Caring in nursing homes to promote autonomy and participation

Hedman, Maria; Häggström, Elisabeth; Mamhidir, Anna-Greta; Pöder, Ulrika

doi:10.1177/0969733017703698

Cited by 30 publications

(51 citation statements)

References 31 publications

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“…Thus, the autonomy of older persons in nursing homes needs to be safeguarded. This process can be ensured through interactions between the older person and the staff by asking for their opinion, involving the older person in everyday activities and care planning and offering choices (Custers et al., 2012; Hedman et al., 2019). If the staff listens to and understands the older person's views and experiences, person‐centred care can be delivered at the nursing home.…”

Section: Discussionmentioning

confidence: 99%

Quality of life among frail older persons (65+ years) in nursing homes: A cross‐sectional study

et al. 2020

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Aim To assess the quality of life in frail older persons (65+ years) living in nursing homes and to examine differences between quality of life perceptions among different gender and age groups. Design Cross‐sectional. Methods Data were collected during 2015‐2017 based on two questionnaires (WHOQOL‐OLD and WHOQOL‐BREF). Seventy‐eight older persons living in nursing homes in southern Sweden answered the questionnaires in structured interviews. Descriptive and comparative statistics were used to analyse the data. The study was guided by Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines. Results The frail older persons reported low autonomy related to few opportunities to engage in everyday activities and were unable to do the things they liked to do and not feeling in control of their future. Another important result was that frail older persons seemed to have no or little fear of death and dying. No significant differences between gender or age on quality of life were revealed.

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Section: Discussionmentioning

confidence: 99%

Quality of life among frail older persons (65+ years) in nursing homes: A cross‐sectional study

et al. 2020

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“… 9 That is why autonomy is a core value in older people’s care. 15 Professionals need to be aware of what autonomy means and they need to consider how older people perceive autonomy as part of their everyday practice. 12 , 16 Professionals face wide-ranging responsibilities when it comes to recognising and enabling older people’s perceived autonomy in residential care.…”

Section: Introductionmentioning

confidence: 99%

Older people’s perceived autonomy in residential care: An integrative review

Moilanen¹,

Kangasniemi

Papinaho

et al. 2020

Nurs Ethics

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Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people’s perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up to September 2019. Electronic and manual searches were conducted using the CINAHL, Philosopher’s Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people’s individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples’ autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people’s choices. Professionals’ characteristics, such as education and attitudes, and the older people’s living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people’s perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved.

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“…Nurses and physicians do not always involve nursing home residents in end-of-life discussions, although they are capable of decision-making (Dreyer et al, 2010). This can be remedied by having family members monitor the care (Davies & Nolan, 2006) and, by proxy decision-making, they can achieve autonomy and participation for the residents (Hedman et al, 2017). However, being a proxy decision-maker in end-of-life care can be a burden for family members because they perceive themselves as being responsible for the decisions that are made (Dreyer et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Residents' and family members' perceptions of care quality and self-determination in palliative phase in residential care

et al. 2019

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ObjectiveDependency on others can compromise self-determination for older persons in the palliative phase in residential care. Family members can support the residents' self-determination but may also jeopardize it. Quality of care (QoC) is linked to respecting the autonomy of the residents and providing opportunities to participate in decision-making. The aim of the study was to provide knowledge about residents' and family members' perceptions of QoC and self-determination and to detect possible differences between their experiences.MethodThis cross-sectional study used an abbreviated version of the questionnaire, Quality from the Patients' Perspective, with additional items about decision-making. Wilcoxon's signed rank test was used to analyze the perception of QoC and to detect differences between residents' and family members' perceptions.ResultQoC was perceived as lower than preferred in the majority of items and there was a high level of agreement between residents and family members. Lowest mean values in QoC were found in: support when feeling lonely; support when feeling worry, anxiety or fear; and staff's time to talk to the residents. Decision-making in everyday life and in life-changing situations showed that neither residents nor family members trusted staff to know about the residents' preferences.Significance of resultsBroad improvements are needed, especially in psychosocial care. Several of the negative outcomes on QoC and self-determination seem to derive from a focus on practical tasks and the lack of trustful relationships between residents and staff. An early implementation of palliative care, with a focus on what brings quality to each resident's life, could facilitate QoC and self-determination, in both everyday life and at the end of life.

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Caring in nursing homes to promote autonomy and participation

Cited by 30 publications

References 31 publications

Quality of life among frail older persons (65+ years) in nursing homes: A cross‐sectional study

Quality of life among frail older persons (65+ years) in nursing homes: A cross‐sectional study

Older people’s perceived autonomy in residential care: An integrative review

Residents' and family members' perceptions of care quality and self-determination in palliative phase in residential care

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