Influencing everyday activities in a nursing home setting: A call for ethical and responsive engagement

Abstract

This study focuses on influence that older adults, living in nursing homes, have over everyday activities. Everyday activities are key to sustain a sense of stability, predictability, and enjoyment in the local world of people's everyday and therefore a critical dimension of the person‐centeredness framework applied within gerontology. This narrative ethnographic study aimed to shed light on how influence can be situated contextually, and how it can emerge through activities as well as how it is negotiated in everyday by frail older adults living in a nursing home. Residents, staff members, and significant others from one nursing home in an urban area of Sweden participated in this study. Data were gathered through fieldwork, including participant observation and formal and informal conversations during a period of 6 months. Data were analyzed through a narrative interpretative approach. The findings are presented in narrative form as exemplars. The exemplars—Craquelures as justification, Seeking a place for other life worlds and An almost perfect trip—reveal a gap between the client‐centeredness framework and lived experiences regarding older adults’ influence in everyday activities. The role of everyday activities in the context of frailty is discussed in terms of ethical and responsive engagement, and implications for health‐care practices are considered.

Engagement in Everyday Activities among People Living in Indian Nursing Homes: The Association with Person-Centredness

“…Nevertheless, this is not consistent with the fact that the majority of the nursing staff said that residents were offered the opportunity to be involved in individualized everyday activities as reported in one of the items in the P-CAT questionnaire. A possible explanation [41], who suggested that the deeper meaning of everyday activities might remain invisible to the staff representing and focusing on the institutional routines, or as Smebye and Kirkevold [42] indicated in their study: the activities were not self-evident in the context of nursing homes. Workload or the high prevalence of residents with cognitive impairment in nursing homes have also been suggested as possible explanations for the lack of provision of activities [43].…”

Altering the boundaries of everyday life in a nursing home context

“…In a previous study conducted in the same setting [24] occupational interests among older adults living at a NH and the facilitating conditions to enact those interests were explored. The main findings revealed that older adults wanted to feel connected with the world outside the NH, to put their capabilities in action, to have something to look forward to, to have a chance of meeting new people and to feel active in their own capacity.…”

“…Older adults' engagement in occupations is an important issue in the development of quality standards and the person-centred approach [1][2][3] within nursing home (NH) and has been a clear focus in aging research [4][5][6][7][8], occupational therapy research [9][10][11][12][13][14][15][16], policy [17][18][19] and in clinical practices. It is well known that older adults' engagement in occupations contributes positively to quality of life and meaning making [13,[20][21][22][23][24][25]. Although an occupational perspective [26] is often an important part of NH settings, many programs fail to incorporate and accommodate the residents' views and resources [2,11,14,24,27,28].…”

“…It is well known that older adults' engagement in occupations contributes positively to quality of life and meaning making [13,[20][21][22][23][24][25]. Although an occupational perspective [26] is often an important part of NH settings, many programs fail to incorporate and accommodate the residents' views and resources [2,11,14,24,27,28]. Occupations can take a more instrumental form, as a tool that serves delimited purposes, e.g.…”

“…Research also shows that older adults are often seen by NH staff as passive recipients [34] who have limited possibilities to influence available occupations. These constrained possibilities to influence occupations [4,10,24,[34][35][36] could, for example be due a stereotyped view of older adults' preferences and interests [28]. However, there is limited knowledge about how occupations could be embedded in everyday life and aligned with older adults' interests, preferences, and values in the NH context.…”