Dignity at stake: Caring for persons with impaired autonomy

Rejnö, Åsa; Ternestedt, Britt‐Marie; Nordenfelt, Lennart; Silfverberg, Gunilla; Godskesen, Tove

doi:10.1177/0969733019845128

Cited by 14 publications

(8 citation statements)

References 40 publications

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“…This issue has also been reported to be predominant for older persons in other studies, 36 , 37 , 38 since self-image and identity are key factors in promoting dignity. 39 …”

Section: Discussionmentioning

confidence: 99%

Valuing the individual – evaluating the Dignity Care Intervention

et al. 2022

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Background Palliative care needs in older persons can endanger their dignity. To provide dignity-conserving care to older persons, the Swedish Dignity Care Intervention (DCI-SWE) can be used. The DCI-SWE is built on Chochinov’s dignity model and the original version, developed and tested in UK and Scotland. Aim To describe older persons’ and their relatives’ experiences of dignity and dignity-conserving care when using the DCI-SWE in municipal health care. Research design A mixed method study with convergent parallel design. Participants and research context The DCI-SWE was used and evaluated in a Swedish municipality health care context. Older persons’ ( n=17) dignity-related distress and quality of life were assessed after the intervention. Interviews with older persons ( n=10) and their relatives ( n=8) were analysed using thematic analysis. Ethical considerations The study followed the World Medical Association Declaration of Helsinki. Ethical approval was obtained from the Regional Ethical Review Board in Uppsala, Sweden (Reg No. 2014/312) and the National Swedish Ethical Review Authority (Reg. No. Ö 10-2019). Informed consent was collected from older persons and their relatives. Findings The older persons’ dignity-related distress did not significantly change over time ( p = 0.44) neither was their overall quality of life ( p = .64). Only psychological quality of life was decreased significantly ( p = 0.01). The older persons and their relatives emphasized the importance of valuing the individual. Conclusions The DCI-SWE provides a forum to talk about dignity issues, but relevant competence, continuity and resources are needed. Psychological care actions and health care professionals’ communication skills training are important. To fully evaluate, the DCI-SWE a larger sample and validated instruments are necessary.

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“…This issue has also been reported to be predominant for older persons in other studies, 36 , 37 , 38 since self-image and identity are key factors in promoting dignity. 39 …”

Section: Discussionmentioning

confidence: 99%

Valuing the individual – evaluating the Dignity Care Intervention

et al. 2022

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“…In some cases, nurses concentrated on their own needs rather than the residents' needs, and sometimes, they medicated residents to calm them down (Solum et al, 2008). This contravened professional ethics, where the main aim is to protect residents’ human dignity and provide the best possible care (Kangasniemi et al, 2015; Rejnö et al, 2020). On the contrary, how well a nurse understood professional ethics, and their role as an advocate for older people (Preshaw et al, 2016), could facilitate ethical conduct in residential care.…”

Section: Discussionmentioning

confidence: 99%

Nursing support for older people's autonomy in residential care: An integrative review

Moilanen

Suhonen

Kangasniemi

2021

Int J Older People Nursing

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Background Nurses play a crucial role in enabling older people's autonomy in residential care. However, there is a lack of synthesised knowledge about how nurses can support older people. Objective The aim of this study was to identify and synthesise nursing support for older people's autonomy in residential care. Methods An integrative review was carried out by searching the CINAHL, Philosopher's index, PubMed, SocINDEX, Scopus and Web of Science databases, supplemented by manual searches. The searches focused on peer‐reviewed scientific empirical research papers published in English, without date limitations. The constant comparison method was used for the analysis. Results The review identified 24 papers, and these showed that older people's autonomy was based on dignity. Nurses protected older people's autonomy in eight different ways. They protected their right to make their own decisions, acted as advocates, respected their wishes, provided opportunities for autonomy, fostered independence, gave information to residents and relatives, provided individualised care practices and protected older people's safety. However, there were also barriers that needed to be overcome. Conclusions Nurses used multiple, individually tailored activities to support older people's autonomy, but they also had different reasons for supporting or hindering it. Work and leadership structures are needed to ensure that older people's autonomy is driven by ethical practices. Implications for practice The results of this review can help nurses who provide residential care for older people to recognise the different nursing activities that can be used to support older people's autonomy and to develop strategies to apply them in different daily care situations. However, further research is needed to determine how these activities can be realised in daily care and how they cover different aspects of older people's lives in residential care.

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“…During the collaborative care planning process, the care partners often acted as proxies on the older adult's behalf and contributed to narrating the life story of the older adult. This is common during care interactions in health and social care (Rejno et al, 2020 ). People reveal themselves as humans through narration, and it is also how their identity as persons appear.…”

Section: Personhoodmentioning

confidence: 99%

Reflections of the collaborative care planning as a person‐centred practice

Jobe

2022

Nursing Philosophy

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The ageing population is increasing worldwide with an increase in chronic disorders.At the same time, person-centred care has become a policy within both health and social care. To facilitate coordination and collaboration and integrate the older adult's perspective in the decision-making process the collaborative care planning process with the development of a written care plan can be used. In this study, the result of an interpreted analysis of four empirical studies of the collaborative care planning as a person-centred practice will be discussed and reflected on. A framework based on the French philosopher Paul Ricoeur's little ethics was used in the synthesis of the studies. The findings revealed two common threads: personhood and power asymmetry. Both challenges in achieving a person-centred collaborative care planning. Ricoeur's dialogical thinking and description of a person served as an underpinning in discussing and reflecting upon the findings of the interpreted synthesis. Collaborative care planning is a complex process. However, Ricoeur's philosophy contributed to a greater understanding of the collaborative care planning as a person-centred practice and accentuated that ethics, human values, and the older adults and care partners perspectives need to be given the same importance and considerations as the medical and social sciences perspectives for the collaborative care planning process to truly become person-centred.

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Dignity at stake: Caring for persons with impaired autonomy

Cited by 14 publications

References 40 publications

Valuing the individual – evaluating the Dignity Care Intervention

Valuing the individual – evaluating the Dignity Care Intervention

Nursing support for older people's autonomy in residential care: An integrative review

Reflections of the collaborative care planning as a person‐centred practice

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