School of Nursing, College of Health, Massey University Albany, Auckland, New Zealand.
School of Humanities, Massey University Albany, Auckland, New Zealand.
J Adv Nurs. 2017 Dec;73(12):3017-3027. doi: 10.1111/jan.13361. Epub 2017 Jul 16.
To analyse the accounts of staff, family and residents to advance ethical insights into intimacy and sexuality in residential care.
Discourses of ageing readily construct people in residential aged care as postsexual, vulnerable and at risk of sexual exploitation, and therefore, expressions of intimacy and sexuality may be responded to as deviant and inherently risky. Staff may manage decision-making tacitly, without recourse to policies and education.
The proof-of-concept study used a discursive methodology, identifying discourses that shape diverse meanings of intimacy, sexuality and ageing. Data analysis involved thematic analysis.
Semi-structured interviews were conducted with four participants in 2015 as part of a mixed-methods study. This article reports on the qualitative data.
Four themes were identified in the data analysis: mediated intimate relationships and everyday ethics; self-referential morality; knowing the person then and now; and juggling ethical priorities. Data indicated that participants used their personal moral compass to inform their decision-making, without any related policies and applied ethics and communication education. As a result, staff described moral uncertainty and moral distress. Staff indicated that there were tensions in terms of the role of proxy decision-makers, as there were situations where staff believed they were more aware of residents' current wishes and cognitive capabilities than family members.
Staff, families and residents routinely address intimacy and sexuality in aged care. Ethically informed education and policies may enhance the role of staff as advocates, ensuring older people living in RAC are as at home and autonomous as possible.
分析员工、家属和居民的叙述，深入了解养老院中亲密关系和性行为的伦理问题。
有关老龄化的论述很容易将养老院中的人描述为无性的、脆弱的，并且容易受到性剥削的风险，因此，亲密关系和性行为的表达可能会被视为异常和固有风险。工作人员可能会在没有政策和教育的情况下，默许地进行决策。
概念验证研究采用话语方法论，确定了塑造亲密关系、性行为和老龄化多样性意义的话语。数据分析涉及主题分析。
2015 年，作为混合方法研究的一部分，对四名参与者进行了半结构化访谈。本文报告了定性数据。
数据分析中确定了四个主题：中介的亲密关系和日常伦理；自我参照的道德；了解过去和现在的人；以及平衡伦理优先事项。数据表明，参与者使用个人道德指南针为决策提供信息，而没有任何相关政策、应用伦理和沟通教育。因此，工作人员描述了道德上的不确定性和道德困境。工作人员表示，在代理人决策制定者的角色方面存在紧张关系，因为在某些情况下，工作人员认为自己比家属更了解居民的当前意愿和认知能力。
员工、家属和居民在养老院中经常处理亲密关系和性行为问题。知情的伦理教育和政策可以增强工作人员作为倡导者的角色，确保居住在养老院的老年人尽可能地感到舒适和自主。
