Rehabilitation Unit Liverpool Hospital
Rehabilitation Directorate (BIRD) NSW Agency for
Clarify personal and professional values in relation to issues
i) Case study:
ii) Case study:
iii) Case study:
decision making Q
following case studies involve issues of sexuality after TBI. Read
the case studies and then use the brainstorm to think of possible
value issues that arise in responding to the identified sexual
health concerns. Remember, there are no right or wrong answers
Greg is 22 years old, has a severe brain injury and is in a nursing
home. He wants to masturbate but feels that he can’t,
as he has little privacy. Staff enter the room without any
notice. Also, he isn’t able to clean himself
up after masturbating due to restrictions in his upper limb
functioning and feels too embarrassed to ask the nursing
staff for assistance.
is starting to feel very frustrated with his situation as he feels
that no-one is listening to him and no-one can help him.
Staff have discussed
whether Greg should be allowed time to masturbate in the privacy
of his room and to provide assistance in cleaning up
Peter is 24 years old and is in an inpatient rehabilitation service
after sustaining a severe TBI. He has made a fairly good cognitive
recovery but has significant impairments with his lower limbs,
is a one-person transfer, needs assistance to turn in bed
and is wheelchair dependent.
to the severity of his physical injuries he has been in the rehabilitation unit
for a number of months. He is feeling sexually very frustrated. He hadn’t
been in a relationship at the time of the injury. He asks one of
the rehabilitation staff if they could organise for him
to go to a brothel so he can have sex with a sex worker.
Staff have discussed whether they should seek to meet this
request, or alternatively, allow him to view some erotic movies and
then masturbate in the privacy of his room.
A former street kid, Jane, resumes some of her pre-injury lifestyle
while living in a transitional living unit. She starts going
to the pub and being freely sexually available to anyone who is interested.
members caring for her are concerned that her severe cognitive impairments
are reducing her control over what happens in these sexual encounters,
whereas once she had been street-wise enough to protect herself.
They are also concerned for the safety of Jane, other clients and
when some of her sexual partners turn up late at night looking
street kid, Jane, resumed some of her old lifestyle while living
in a transitional living unit. She started going to the pub and being
freely sexually available to anyone who was interested.
Staff have decided that Jane should be given safer sex counselling
and provided with some condoms. Also, they will speak to the publican
about her situation, so that there is someone to keep an eye on her.
What influences your clinical decision-making?
The case studies highlighted a range of values that staff may hold
in relation to sexuality and how these might influence or conflict
with clinical decision-making in terms of client management. Where
would you stand in relation to these cases? What sorts of options would
you feel comfortable with in addressing the sexual health issues of
Greg, Peter and Jane?
There are many
things that influence what courses of action we think are appropriate,
in issues regarding sexuality. These things include our culture, personal
values and those we get from our family and upbringing, our professional
training and personal experience.
There may be conflict
between these different influences which might make it difficult for
you to decide what to do. Think about whether such a conflict would
affect your actual response.