Clients with mental health problems who sexualize the nurse-client encounter: the nursing discourse

Abstract

Aim: This paper is a report of a study of psychiatric nurses' responses to clients who were sexualizing the nurse-client encounter.

Background: Studies involving general nurses have reported incidents of 'unwanted sexual attention/behaviour' from clients. These behaviours have been identified, in the literature, as a form of sexual aggression and sexual harassment. Reported responses have included physically avoiding the person, ignoring verbal comments or adopting a no-'nonsense' professional approach.

Methods: A grounded theory study was conducted in 2005-2006 using tape-recorded unstructured interviews with 27 psychiatric nurses working in an urban mental health service in the Republic of Ireland. Tapes were analyzed, with the assistance of Nud*ist 4, Word documents, mind maps and memoing.

Findings: There were unwritten and unspoken professional expectations or norms that clients treated participants and nursing encounters in an asexual way. However, on occasions, clients transgressed these taken-for-granted norms and engaged in behaviour labelled 'sexualizing the nurse-client encounter'. In contrast to previous studies, our interviewees did not use the language of sexual harassment, but used the discourses of 'mad/bad' and 'inappropriate' to codify the behaviour. The tendency to view behaviour through the psychiatric discourse of badness and boundary violation gave rise to nurses either ignoring the behaviour or responding by using 'suppressive strategies'. Consequently, other possible lenses of understanding were pushed to the background.

Conclusion: Only when educators and clinicians view clients' sexual behaviours through alternative lenses of understanding will different actions and outcomes become possible and the rights of all, both nurses and clients, be respected.