Staff responses to residents exposing their genitals in public in long‐term care settings: The gap between common and perceived best practices

Abstract

Aims and objectives To explore staff reactions to residents’ behaviour consisting in exposing their genitals in public, and to differentiate between what is perceived as common practice (what most staff do) and best practice (the best possible approach). Background The presence of inappropriate sexual behaviours (ISBs) in long‐term care facilities poses practical and ethical dilemmas since they may impinge on the rights of others (staff and residents) and thus need to be adequately monitored and managed. However, no studies have focused on how staff handle ISBs, and particularly exposing oneself in public. Methods A total of 2,175 people working in 152 Spanish LTC facilities participated in the study. They were presented with a vignette describing a resident exposing his/her genitals in public, and they were asked what they think most of their workmates would do and what they think should be done in that situation. The STROBE checklist was used to enhance the quality and transparency of the research. Results Approximately one‐third of participants (32.4%) reported having experienced behaviours such as the one described in the vignette. Staff reactions underline the predominance of restrictive practices. However, if prompted to think in terms of best practice, supportive reactions increased in frequency. Finally, factors such as work position have an influence on perceived common and best practices, with care assistants generally holding more restrictive views than directors or technical staff. Conclusions Around one‐third of staff members, and particularly those in managerial or technical positions, had witnessed residents exposing their genitals in public. However, there is no common ground among staff regarding the best way to handle the situation. Relevance to clinical practice Our findings stress the importance of organisational policies and workplace training in the management of challenging behaviours such as exposing oneself.

Using the Intersectionality-Based Policy Analysis Framework to Evaluate a Policy Supporting Sexual Health and Intimacy in Long-Term Care, Assisted Living, Group Homes & Supported Housing

“…Various dominant discourses (e.g., biomedical approach, ageism, ableism, and heterosexism) have intersected to culminate in a culture that places limits on sexual freedoms in the guise of protection of individual’s safety and/or organizational liability. Frequent responses to sexual expression in LTC are to remove, restrain, or reprimand rather than take a supportive, proactive approach, such as providing sex education and access to sexual privacy (Barmon et al, 2017; Villar et al, 2019b).…”

“…An associated policy problem is the moral distress, discomfort, and dissatisfaction for HCP caused by sexual situations in the workplace (Cook et al, 2017; Srinivasan et al, 2019; Villar et al, 2019b). These sexual situations range from having to talk about sexual issues with residents to dealing with disinhibited sexual behavior or sexual advances (Villar et al, 2019a).…”

A Scoping Review on Attitudes towards Sexuality in Residential Aged Care

“…In several instances, sexual expressions that contained erotic or more explicit elements were subject to more severe condemnation [35,55] than expressions of tenderness. Many of the most common sexual expressions among the residents, such as masturbation, kissing, and intercourse, were also the ones that staf found most discomforting [40,52,62].…”

“…Masturbation was one of the most common sexual expressions among the residents and one that staf most believed the residents needed to be satisfed [52,59,61,64]. Despite this, masturbation was also one of the sexual expressions that created the most discomfort among staf [54,62]. Villar et al [54] found that staf saw masturbation in the RAC as an unexpected event, and they did not know how to react.…”

Managing apathy among people with dementia living in institutional settings: Staff's perceived gap between common and best practices

“…what they actually do) and best practice (how members of staff think apathy in PLWD should be ideally managed). As reported in other areas of intervention with PLWD involving communication 40 or sexual behaviors 41 , if differences between common and best practices are great, the gap would indicate that there are barriers preventing staff from dealing with apathy in the way they should.…”