Organisational enablers and barriers to the recognition of sexuality in aged care: A systematic review

Abstract

Aim To identify organisational characteristics and practices that promote or inhibit the recognition of sexuality in the care of older people in health and aged care settings. Background Sexuality in old age is poorly understood by health professionals and rarely addressed in care planning and delivery. Nurse managers are ideally placed to lead organisations in promoting a culture of acceptance that enables the expression of sexuality. Evaluation A search for research/expert opinion papers published from January 2004 to February 2017 was undertaken. Two reviewers performed data extraction and appraisal of 34 included studies using Joanna Briggs Institute tools. The primarily qualitative research was analysed to identify 152 findings that were organised into 22 categories and combined into four syntheses. Key issue(s) An organisation's philosophies frame the way older people's sexuality is perceived. Cultivating a culture and environment of acceptance, engagement and knowledge and delivering care in a way that promotes opportunity for safe and private expression of sexuality are key enabling factors. Conclusion(s) Organisations and nurse leaders can support and facilitate older adults’ expression of their sexuality through the review and development of philosophies, policies, procedures, staff attitudes and knowledge and the creation of a conducive environment. Implications for Nursing Management Nurse managers play a pivotal role in developing a sexuality‐positive organisational ethos by ensuring policies, care practices, the environment and amenities are supportive of the expression of sexuality and by role modelling attitudes of respect and inclusivity.

Educating health and social care practitioners on the experiences and needs of older LGBT+ adults: Findings from a systematic review

“…While this may be interpreted as a negative outcome, an alternative reading could be that while the programme enhanced knowledge it also increased participants’ awareness of diversity and the specific health and social care needs of older transgender adults, thus giving rise to greater discomfort in terms of care provision. Developing comfort and confidence is something that occurs with time and with practice, especially if practitioners are exposed to good role models within the practice setting (Bauer, Haesler, & Fetherstonhaugh, 2019; Fronek, Kendall, Booth, Eugarde, & Geraghty, 2011). Higgins et al.…”

Navigating Tensions About Resident Sexual Expression in Alberta’s Continuing Care Homes: a Qualitative Study of Leaders’ Experiences

“…For support with decision-making around a sensitive topic, managers often turn to other professionals such as social workers, clinical ethicists, geriatric specialists, and recreation therapists. These parties play an important consultative role in communicating expectations about staff's response to resident sexual expression (Bauer, Haesler, & Fetherstonhaugh, 2018) and setting the culture of a care home. Additional inclusion criteria required participants to be at least 2 years in their practice area to ensure familiarity with both the context and processes of resident sexual expression.…”

“…A policy, with education to support its application, can establish the place of resident sexual expression, support consistency in the staff's responses, and communicate what residents can expect. As noted elsewhere, in absence of policy about resident rights to sexual expression, the preferences and priorities of staff and family may eclipse those of residents (Bauer et al, 2018). Several scholars have developed guidelines for how to develop such a policy (Everett, Young, Carlson, & Clements, 2010;Lester et al, 2016).…”

Culture clash: responses to sexual diversity in residential aged care

“…Family members and other residents contribute to the environmental complexity with their attitudes and expectations. Sexuality and sexual diversity in residential aged care facilities are increasingly of interest in international research (see for instance Bauer, Haesler, and Fetherstonhaugh 2019;Cronin et al 2011;Di Napoli, Breland, and Allen 2013;Gewirtz-Meydan et al 2019;Hafford-Letchfield et al 2018;Traeen et al 2017;Villar et al 2018;Tabak and Shemesh-Kigli 2006). Featuring older persons' voices and experiences alongside those of family members and staff ensures an opportunity to understand those experiences and shape services and care (Gewirtz-Meydan et al 2019;Gott and Hinchliff 2003) but few studies have considered social generations as providing cultural context.…”