The Experiences of mental health nurses whose clients disclose sexual contact with a former physician : Three comparative case studies

This study explored the subjective experiences of community mental health nurses whose clients disclosed sexual contact with a former physician. Theory, opinion literature, and my own clinical experience support the belief that disclosures such as these challenge nurses with their complexity and intensity. Three nurses' accounts of their clients' disclosures constituted cases for comparison and generated a beginning theoretical framework. Data were collected by multiple, indepth, unstructured, audiotaped interviews. Open coding and axial coding techniques of content analysis were used to analyze the data collected, and each set of data was .then compared and contrasted. The Cycle of Focusing Attention was identified as the integrating concept in a conceptual framework that describes how nurses alternately focus their attention on the client and on themselves, with the goal of alleviating client suffering. Contained in this cycle were: two concepts, Focusing on the Client and Focusing on Self; four subconcepts, Collecting Information, Using Interventions, Experiencing Feelings, and Analyzing Thoughts; and two modifying-concepts, Analyzing Boundaries and Analyzing Power. Data analysis revealed that despite the passage of time the details and circumstances of the disclosure experience remained vivid in the nurses' minds. Nurses experienced moral outrage and powerlessness at the physicians' misuse of professional power, and these feelings did not lessen with time. Despite their personal feelings the. nurses maintained a professional demeanor and consistently treated their clients in caring and respectful ways. The nurses were immediately certain that the physician's sexual behavior was unethical. They understood the therapeutic needs of their clients related to client-therapist sexual contact, and the social and ethical demands of reporting. Implementation of the study's findings could lead to more effective clinical practice, thereby lessening the suffering of both client and nurse.Applied Science, Faculty ofNursing, School ofGraduat