Remar Mangaoil, Advanced Practice Nurse
Gaby Golea, Director of Interprofessional Practice
Centre for Addiction and Mental Health, Toronto, Canada
The sexuality of mental health clients, their capacity to engage in sexual activity, and their ability maintain intimate relationships can be altered by illness or by the effects or side-effects of medications (Quinn et al., 2011). Nevertheless, these factors cannot disregard the fact that clients remain sexual beings, and sexual expression brings many benefits. As nurses make up the largest proportion of workforce in hospitals, providing round-the-clock care, nurses are in a unique position to understand vital information around the client’s sexual history and needs during hospitalization. Building trust with clients through therapeutic relationships is one of the foundations of mental health nursing. Nurses are there to listen and offer support to clients whose illness had affected their relationships and sexual intimacy with others, and to provide hope and optimism in regaining a meaningful and fulfilling sex life.
Nurses also act as advocates for clients who may not be able to speak for themselves because of ignorance, prejudice and marginalization. Such groups include children, individuals from culturally diverse backgrounds, LGBTQQI2S (lesbian, gay, bisexual, transgender, queer, questioning, intersex, 2 spirited) community, individuals with intellectual disability, and older mental health clients. Nurses work with their clients, family members and other members of the health care team to come up with ways to promote sexual expression in a safe and supportive environment.
The two main goals are creating sexually safe therapeutic spaces which can also be safely sexual.
Help from mental health nurses can include education and problem solving around the side effects of medication that can affect our bodies physically, our body image, our self-esteem and our energy levels. This can involve discussing healthy sexual expression and its relationship with anatomy and physiology in ways that different clients can readily understand and apply in their own life.
Risk assessment is also a crucial nursing role. Helping identify and explain potential risk of sexual harassment or assault is one way so that strategies can be implemented to manage the risk (Cole et al. 2003). To maintain a safe and therapeutic environment for sexual expression, nurses conduct assessment of clients’ mental status, level of orientation and cognition, and level of understanding to psychological and physical consequences of sexual activity, such as pregnancy and infection. Exploring safer sex practices and birth control options are part of the support that nurses can offer.
Whether in hospital or as part of a community support team, mental health nurses can provide education and counseling to clients on maintaining healthy relationships and sexual expression. For some clients, counselling or teaching around sexual health, sexual relationships and interpersonal boundaries may help ensure safe sexual activities with self and/or others (Magnan et al. 2005). Other skills that clients may benefit from include social skills training, conflict resolution, and minimizing harm from potentially risky sexual behaviours – one’s own or those of others.
The nurse-client relationship provides an opportunity to take sexual history into consideration, promote safe sexual practices, discuss sexual problems, and educate clients about sexual issues. Past experience can be a help or a hindrance to enjoying sex in the present and future. Trauma is regularly part of the history of individuals living with mental health challenges. Nurses will also recommend specialized support from other professionals where this may be helpful.
Cole, M., Baldwin, D. & Thomas, P. (2003). Sexual assault on wards: Staff actions and reactions. International Journal of Psychiatry in Clinical Practice, 7, 239-242.
Magnan, M.A., Reynolds, K.E. & Galvin, E.A. (2005). Barriers to addressing patient sexuality in Nursing Practice. MEDSURG Nursing, 14(5), 282-289.
Quinn, C., Happell, B. & Browne, G. (2011). Talking or avoiding? Mental health nurses’ views about discussing sexual health with consumers. International Journal of Mental Health Nursing, 20, 21-28.