How do nurses respond to sexual expression in persons living with dementia in acute care settings?

Abstract

Dementia is a widely used term encompassing various chronic mostly age-related neurodegenerative disorders that in medicine are characterised by the individuals' progressive loss of cognitive and functional ability. Dementia can result in complex symptoms such as memory loss, communication difficulties, behavioural and psychological disturbances and changes in judgement and reasoning. Currently the number of people in the United Kingdom living with dementia is estimated to be 800,000; while the number of older adults with dementia in Scotland is around 90,000. Therefore, it is likely that nurses working in any environment will encounter people living with dementia. The need for physical intimacy and sexual contact does not diminish with age or loss of capacity and continues to provide psychological and physical benefits throughout life. However, due to behavioural disinhibition and disorientation, individuals living with dementia may display their sexual needs and desires in ways considered by others as being inappropriate. A major concern for persons with dementia in acute care settings is that it has been shown that individuals who express themselves sexually in front of or towards nursing staff receive poorer and less frequent care. Given there are already various concerns about the quality of care for older persons with dementia in acute settings, this is extremely concerning. Research on dementia care and sexual expression is sparse, especially on how nurses respond to these behaviours in the acute care settings. The majority of research on sexual expression has focused in long-term care settings or dementia specialist units. It is clear from the literature review, that nurses find sexual expression difficult and stressful to respond to, even though they acknowledge that sexuality is an important component of person-centredness. The review has established that research on dementia care and sexual expression is sparse and interventions that are more effective are needed to be implemented to provide high quality holistic care in relation to sexuality. The purpose of this research proposal is therefore to explore how nurses respond to sexual expression in persons living with dementia in the acute care setting. An ethnographic methodology will be used to address the aims of this study. The study will be conducted over a six-month period in three acute general medical/surgical wards. Both nurses and persons living with dementia will be invited to participate in this study. Data collection and analysis will be an ongoing cyclic process, until saturation is achieved, and data will be obtained from observations, informal conversations and unstructured interviews. Ultimately, the implications found from this study will be used to develop non-pharmacological, person-centred interventions in which can help nurses to respond to persons with dementia who express themselves sexually. Key Words: Dementia; Sexual Expression; Nursing; Acute Care; Person-centred Care; Ethnography