Nursing, sexual health and youth with disabilities: a critical ethnography

Abstract Aim To explore the experiences of nurses providing sexual health care to adolescents with physical and/or developmental disabilities, with attention to the institutional and social discourses that shape these interactions. Background Previous research has shown that nurses demonstrate a lack of attention to the impact of illness or disability on sexual health. However, in their therapeutic relationship with patients and families, nurses are in an ideal position to promote sexual health. Design A critical ethnography study was conducted in an urban paediatric rehabilitative facility. Method Field work occurred over 4 months (2008–2009) and data collection included interviews ( n  = 9), key informant discussions, collection of documentary evidence and observation of the institutional setting. Findings Four themes were identified (institutional space, professional interactions, engaging with sexuality, nursing experience), which revealed that nurse–patient interactions about sexual health were affected by a complex network of discourses. These encounters were shaped by practical discourses, such as time and space and by more complex discourses, such as professional relationships, normalization and asexuality. Conclusion Nurses occupy and strive to maintain, the role of a caring agent. However, aspects of the clinical, institutional and broader social environments may undermine their ability to promote sexual health. In nurses' efforts to maintain therapeutic relationships with clients, sexual health is often medicalised to legitimize it as an appropriate topic of discussion with patients and families. Facilities serving youth with disabilities should take steps to address barriers to the delivery of sexual health promotion and several solutions are proposed.