Simulating Intimacy Without Disrobing: Teaching Relational Ethics Through Feeding and Oral Care

Abstract

Background: At least four and potentially six of the eight basic activities of daily living (ADL) described in the Occupational Therapy Practice Framework involve the patient in a naked or partially-clothed state. Preparing occupational therapy students to assist with intimate ADLs such as bathing, toileting, and dressing poses unique challenges, particularly regarding relational and ethical dimensions of care. While active learning is widely supported in occupational therapy education, little evidence describes high fidelity methods for reproducing these private states.

Methodology: This study examined an innovative feeding and oral care lab designed to replicate relational demands of intimate ADL care. The lab required second year students in a Master of Occupational Therapy program to alternate between the roles of therapist and patient while engaging in tasks such as feeding a partner and providing oral hygiene. Following the lab, 106 students across three cohorts submitted reflections which were qualitatively analyzed.

Results: Students reported significant emotional complexity in both roles. As student-therapists, they noted discomfort with proximity, bodily functions, and navigating dignity, communication, and consent. As dependent student-patients, they described vulnerability, loss of control, and embarrassment. These reflections underscore core elements of relational ethics in practice, highlighting empathy, professionalism, cultural humility, and therapeutic use of self. This lab successfully simulated the emotional aspects of intimate ADLs in an educationally appropriate, safe environment, supporting self-discovery, emotional processing, and skill development.

Conclusion: Findings suggest that high fidelity simulation should emphasize relational authenticity, and this lab experience is recommended for preparing occupational therapy students for the relational and ethical demands of intimate ADLs.