SEXUAL EXPRESSION IN LONG-TERM CARE: WHAT WOULD DONS DO?

Sexual expression in long-term care is complex and ambiguous, yet facilities often address it without any institutional policy. Thus, we know little about the decision-making of staff and administration in these situations. The purpose of this study is to understand the decision-making processes of Directors of Nursing (DONs) when faced with these complex sexual expression situations. An in-depth qualitative examination of open-ended responses to hypothetical intimate situations was conducted. The data were collected from a convenience sample of 77 DONs across the US who were predominantly White and female. A recruitment email was sent out to members of the National Association of Directors of Nursing in Long Term Care (NADONA-LTC). Respondents were directed to fill out an online survey, consisting of background questions, three vignettes describing intimate situations among resident pairs in long-term care, and follow-up questions about how they would address the situation. Thematic analysis was utilized to code responses, from which specific codes, categories, and themes were identified. Six overall themes relating to decision-making factors were identified: resident health, resident quality of life, relationship between residents, observations/behavior changes, non-resident factors, and law and safety. Several subcategories were also identified (e.g., relationship – quality; relationship- status; non-resident factors – family), with cognitive/psychological health being the most often mentioned subcategory by DONs as a deciding factor in appropriateness of the intimate activity. Data suggest that DONs consider several important resident and non-resident factors. These can be utilized to begin developing decisional support tools for sexual expression procedures in long-term care.