title: Recommendations for sexual expression management in long-term care: a qualitative needs assessment.
abstract: OBJECTIVE
  To conduct a qualitative needs assessment of Directors of Nursing regarding challenges and recommendations for addressing sexual expression and consent.
  
  
  BACKGROUND
  Sexual expression management among long-term care residents is a complex issue for nursing home staff. Little guidance is available for those wanting to follow a person-centred approach. Policies and procedures are needed, and must be usable across long-term care settings.
  
  
  METHODS
  Qualitative design for in-depth exploration.
  
  
  METHODS
  Semi-structured interviews were conducted with 20 Directors of Nursing in the spring and summer of 2013, representing a range of regions, facility sizes and resident populations. Interview questions prompted them to identify recommendations that address challenges to improving sexual expression management in long-term care settings.
  
  
  RESULTS
  Comparative thematic analysis resulted in several codes, which were grouped into eight overall categories. Recommendation categories that addressed key challenges included: address the issue, make environmental changes, identify staff expertise, provide education and training, assess sexuality initially and recurrently, establish policies/procedures for sexual expression management, develop assessment tools for sexual expression and consent, and clarify legal issues. The recommendation to develop national guidelines was observed across categories.
  
  
  CONCLUSIONS
  Directors of Nursing report several challenges to sexual expression management in their facilities, and perceive their current methods to be ad hoc. A proactive approach to policy and procedure development is needed.
authors.affiliation: Center on Aging, Kansas State University, Manhattan, Kansas, USA.
authors.forename: Maggie L
authors.initials: ML
authors.lastname: Syme
authors.affiliation: Institute of Gerontology, Merrill Palmer Skillman Institute, Detroit, Michigan, USA.|Wayne State University, Detroit, Michigan, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Lichtenberg
authors.affiliation: VA Boston Healthcare System, Brockton, Massachusetts, USA.|Harvard Medical School, Brockton, Massachusetts, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moye
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D020380:Needs Assessment; D009735:Nursing Homes; D009740:Nursing Staff; D019529:Sexuality
keywords: long-term care; nurses; nursing; older people; policy; sexuality