people.

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.

Talking about sexuality with consumers of mental health services

PURPOSE

To explore nurses' perceptions of how consumers of mental health services have responded to mental health nurses discussing sexuality with them.

DESIGN AND METHODS

Qualitative exploratory design including in-depth individual interviews with 14 mental health nurses in Australia on two occasions. Nurse participants were taught the BETTER model in the first interview and were asked to use this in their practice.

FINDINGS

In the second interview nurse participants described the model as useful and consumer responses as very positive.

PRACTICE IMPLICATIONS

The findings suggest the BETTER model is a simple and effective intervention that can assist mental health nurses to include sexuality as part of nursing care.

The 5-As framework for including sexual concerns in mental health nursing practice

Available evidence informs us that sexual health concerns of consumers are commonly avoided within mental health services. This paper describes the findings of a qualitative exploratory research project. This research was conducted in three stages, all involving in-depth interviews with 14 nurses working in a mental health setting. Stage 1 involved an exploration of participants' views about including sexual concerns in their practice and included an educational intervention designed to encourage sexual inclusivity in practice. Stage 2 involved follow up interviews 4-6 weeks later to discuss the effectiveness of the intervention and whether practice change had resulted. Stage 3 was conducted two years later with the aim of determining the extent to which practice changes had been sustained. The themes emerging throughout the research emphasised five main stages in the nurses' experience: avoidance; awareness; applying; approval; and acknowledgement. Avoidance of the topic was commonly noted in the early stages of the research. The education program led to awareness raising of sexual concerns and approval towards the importance of this area to which lead to applying it to practice. This ultimately resulted in acknowledgement of the need for sexual concerns to become part of mental health nursing practice. These five stages are represented in the Five A's for including sexual concerns in mental health nursing practice, the framework developed by the first author.