Sexual harassment in care work - Dilemmas and consequences: A qualitative investigation

Abstract

Background: Care workers are often exposed to sexual harassment from patients. Research shows that such exposure may have detrimental effects on mental health of the care workers. Inappropriate sexual behaviour from patients is a particular challenge for formal and informal care workers alike. There is a scarceness of studies investigating the experience and the handling of sexual harassment from patients.

Objectives: To investigate the experience and handling of sexual harassment from patients in care work.

Design: The study follows an explorative qualitative approach based on group interviews (n=19) with 39 care workers.

Settings: Ten workplaces participated in the study, including hospitals, nursing homes, community health centres, rehabilitations care centres, and psychiatric residential facilities.

Participants: We conducted group interviews with care workers (employees), managers, shop stewards and/or safety representatives. The majority of the interviewees were trained nurses.

Results: The interviews revealed that sexual harassment is a complex and multifaceted phenomenon. The care workers often separated between intentional and unintentional behaviours initiated by cognitively impaired patients. Thus, they often refrain from using the term harassment, because it implies that the actions were intentional. However, the interviews revealed that, in practice, this separation was very difficult, and that sexual harassment often creates a range of dilemmas in the daily work. At the same time, sexual harassment is a taboo. The managers, shop stewards and safety representatives in this study were often not aware of the frequency and the impact of the episodes had on the care workers. The workplaces participating in this study, rarely had guidelines or policies for managing and/or preventing sexual harassment or inappropriate sexual behaviours, but often responded to episodes in an ad hoc and case-by-case manner.

Conclusion: The term sexual harassment might not be appropriate in the context of care work, because many patients who display inappropriate behaviours are cognitively impaired. While the interviews revealed that there is no universally accepted term, it might be more prudent to avoid the term harassment and refer it to as sexual behaviours. Considering the demographic development with a rising number of elderly and the increase in various forms of dementia, the management of inappropriate sexual behaviour by patients will be even more pressing in the future. It is time to address the prevention of sexual harassment and the management of patients' sexuality as an explicit part of the professional organisational culture of care work.

Keywords: Mental health; Patient care planning; Patients; Qualitative research; Sexual harassment.