Care staff’s sense-making of intimate and sexual expressions of people with dementia in Dutch nursing homes

Objectives:
The Person-centered Care (PCC) philosophy emphasizes close care relationships to enable care professionals to recognize the needs of nursing home residents with dementia. This study explored how care professionals make sense of resident behavior with regard to intimacy and sexuality.

Methods:
26 nursing home care professionals (15 Nurses, 9 Health Care Professionals and 2 Managers) completed in-depth interviews that were subjected to an Interpretative Phenomenological Analysis (IPA).

Results:
Three thematic layers were identified. 1. Care Professionals pursue a “true” understanding of intimate and sexual behavior that underpins a resident’s expression. 2. When care professionals feel the need to protect themselves, they can reframe a specific care relation in order to continue care. 3. The social context around the resident, from family to professionals (i.e. peers), influences interpretation of behavior and, consequently, the provision of care.

Conclusions:
Intimate and sexual expressions of residents can put care relations under pressure. Care relations that lack professional distance may compromise care professionals’ judgments, impede their natural boundaries and decrease their well-being.

Clinical implications:
Along with implementing PCC principles, organizations should empower staff to develop, discuss and include self-reflection skills and personal boundaries within their work.