• Catherine Cook, Vanessa Schouten, Mark Henrickson, and Sandra McDonald.
• School of Nursing, College of Health, Massey University Albany, Auckland, New Zealand.
• J Adv Nurs. 2017 Dec 1; 73 (12): 3017-3027.

AimTo analyse the accounts of staff, family and residents to advance ethical insights into intimacy and sexuality in residential care.BackgroundDiscourses of ageing readily construct people in residential aged care as postsexual, vulnerable and at risk of sexual exploitation, and therefore, expressions of intimacy and sexuality may be responded to as deviant and inherently risky. Staff may manage decision-making tacitly, without recourse to policies and education.DesignThe proof-of-concept study used a discursive methodology, identifying discourses that shape diverse meanings of intimacy, sexuality and ageing. Data analysis involved thematic analysis.MethodsSemi-structured interviews were conducted with four participants in 2015 as part of a mixed-methods study. This article reports on the qualitative data.ResultsFour themes were identified in the data analysis: mediated intimate relationships and everyday ethics; self-referential morality; knowing the person then and now; and juggling ethical priorities. Data indicated that participants used their personal moral compass to inform their decision-making, without any related policies and applied ethics and communication education. As a result, staff described moral uncertainty and moral distress. Staff indicated that there were tensions in terms of the role of proxy decision-makers, as there were situations where staff believed they were more aware of residents' current wishes and cognitive capabilities than family members.ConclusionsStaff, families and residents routinely address intimacy and sexuality in aged care. Ethically informed education and policies may enhance the role of staff as advocates, ensuring older people living in RAC are as at home and autonomous as possible.© 2017 John Wiley & Sons Ltd.

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