The practice of mental health nurses: The need to include sexuality in consumer care

Sexuality is fundamental to health, quality of life, and general well-being. For consumers with enduring mental illness their sexual desire, capacity and ability to maintain previous sexual activities or make decisions about sex may be altered by their illness, or side effects from psychotropic medications. The inclusion of sexual concerns in care has been identified as a low priority in nursing. It has been suggested that nurses, including those working in mental health settings lack preparation, confidence and the skill base to address sexual concerns of consumers. The aim of the research was to explore nurses’ attitudes and practices in assessing and supporting the sexuality of consumers, and to explore the usefulness of the BETTER model to support them to improve this area of practice. The BETTER Model was developed to assist oncology nurses to include sexual health and sexuality concerns in their assessments. An exploratory qualitative research study was conducted utilising individual in-depth interviews with 14 mental health nurses from inpatient and community settings in three stages over a two year period. Initial findings identified: low priority towards sexual concerns; avoidance of the issue; and referring to other professionals, even though they acknowledged that others also evade this topic. Avoiding embarrassing consumers, gender and boundary concerns, sexual side effects if psychotropic medication, and the fear of negatively influencing adherence to medication, were particularly influential. At stage 2 participants described including sexual concerns in their practice, arising from awareness building and improved insight that sexual concerns are a legitimate aspect of care, rather than following the structured approach of the BETTER model. Two years later, at stage 3, participants continued to include the sexual concerns of consumers in their practice, considering this an important component of holistic practice. The findings informed the development of the 5A’s framework for including sexual concerns in mental health nursing practice. The framework explains how the experience of applying these skills facilitated acknowledgement of the important role they play in supporting consumers who are experiencing sexual concerns.