Abstract
Objectives: This research sought to identify and explore the limiting or facilitating factors for nurses in assisting older people who are over 60 years of age and who are residing in aged residential care facilities (ARCFs) to express their sexuality. A secondary objective was to identify strategies and guidelines that assist nurses with facilitating the sexual needs or preferences of older people in ARCFs. For the purpose of this study nurses are defined as any nurse certified to practice by their respective national registration councils including enrolled nurses (ENs).
Methods: A integrative literature review methodology was utilised in this research. This method allowed the inclusion of extensive evidence from a range of articles and provided a comprehensive understanding of the research topic. The included articles included qualitative and quantitative studies. Quality appraisal and data extraction was undertaken using the Joanna Briggs Institute (JBI) appraisal and data extraction tools (Joanna Briggs Institute, 2014). A thematic approach was utilised to analyse and synthesise the findings (Braun & Clarke, 2006).
Results: Ten articles were selected for critical appraisal all of which met the inclusion criteria. One article published in 2004 was deemed seminal and was included in the study (Roach, 2004). The themes that emerged from the review of the literature were a lack of privacy, perceptions towards sexuality by older people residing in ARCFs, expression of sexuality as an inappropriate behaviour, roles and relationships and finally attitudes towards sexuality. Lack of privacy was attributed to poor physical environments, the daily routines and interactions that did not promote privacy between staff and residents such as knocking on doors and not waiting for an invitation before entering a resident's room. Most of the health care staff and residents considered the expression of sexuality by older people residing in ARCFs as an appropriate human need and right that continues to be significant throughout life. In contrast some participants especially residents, found the expression of sexuality by older residents as inappropriate. Their peers considered the expression of sexuality as inappropriate due to perceptions of advanced age, poor health and not enough privacy to facilitate sexual activity.
Attitudes such as discomfort when discussing sexuality or addressing matters relating to the expression of sexuality of residents, embarrassment and shock were identified as barriers. Nurses' lack of knowledge and assessment skills to address sexual health concerns of residents and the expression of sexuality by older residents in ARCFs were found to contribute to their discomfort to discuss the sexuality of residents.
Conclusion: Sexuality continues to be important in older age. The expression of sexuality may shift from physical sexual activities to other forms such as showing of affection, loyalty, respect, the need to look and feel attractive and companionship. The expression of sexuality can be more challenging for older people residing in ARCFs particularly those affected by dementia. Nurses have a role to facilitate the expression of sexuality for older people in these settings. Adopting a person-centred approach ensures that the physiological, emotional, social and cultural aspects of care are addressed for the residents. Nurses need to be encouraged to gain knowledge and skills in assessing the sexuality of older adults.