Exploring nurses’ experiences of conducting sexual health assessments on palliative patients in the community

Abstract

Background: Palliative care patients often experience sexual health challenges due to both the illness and the treatment. Nurses have a role in addressing these concerns, but various factors can influence these discussions. Few studies have explored this area; this study aims to contribute new insights to this field. Objectives: To explore the experiences of palliative care nurses conducting sexual health assessments in the community, focusing on how they initiate and manage these conversations. It examined the factors that influence these nurses’ willingness and ability to address sexual health. The study also examined the barriers and facilitators that nurses face when addressing on sexual health issues with their patients. Design: A qualitative phenomenological methodology was adopted, guided by the principles of Interpretative Phenomenological Analysis. Setting: An organisation offering community palliative care services in Malta. Participants: Eight Maltese staff nurses working within the chosen organisation. Methods: Participants were purposively sampled. Data was gathered through face-to-face, semi structured interviews, which were audio-recorded and transcribed verbatim. Data was analysed using Interpretative Phenomenological Analysis. Results: The overarching concept entitled ‘Assessing through complexities’ is composed of three themes namely; (1) Participants’ understanding of sexual health (2) Feeling the weight of unspoken boundaries (3) Negotiating with the forbidden Conclusion: The analysis revealed that palliative nurses face complex challenges when conducting sexual health assessments with their patients in the community. Participants generally recognised the importance of addressing sexual health as part of holistic care but nevertheless, prioritised other clinical needs possibly as a consequence of feelings of discomfort, fear of overstepping boundaries, and a lack of confidence or training. Societal factors such as culture, religion and patient age further complicated these discussions. Furthermore, establishing trust and building strong therapeutic relationships were identified as critical steps for effective sexual health conversations. Overall, the findings highlight the need for further education, organisational support, and culturally sensitive practices to enable nurses to effectively integrate sexual health into palliative care assessments. Areas requiring further research, have also been identified.