Facilitating Conversations about Intimacy Needs in Dementia

---

Thursday, April 20, 2023

Time: 1pm-4pm

Registration Fee: $50

• Lori Schindel Martin, Toronto Metropolitan University
• Katelynn Aelick, Provincial Coordinating Office, Behavioural Supports Ontario
• Birgit Pianosi, Laurentian University
• Kristy McKibbon, Regional Geriatric Program Central
• Rosemarie Mangiardi, Ontario Health

Topic: During this workshop we will discuss the person-centred approaches and communication strategies nurses can use to facilitate conversations about sexual and intimacy expressions with persons living with dementia, their families and with other healthcare team members. 

Purpose:  Expected best practice standards and competencies (CGNA, 2020) require gerontological nurses to address sexuality, intimacy and sexual health of all older persons, including people living with cognitive impairment. Scholarly evidence indicates that without this education nurses will enter a healthcare system that uses inappropriate means such as scolding, isolation, physical restraint and antipsychotic medication as first line response to sexual and intimacy expressions in the dementia context, regardless of the clinical setting. The purpose of the workshop is to assist nurses to learn and apply person-centred strategies to communicate with people living with dementia, their families and team members about sexual and intimacy needs. 

During this workshop, participants will: 

1. Reflect individually and in small groups on personal values, beliefs, biases and myths about sexual and intimacy expressions in dementia that might influence practice;
2. Observe an example of person-centred communication between nurses, persons with dementia, their families and team members; 
3. Share strategies to improve sexual and intimacy expressions within healthcare settings. 

 At the end of this workshop, participants will have a better understanding of the following:

1. Importance of recognizing and setting aside personal biases; 
2. Accountability and responsibility to challenge stigma, myth and punitive practices;
3. Strategies to engage persons living with dementia, their families and healthcare team members in professional, respectful conversations to guide person-centred care. 

This interactive workshop will include review of a case study and actor simulation video. In small groups, participants will discuss observed communication behaviours that can be adopted as strategies for clinical practice. 

Case Study – Susan and Lotti, a married lesbian couple have recently experienced Lotti’s transition from a residential care apartment into the long-term care home section of the same facility. After 3 months of living in the LTCH unit, Lotti is still missing the coziness of the apartment, but she especially misses the intimacy she shared with Susan. She is lonely, even though Susan visits every afternoon for at least 4-5 hours during which they go for walks, have tea or cuddle on the couch watching a movie or two. On one particular day, while watching Thelma & Louse, Lotti passionately kisses Susan. Pointing to the curtain that separates Lotti from her roommate, Diana, Susan feels compelled to end the kiss. Diana has made negative comments to Susan and Lotti referring to their marriage as ‘unnatural and disgusting’. Lotti does not recall specific comments that Diana makes, but is well aware that Diana is ‘unfriendly’. After several such thwarted attempts at intimacy, Lotti tells Ramika, the unit RPN, that Susan does not love her any more and is having an affair. Lotti is so distressed that Ramika becomes troubled and so decides to meet with Shanice, Director of Care. Ramika and Shanice together with Lotti and Susan engage in a supportive conversation.

Simulation Video – This simulation reflects best practice communication and leadership skills. Learners will first watch the simulation video reflecting the stages of a guided conversation between these individuals with the goal to build a person-centred approach that ensures privacy, dignity and well-being for the couple. The filmed simulation demonstrates how these healthcare providers begin an exploratory conversation with Susan and Lotti about perceptions of Diana’s behaviour and attitudes, as well as provide support to sustain meaningful intimacy relationships in long-term care.

Action Discussion – Learners will work in small groups to identify observed communication best practices and strategies they can apply to guided conversations within their own workplaces.  

Closure Ceremony – Behavioural Supports Ontario Pledge; Signing of commitment to apply person-centred communication techniques to exploratory conversations about sexual and intimacy expressions in the dementia context and, Distribution of workshop attendance certificates.