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Sorry for the late reply.
I find taking the time to listen to the patients and explore frustrations with medications to be really beneficial. I also find it beneficial, depending on the patient to relate their medications as important as blood pressure medications or other types of medications people take for “medical” needs. With some folks this seems to really help. However, you also have to group that no matter what you seem to do, really do not want medications and I find in these situations trying to engage more in other ways other than just talking about medications can be helpful, and building that rapport is so important. In a situation a few years ago, I had a patient really not want their medication they continued to refuse it, they had multiple admissions. The case manager was able to build such rapport with the patient that the patient was “willing” to take the medications because he trusted the team who was prescribing.
As for sexual side effects, as an acute care nurse, I have not had a patient discuss that with me. I have however, had patients discuss it with the treating psychiatrist, and in the situations where patients were having sexual side effects, the physician was able to lower the dose or change the medications. I know that is not going to happen all of the time, but in these situations that was what was doable.