Editor's note: This is the second article in a two-part series on understanding and handling inappropriate patient sexual behavior in the healthcare setting.
Most healthcare workers will experience inappropriate patient sexual behavior (IPSB), also called inappropriate client sexual behavior (ICSB), at some point in their careers. Such behaviors can be classified as mild (flirting, suggestive statements), moderate (crude sexual remarks, deliberate touching) or severe (exposure of sex organs, attempts at sexual fondling or activity).
Studies find that a majority of medical students, physical therapists, occupational therapists and nursing students report having experienced IPSB. In my practice, I have observed and experienced IPSB many times, and believe it is very common. Patients may exhibit IPSB due to neurological dysfunction, longstanding sexual dysfunction, fear of loss of sexual function, attempts at control or diversion from treatment, hostility, or confusion about the healthcare worker's intent.
Responses to IPSB vary. Healthcare workers commonly choose to ignore the behavior. Some discuss it with clients. Less often, they report the behavior to supervisors or discuss it with friends. Some threaten to withdraw their services. Some respond with aggression, disgust or anger.
When clinicians withdraw services due to IPSB, the patient may not receive appropriate care. Negative effects of IPSB on healthcare providers include decreased work performance and psychological stress. Knowing what to do when you experience IPSB can help the healthcare provider, the client and the facility to minimize negative effects and benefit all concerned.
How to Cope with IPSB
There is no one response to IPSB. Each situation will depend on who is behaving inappropriately, the severity and type of behavior, the subject and the setting. However, there are some useful guidelines and suggestions that can help determine the best response.
Be assertive. Zook (2000) has several excellent strategies she suggests to nurses she educates. First, she counsels self-awareness; don't deny your feeling about the IPSB. If necessary, talk about your feelings with peers, supervisors or counselors.
Next, provide feedback to the person acting inappropriately in an assertive, non-threatening manner. If he or she is touching you, remove the hand or step away. State clearly which behavior is unacceptable. An assertive response can also include a statement of how the behavior makes you feel.
Set limits by telling the client the consequences of the behavior, such as, "If you stop, I'll finish your treatment and we can talk about what's bothering you; if not, I'll have to stop and leave."
Zook emphasizes that you must enforce the consequences and ensure others follow the same plan.
Don't ignore. Ignoring a behavior was frequently cited as a response in IPSB studies. I would recommend this only when a behavior has never occurred before and is mild. Sometimes the behavior will not be repeated if it does not elicit a response. I emphasize that no provider should permit any behavior from a client that he would not accept from anyone else. If anyone touches you inappropriately, feedback should be firm and immediate. In fact, permitting inappropriate behavior because the person is a patient or client is effectively telling them they don't count as sexual beings and is counter-productive in every way.
Be honest. In dealing with a flirtatious patient, honesty is the best policy. If a patient wants to have a personal relationship with you, it's best to explain clearly that such a relationship is unethical, unprofessional or even illegal, and that you would never consider it. This helps to depersonalize the issue.
Be clear. If you suspect a patient has sexual preoccupations or if your treatment might be misconstrued for any reason, it is very important to protect yourself. Make sure the patient understands the procedures and the reasons for them, such as, "I need to put my arms around you to help you transfer from this chair to the bed," or "It's important for you to learn how to wash yourself, and I am going to help you."
If the patient is unable to understand or responds inappropriately anyway, immediately report the behavior. Often, other caregivers may be having the same experience, and an interdisciplinary behavioral plan should be developed. This is often the case with long-term care clients with dementia. In these cases, a different caregiver may not elicit the behavior. Sometimes one healthcare provider is better able to tolerate the behavior than another.