A concept analysis of intimacy

Feasibility and effectiveness of communication tools for addressing intimacy and sexuality in patients with cancer: a systematic review

PURPOSE

Patients diagnosed with cancer might experience changes in intimacy and sexuality due to the illness itself, treatment, or psychological and social factors. Healthcare professionals (HCPs) often feel reluctant to discuss these changes. This study aimed to provide an overview of the feasibility and effectiveness of communication tools that support communication regarding changes in intimacy or sexuality among patients with cancer.

METHODS

This is a systematic review. Databases are PubMed, Embase, CINAHL, PsycInfo, Web of Science and Cochrane Library from inception to June 2023. The Mixed Methods Appraisal Tool was used to assess included studies. Data were summarized in data charting forms.

RESULTS

In total 35 studies were included, published between 2001 and 2023. Most had a quantitative design and moderate methodological quality. In 11 studies, the PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy) was used. Tools were integrated in counselling sessions or training programmes for individual patients, couples, groups of patients, or HCPs. All tools were considered feasible by patients or HCPs. Twenty studies reported significant improvement in sexual functioning, quality of life, quality of care or combined outcomes.

CONCLUSION

Tools to support communication about changes in intimacy and sexuality among patients with cancer seem feasible and effective. The most commonly used tool, the PLISSIT model, proved to be feasible for HCPs and to have a positive effect on patients' and partners' sexual functioning and quality of life. Giving attention to changes in intimacy and sexuality seems to be important in itself, regardless of the communication tool or approach used.

Promoting appetitive learning of consensual, empowered vulnerability: a contextual behavioral conceptualization of intimacy

Vulnerability is emphasized in a number of theoretical models of intimacy (e.g., Intimacy Process Model), including from behavioral and contextual behavioral perspectives. Vulnerability is generally defined as susceptibility to harm and involves behaviors that have been historically met with aversive social consequences. From these perspectives, intimacy is fostered when vulnerable behavior is met with reinforcement. For example, interventions have trained intimacy by building skills in emotional expression and responsiveness with promising results. Vulnerability has divergent functions, however, depending on the interpersonal context in which it occurs. Functional intimacy is explored through the lens of functional relations, which play a key role in interpersonal processes of power, privilege, and consent. This conceptualization suggests that vulnerability must be under appetitive functional relations, consensual, and empowered for safe intimacy to emerge. The responsibility to promote appetitive learning of consensual, empowered vulnerability to foster intimacy falls to the person with more power in a particular interaction and relationship. Recommendations are offered for guiding this process.

Power-Related Emotions, Alcohol Intoxication, and Nonconsensual Sex Intentions: The Role of Fear of Intimacy

The problem of alcohol-involved sexual assault against women highlights the need to identify how the presence of alcohol interacts with risk factors associated with sexual assault perpetration. One risk factor for sexual assault perpetration is fear of intimacy, the inhibited capacity to exchange vulnerable thoughts and emotions with a valued individual. Men who have perpetrated sexual violence report higher fear of intimacy and alcohol use than those who have not. However, little research has investigated how fear of intimacy may contribute to sexual assault perpetration in the context of alcohol intoxication. This study examined alcohol intoxication, fear of intimacy, proximal power-related emotions, and nonconsensual sex intentions. Non-monogamous, male social drinkers (N = 94) completed measures and were randomly assigned to an alcohol condition (alcohol [BrAC = .10%] versus control). Participants then read a sexual assault analogue scenario depicting sexual assault against a hypothetical woman and reported power-related emotions and nonconsensual sex intentions. Self-reported fear of intimacy differed across types of past perpetration. Results found that for intoxicated men only, fear of intimacy was positively associated with power-related emotions, and power-related emotions were positively associated with nonconsensual sex intentions. These associations were not observed for men in the control condition who did not consume alcohol. Future research should examine intimacy-related interventions for sexual assault prevention programming.

Through Thick and Thin: The Meaning of Dementia for the Intimacy of Ageing Couples

As the population ages, the number of people with dementia increases. An emerging body of research is focusing on living with dementia and understanding the experience of caring and the care burden. There is much less research on the meaning of dementia from the perspective of an older couple's spousal relationship and related intimacy. This qualitative study explores the meanings of emotional and physical intimacy and the changes brought by dementia in the couplehood of persons with dementia and their spousal carers. The data comprise semi-structured interviews with 35 persons. The interviews were analysed using inductive qualitative content analysis. Four themes describing the meanings of relational intimacy were identified: intimacy as a striving force, intimacy turning into worrisome behaviour, intimacy as physical and emotional dependency, and intimacy turning into one-sided caring for a partner. Dementia changes the intimate relationship in many ways, but shared affection and long-term partnership help maintain the spousal relationship. While dementia may bring about conflicts and behavioural challenges in an intimate relationship, the couple's shared intimacy and a sense of responsibility for one another may serve as a resource and support the continuity of couplehood.

Romance Behind the Screens: Exploring the Role of Technoference on Intimacy

Intimacy is essential for fulfilling romantic relationships. Although many factors can impact intimacy, the increased regular use of technological devices within our daily lives makes technoference an important one to consider. Technoference (i.e., interference in face-to-face interactions caused by the use of technological devices) is commonly associated with relationship difficulties, including conflict, dissatisfaction, and decreased relational well-being. However, less is known about the direct and indirect impact of technoference on intimacy among couples. We hypothesized that negative perceptions of a partner's technology use and poor communication satisfaction within a romantic relationship help explain the association between technoference and intimacy. University students (N = 141), who were in a romantic relationship of at least 6 months duration, completed online questionnaires assessing technoference, perceptions of their partner's technology use, communication satisfaction, and intimacy in their romantic relationship. PROCESS macro model 6 was used to test the serial mediation models. Results suggest that the relationship between technoference (general, partner's, and participant's) and intimacy is serially mediated by negative perceptions of partner's technology use and communication satisfaction. These findings can help to identify and inform strategies to maximize intimacy levels between couples, thus fortifying romantic relationships as a whole.

Sexual Dysfunction Among Childhood Sexual Abuse Survivors: The "Functional" Dysfunction?

Various studies have established the association between child sexual abuse and sexual dysfunction. Although sexual dysfunction can be a distressing and undesirable condition for survivors of child sexual abuse, the current article suggests viewing sexual dysfunction not solely as a negative outcome but as a condition with a potent psychological function in regulating various psychological and relational needs among survivors. The main question addressed in the current paper is: What are the functional aspects of sexual dysfunction among child sexual abuse survivors? Four main protective purposes for sexual dysfunction among survivors of child sexual abuse are proposed: avoiding re-traumatization, regulating closeness within the relationship, gaining a sense of power and control and avoiding vulnerability, and restoring a positive sense of self. Although healthy sexual functioning is a desirable long-term goal for survivors, therapists need to view sexual dysfunction within the context of trauma, and to understand the protective functions of dysfunctions, before attempting to restore sexual function.

COVID-19 pandemic and its impact on social relationships and health

This essay examines key aspects of social relationships that were disrupted by the COVID-19 pandemic. It focuses explicitly on relational mechanisms of health and brings together theory and emerging evidence on the effects of the COVID-19 pandemic to make recommendations for future public health policy and recovery. We first provide an overview of the pandemic in the UK context, outlining the nature of the public health response. We then introduce four distinct domains of social relationships: social networks, social support, social interaction and intimacy, highlighting the mechanisms through which the pandemic and associated public health response drastically altered social interactions in each domain. Throughout the essay, the lens of health inequalities, and perspective of relationships as interconnecting elements in a broader system, is used to explore the varying impact of these disruptions. The essay concludes by providing recommendations for longer term recovery ensuring that the social relational cost of COVID-19 is adequately considered in efforts to rebuild.

Professional intimacy in nursing practice: A concept analysis

AIM

This paper provides a critical analysis of the concept of professional intimacy in nursing practice.

BACKGROUND

Professional intimacy is a key attribute to the therapeutic nurse-patient relationship. However, there is a lack of clarity on the concept from a nursing perspective and little research has been done to explore the multiple dimensions of professional intimacy. Because of this, there is tentativeness in enacting and openly discussing this concept.

DESIGN

The concept analysis approach of Walker and Avant (2011) was used to guide this manuscript.

REVIEW METHODS

The eight steps described by Walker and Avant (2011) were implemented to identify antecedents, defining attributes, empirical referents, and consequences of professional intimacy using the literature published both historically and currently.

RESULTS

The review identified 11 articles and based on analysis of the included articles, professional intimacy is the therapeutic relationship between a nurse and a patient that fosters closeness, self-disclosure, reciprocity, and trust at physical, psychological, and/or spiritual levels.

CONCLUSION

This concept analysis shows that professional intimacy influences nursing satisfaction and promotes optimal patient outcomes. Nurses need to recognize that professional intimacy does not involve a crossing of professional boundaries and is vital to quality care.

Selected Predictors of the Sense of Intimacy in Relationships of Young Adults

The main research objective of this study was seeking the predictive role of closeness to parents, attachment, identity style, identity commitment, type of relationship, and having children in intimacy among young women and men. Many studies indicate differences in the level of engagement, communication, and satisfaction in relationships. The study group comprised 227 people, including 114 women (M = 29.99; SD = 4.36), and 113 men (M = 30.00; SD = 4.33). A total of 40% of the subjects were married, and the remaining 60% subjects were in informal relationships; 101 people had children and the other individuals were childless. The following instruments were used: The Miller Social Intimacy Scale, questionnaires to assess closeness and attachment, and the Identity Style Inventory. The significance of the differences and the stepwise regression analysis were performed. The results of the study demonstrated a higher level of intimacy in a relationship with a partner among women than men. The nature of a relationship does not matter to the sense of intimacy. However, closeness to parents during childhood and adolescence, the model of interpersonal relations, and the identity style are predictors of intimacy in a relationship. The study results can be used in creating preventive and educational programs focused on family life and satisfied relationships.

Disclosure: a concept analysis

AIM

This article is a report of a concept analysis of disclosure.

BACKGROUND

Disclosure of health concerns is often delayed or incomplete, resulting in a lack of appropriate care or inability to avoid complications. Disclosure is a poorly understood phenomenon in nursing, however, an understanding of the concept is critical to providing effective nursing care.

DATA SOURCES

Literature from the humanities, social sciences, business, law, nursing and allied health fields in five search engines was reviewed for insight into a patient's decision to disclose health information to a healthcare provider.

REVIEW METHODS

Wilson's method of concept analysis guided this study into the meaning of disclosure from the point of view of a patient seeking healthcare. Inclusive years of search ranged from 1991 to 2010.

RESULTS

Disclosure is defined as the act of seeking care by revealing personally significant information that exposes the bearer to the risk of rejection or negative judgment. Attributes of disclosure are identified as: holding significant health-related information, assistance needed to cope, tolerance for unpredictable result, divulgence and expectation of serious response. Consequences of disclosure include resolution, reassurance or assistance gained, but may also include suffering rejection or negative repercussions.

CONCLUSION

Implications for nursing practice are explored and include focused questioning, providing for safety concerns, acknowledging significance and sensitivity of disclosed information and acting on the disclosure.

Beyond empathy: clinical intimacy in nursing practice

Understanding, shared meaning, and mutual trust lie at the heart of the therapeutic nurse-patient relationship. This article introduces the concept of clinical intimacy by applying the interpersonal process model of intimacy to the nurse-patient relationship. The distinction between complementary and reciprocal behaviours, and between intimate interactions and intimate relationships, addresses background concerns about the appropriateness of intimacy in nursing relationships. The mutual construction of meaning in the interactive process between nurses and patients is seen to lie at the heart of clinical intimacy as a hermeneutic enterprise. Intimacy is distinguished from empathy based on intentionality and the status and location of meaning. Reasons for continued investigation into clinical intimacy as an explanatory model for nursing as a hermeneutic practice are presented.

Intimacy in nursing

There are many definitions of intimacy in nursing but what they all have in common is the need for communicated empathy, for nursing that is not just caring for but also caring about.

Male nurses' experiences of providing intimate care for women clients

AIM

This paper reports a study of male nurses' experiences of providing intimate care for women clients.

BACKGROUND

The number of men entering the nursing profession has increased worldwide. As a consequence of the move to a more gender-balanced profession, debate has ensued over how intimate care should be performed when this requires male nurses to be physically close to women clients. As there was little previous work on this topic, we wished to provide nurses, clients and other healthcare professionals with a better understanding of male nurses' experiences of working with women clients and within a healthcare system where they often feel excluded.

METHOD

Semi-structured, open-ended interviews were conducted with male nurses working in various clinical settings in Western Australia. Latent content analysis was used to analyse the interviews, which were carried out between June and July 2004.

FINDINGS

Three themes were identified: the definition of intimate care, the emotional experience associated with providing intimate care and strategies used to assist in the delivery of intimate care for women clients. Providing intimate care for women clients was a challenging experience for male nurses. Participants described how it required them to invade these clients' personal space. Consequently, they often experienced various negative feelings and used several strategies to assist them during care delivery.

CONCLUSIONS

Nurse educators should assist male nurses to be better prepared to interact with women clients in various settings. Furthermore, workplace environments need to provide additional support and guidance for male nurses to enable them to develop effective coping strategies to manage challenging situations.

Promoting Prevention

Preventive therapies have been shown to reduce morbidity and mortality from cardiovascular disease. However, health care providers are not addressing prevention and not treating patients according to evidence-based guidelines. Reasons frequently cited for not delivering health promotion/disease prevention oriented care is lack of training or skills to provide counseling, and a lack of confidence in health care provider skills. This article outlines the skills and attributes considered essential for a health care provider to promote behavioral change and risk reduction. The skills and attributes of the health care provider, such as expertise and knowledge, skills for assessing readiness for behavior change, relationship building skills, and skill in considering the patient's attitudes and beliefs about the disease or treatment are discussed. Principles of communication to guide the patient-provider encounter, key behavioral change strategies, and use of technology are reviewed and resources available to support prevention goals are presented.

A study of practising nurses' perceptions and experiences of intimacy within the nurse-patient relationship

AIM

This study investigated the perceptions and experiences of intimacy within the nurse-patient relationship.

BACKGROUND

Intimacy is an increasingly recognized nursing concept, which is intrinsically related to the therapeutic potential of nursing. However, the nature of intimacy as practised in nursing remains largely unexplored. A qualitative design was used and a purposive sample of 10 nurses was involved. Data were collected by means of semistructured interviews and diaries.

FINDINGS

Content analysis of the data yielded five categories relating to the nature of intimacy, involvement, resources, affinity for the patient and the rejection of intimacy. This paper focuses on the first of these categories. Intimacy emerged as a complex concept and included the subcategories of disclosure, levels of disclosure, sharing personal experiences, patient dependency and vulnerability, instrumental touch and intimacy and intimacy as an inappropriate term for the nurse-patient relationship. These findings are discussed in the light of existing theories and recommendations made for further research to expand and develop the issues highlighted.

CONCLUSIONS

The paper concludes by highlighting the complexity of the concept and identifies some of the constraints to intimacy in practice such as insufficient resources, the health care system and role changes.

A literature review on the concept of intimacy in nursing

AIM

This paper explores the concept of intimacy in nursing.

RATIONALE

Intimacy is an increasingly important concept in nursing and feature of the nurse-patient relationship, which is perceived to be intrinsic to the proposed therapeutic potential of nursing. The introduction to the paper highlights the theoretical enthusiasm and endorsement of intimacy, the apparent lack of conceptual clarity from a nursing perspective and little published research investigating intimacy in practice.

METHOD

Literature is reviewed from nursing and a variety of health-related disciplines.

FINDINGS

The paper traces the historical background of the nurse-patient relationship and intimacy and highlights the change in value from detachment and distancing to intimacy, commitment and involvement. The nature of intimacy is examined and a concept analysis based on literature from psychology and psychiatric medicine is critically analysed. Intimacy is suggested to have psychological, emotional and physical aspects, which are explored. An ethnographic research study on intimacy in nursing is reviewed, which also recognizes physical and emotional dimensions of the concept and the importance of sufficient resources to allow the close relationships advocated. Attention is drawn to the constraints on intimacy imposed by the current market-led health service. Literature and research on the implications and consequences of intimacy for the nurse are discussed. These report practical difficulties of maintaining close relationships with individual patients and the potential for over-involvement and emotional labour.

CONCLUSION

The paper concludes with the increasing importance attached to intimacy in nursing and its complex, ill-defined nature. This serves to highlight the importance of research aimed at exploring and clarifying intimacy and further illustrating the therapeutic potential of nursing.

Conceptualizing sexual health in cancer care

This qualitative study was designed to describe women's experiences with changes in sexual function related to physical comfort, sexual satisfaction, and feelings of intimacy post-treatment for gynecological cancer. The 17 women who participated in this study described sexuality as a much broader construct. Contrary to existing literature, sexual functioning was found to be one aspect that contributed to the view of the self as a sexual being, but the women's perceptions were not limited to this single dimension. The identification of multidimensional components to be considered in developing a conceptual model to describe sexual health are presented. This study indicates that sexuality should be viewed as a health issue that has an impact on quality of life.

Intimacy--meeting needs and respecting privacy in the care of elderly people: what is a good moral attitude on the part of the nurse/carer?

This article explores notions of intimacy in the caring context. The aspects discussed are: privacy and intimacy; intimacy as emotional and/or physical closeness; intimacy as touch; sexual intimacy and normal ageing; sexual intimacy and patients suffering from dementia; and intimacy as trust. Examples are given and problems are identified, with reflection on the attitude and behaviour of the carer. It is suggested that when trying to make moral decisions in concrete situations it is imperative that the carer is aware of the values upon which his or her own thinking is based. It is argued that the guiding principle should be the moral assumption that the carer's responsibility can never be interpreted as a right to disregard the wishes of the patient. Hence, the key word in daily care is 'respect'.

Intimacy patterns and relationship satisfaction of women with eating problems and the mediating effects of depression, trait anxiety and social anxiety

The association between eating problems; and intimacy and relationship styles was examined. Young adult females (n = 360) completed the Adult Attachment Style (AAS), questionnaire; questions on satisfaction with intimacy; the Sexual Attitude Scale; items on sexual avoidance; a set of six descriptions for mother, friend, and partner; and measures of depression, general anxiety, social anxiety, and eating problems. Women with greater eating problems described more difficulties in intimate relationships including less satisfaction with closeness, more discomfort in close intimate relationships, and less positive descriptions of friend and mother. When depression, general anxiety, and social anxiety were entered first in a regression, intimacy measures no longer added unique variance. However, public self-consciousness predicted over and above general affect and social anxiety measures. Results were consistent with a mediator model in which intimacy difficulties for women with eating problems are explained by depression, trait anxiety, and public self-consciousness.

A study to ascertain gynaecological patients' perceived levels of embarrassment with physical and psychological care given by female and male nurses

The Sex Discrimination Act lifted the barriers which prevented men from training and practising as midwives. However, cultural attitudes perceive nursing to be a female profession, and whilst care from a male doctor is considered to be acceptable, care from a male nurse is said to be embarrassing. The purpose of the study was to identify if there was any relationship between the intimacy of a nursing interaction and the patient's level of embarrassment. Data collection was by questionnaires with rating scales. Demographic data was obtained from nursing and medical notes. Statistical analysis was performed by non-parametric methods using Mini-tab. Ninety-one questionnaires were returned from a convenience sample of patients on a gynaecological oncology ward. Analysis of the data indicates that in a population of patients who have no prior experience of hospital admission, or of being cared for by a male nurse, there is a preference for care by a female nurse. However, this preference is not demonstrated in patients who have undergone previous hospital admission within the last five years or who have been cared for by a male nurse. These findings would indicate a cultural preference for care by a female nurse in patients with gynaecological cancer that is changed by experience during hospital admission.

Understanding intimacy as experienced by breastfeeding women

The woman who is breastfeeding her infant may experience intimacy in a variety of ways. The author explores some of those ways, starting with identity and the woman's intimacy with herself and proceeding to the woman's intimate interaction with her infant, partner, family, or significant friends. The characteristics associated with intimacy, such as reciprocity, mutual joy, harmony, concern for other, trust, and closeness, have all been described as part of successful breastfeeding experiences. Researchers have acknowledged the influence of emotional support on breastfeeding but have failed to recognize the dynamics of intimacy as other than physical or sexual. The popular concepts of intimacy as sexual and the breast as sexual derive from a male perspective, one that restrains and shapes women's attitudes toward breastfeeding. Research on this topic is required if professionals hope to help women and their partners to understand the psychosocial dynamics of breastfeeding.

Explorations of close friendship: a concept analysis

Friendship is a meaningful and highly significant human activity. Every psychiatric nurse would acknowledge the value of friendship to mental health. But what is friendship? Development of theoretical understanding and research based interventions using friendship are hampered by inconsistent definitions of friendship. Using concept analysis, the author discusses the characteristics of close friendship and its distinguishing features. The definition created has potential implications for future theory development, research, and nursing care.