Value pluralism about sexual intimacy in residential care.

BACKGROUND: The existing literature on sexuality and intimacy in residential care tends to focus on either the question of rights, or the value of autonomy. Where the literature does reference values other than autonomy, such values are considered in the context of being a guide to whether or not a resident is autonomous, rather than being important values in their own right. OBJECTIVE: This paper draws on qualitative data gathered as part of a larger study in order to inform practice on how care workers respond to intimacy issues that arise with residents with dementia and to inform a general ethics of sex and sexuality, demonstrating that an approach which permits value pluralism can be appropriate in certain contexts. RESEARCH DESIGN: The qualitative data referred to in this paper was gathered from semi-structured interviews undertaken as part of a larger mixed-method research project. The interview text was analysed using Thorne's methodological approach, interpretive description. PARTICIPANTS AND RESEARCH CONTEXT: The qualitative arm of the project consisted of semi-structured interviews conducted between October 2018 and October 2019 with participants (staff, residents and family members) recruited from 35 residential care homes in Aotearoa New Zealand. ETHICAL CONSIDERATIONS: Participation was informed, voluntary and written consent was gained before interviews. The project was approved by the Massey University Human Ethics Committee (Northern), number NOR 18/25. FINDINGS: Analysis of the scenarios presented in this paper shows that decision-making around sexual intimacy involving people with dementia in a residential care setting is complex and requires recognizing and weighing the different values that may be a in play. CONCLUSION: A focus on safety and consent to the exclusion of other values which matter morally in this context is a mistake which prevents care workers from providing appropriately person-centred care to residents, as policies which focus on the goal of care allow space for critical examination of issues which are likely to be highly context-sensitive.

Sexual harassment or disinhibition? Residential care staff responses to older adults' unwanted behaviours.

BACKGROUND: The ethical complexity of residential care is especially apparent for staff responding to residents' inappropriate sexual expression, particularly when directed towards care workers as these residents are typically frail, often cognitively impaired, and require ongoing care. OBJECTIVES: To explore staff accounts of how they made meaning of and responded to residents' unwanted sexual behaviours directed towards staff. This exploration includes whether staff appeared to accept harassment as a workplace hazard to be managed, or an unacceptable workplace violation, or something else. METHODS: These qualitative data are drawn from a national two-arm mixed method study in Aotearoa New Zealand undertaken in 35 residential care facilities. Semi-structured interviews were conducted with 77 staff, residents and family members. Interpretive description was used to analyse the data. RESULTS: Staff had numerous ways they used to respond to behaviours: (1) minimisation, deflection and de-escalation, where staff used strategies to minimise behaviours without requiring any accountability from residents; (2) holding residents accountable, where staff to some degree addressed the behaviour directly with residents; (3) blurred boundaries and complexities in intimate long-term care, where staff noted that in a context where touch is common-place, cognitive function was diminished and relationships were long-term, boundaries were easily breached; (4) dehumanising and infantilising residents' behaviours, where staff appeared to assert control through diminishing the residents' identity as an older person. It was evident that staff had developed considerable practice wisdom focused on preserving the care relationship although few referred to policy and education guiding practice. CONCLUSIONS: Staff appeared to be navigating a complex ethical terrain with thoughtfulness and skill. Care workers seemed reluctant to label resident behaviour as sexual harassment, and the term may not fit for staff where they perceive residents are frail and cognitively impaired. IMPLICATIONS FOR PRACTICE: Policy, education and clinical leadership are recommended to augment practice wisdom and ensure staff and resident safety and dignity and to determine how best to intervene with residents' unwanted sexual behaviours.

Not in the Brochure: Porneia and Residential Aged Care.

Introduction: Sexuality and intimacy in residential aged care (RAC) are receiving increased research attention. In this article, porneia refers to access to sex workers, as well as online pornography, and masturbation by residents in RAC. Sex work is legal and regulated in Aotearoa New Zealand. Methods: The present study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. A validated survey tool was developed. Data were collected in 2018-2019: 433 staff surveys were collected from 35 RAC across the country; 61 interviews were carried out with 77 staff, residents, and family members. Results: Staff opinions about sex work and pornography were inconclusive. Nevertheless, access to sex workers occurs in many RAC facilities across the country. Interviews demonstrated a diversity of responses among the three groups; staff attitudes are paramount. Conclusions: Some staff are prepared for resident requests for sex workers; others continue to look to policies and management for guidance, but such policies are often lacking. Most staff have adopted the language of needs vs. rights which dominates the literature. Policy Implications: Staff education on sexuality and facility policy is essential; education for residents and their families is also desirable. Facilities often over-notify third parties. Discourse about sexuality needs to move towards a person-centred, salutogenic approach.

Culture clash: responses to sexual diversity in residential aged care.

This paper explores attitudes of staff, residents and family members towards sexually diverse persons based on data from the first national study of its kind in Aotearoa New Zealand. The study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. The quantitative arm included the results of 433 staff surveys related to knowledge, attitudes, behaviours and beliefs about sexuality, intimacy and ageing. The qualitative arm included interviews with 77 participants including staff, residents and family members. This paper focuses only on sexual diversity. A generational cultural effect was noted among all respondents; younger participants expressed the most open and accepting views of diversity. Residents were aware that they mostly held the views of their generation; nonetheless they also looked to staff to set the tone. Staff held varying views and felt that residents would be less accepting; some staff felt the issue of intimate relationships was not something they were willing to discuss at intake. Facilities will want to establish policies about sexuality and intimacy and communicate those policies and practices to staff, residents and family members. Facilities may also wish to consider specific educational events about sexual diversity for residents.

Intimacy for older adults in long-term care: a need, a right, a privilege-or a kind of care?

BACKGROUND: To investigate attitudes of staff, residents and family members in long-term care towards sex and intimacy among older adults, specifically the extent to which they conceptualise sex and intimacy as a need, a right, a privilege or as a component of overall well-being. METHODS: The present study was a part of a two-arm mixed-methods cross-sectional study using a concurrent triangulation design. A validated survey tool was developed; 433 staff surveys were collected from 35 facilities across the country. Interviews were conducted with 75 staff, residents and family members. RESULTS: It was common for staff, residents and family members to talk about intimacy and sexuality in terms of rights and needs. As well as using the language of needs and rights, it was common for participants to use terms related to well-being, such as fun, happiness or being miserable. One participant in particular (a staff member) described receiving intimate touch as a 'kind of care'-a particularly useful way of framing the conversation. CONCLUSION: While staff, residents and family frequently used the familiar language of needs and rights to discuss access to intimate touch, they also used the language of well-being and care. Reframing the conversation in this way serves a useful purpose: it shifts the focus from simply meeting minimum obligations to a salutogenic approach-one that focuses on caring for the whole person in order to improve overall well-being and quality of life.

Effect οf Genotype and Growing Year on the Nutritional, Phytochemical, and Antioxidant Properties of Industrial Hemp (Cannabis sativa L.) Seeds.

Cannabis sativa L. seeds have been an important source of protein, oil, and dietary fiber for human and animals. Currently, there is a growing interest in the commercial products of these seeds, which are recognized as a legitimate source of medicaments, cosmeceuticals, and nutraceuticals. The objective of this study was to investigate the nutritional, phytochemical composition, and antioxidant properties of seeds from seven hemp cultivars grown in Greece for three consecutive years. All the measured parameters strongly varied under the influence of growing year and genotype. In particular, protein, oil, and carbohydrates' content of hemp seeds as well as fatty acids' composition were mainly affected by genotype, whereas the growing year had a major effect on phytochemical components and antioxidant activity, which was determined by the 2,2'-azino-bis (3-ethylbenzthiazoline sulfonate) (ABTS) and ferric-reducing antioxidant power (FRAP) assays. Moreover, a predominant effect of the year was observed for phenolic profiles as determined by high-performance liquid chromatography and total carotenoids' content. This study suggests that hemp seeds could be a promising food crop as a result of their high nutritive traits and antioxidant potential. A comparison of the studied cultivars, showed that Finola seeds had the highest oil and protein contents and, thus, appeared to be the most promising cultivar for cultivation in Greece.

Disrupted bonds - parental perceptions of regionalised transfer of very preterm infants: a small-scale study.

BACKGROUND: Routine regionalised transfer of preterm infants occurs throughout Westernised countries. Transfer to lower acuity units occurs once infants are ready for convalescence and signals an infant's improving health. However, many parents find transfer traumatic. AIMS: To investigate parents' perceptions of preterm infants' transfer; to provide neonatal clinicians with insights to facilitate optimal service provision. METHODS: Participants had experienced their baby born at less than 29 weeks gestation, and subsequent transfer. Six parents were interviewed. DESIGN: Data were analysed using a general inductive approach. FINDINGS: Three themes were interpreted through data analysis: NICU - incomparable haven; abandonment; and parental expertise side-lined. These themes represent a journey of interrupted identity that parents undergo when their baby is transferred to another unit. CONCLUSION: Despite studies recommending more family-centred transfer planning, gaps persist. Nursing care might be enhanced by incorporating insight into parental experiences and promotion of collaborative changes within and between units.

Midlife safer sex challenges for heterosexual New Zealand women re-partnering or in casual relationships.

INTRODUCTION: The rate of sexually transmitted infections (STIs) amongst midlife and older heterosexual women in New Zealand is rising. Popular culture celebrates a heightened sexuality for this population group. However, depictions of sexually savvy 'cougars' are at odds with reality for many women. International literature highlights that these women are often ill-equipped to negotiate safer sex and condom use, instead focusing on pleasing men and attributing their silence to spontaneity. The study aimed to explore barriers to safer heterosexual sex as perceived by midlife and older New Zealand women who are re-partnering or in casual relationships. METHODS: This qualitative study utilised Interpretive Phenomenology Analysis, supported by the theory of gender and power, to examine the gender-normative assumptions and behaviours in women's accounts of unprotected sex. Eight single women aged 40-69 participated in individual, in-depth interviews. This exploration included eliciting women's accounts of potential information resources, such as clinical consultations. FINDINGS: Analysis indicated that these women held misconceptions about STI transmission but had not sought educational material, nor discussed their sexual health with health professionals. Results highlighted women's ambivalence about prioritising safer sex, preferring to comply with partners' wishes, particularly when under the influence of alcohol. Women described valuing their own pleasure and their distaste for condom use, but data emphasised that women predominantly aligned their choices with men's preferences. CONCLUSION: This study highlights that the women were both ill-informed and vulnerable with regards to sexual health. General practitioners are well placed to provide education and sexual health advice.

The US Food and Drug Administration review of the safety and effectiveness of nonstandardized allergen extracts.

BACKGROUND: Nonstandardized allergen extracts have been used for a century. Until 1972, these products were regulated by the National Institutes of Health, and products were not required to have an individualized showing of effectiveness. Jurisdiction was then transferred to the US Food and Drug Administration (FDA), which established external review panels to make recommendations regarding safety and effectiveness. Two external panels deliberated, the first from 1974-1979 and the second from 1982-1983. OBJECTIVE: We sought to review external panels' recommendations and assess the safety and effectiveness of nonstandardized allergen extracts, FDA-reviewed available literature, and databases since 1972. METHODS: Currently licensed nonstandardized allergen extracts were reviewed according to extract type. Available data were collected from medical and nonscientific search engines. Nomenclature was ascertained by consulting www.itis.gov or www.atcc.org. The FDA's Adverse Event Reporting System was probed for events associated with extract use. Provisional threshold levels of safety and effectiveness were established, and extracts were sorted according to whether they met the thresholds. RESULTS: In the Adverse Event Reporting System, there were 178 adverse event reports, including 13 deaths, associated with allergen extract use over 23 years. No single group of extracts predominated. Among 1269 allergen extracts reviewed, there were 480 for which use in the diagnosis and treatment of allergic disease were addressed in the literature, 207 for which only diagnostic use was addressed, 565 for which minimal or no supportive literature was identified, and 17 for which potential safety concerns were found. CONCLUSIONS: When used according to professional guidelines, almost all nonstandardized allergen extracts for diagnosis and therapy appear to be safe. Provisional thresholds of effectiveness were met by 54% of extracts reviewed.