Which characteristics of nursing home residents relate to factors influencing their dignity?

We need a radical change to take place now´-The potential of integrated healthcare for rural long-term care facilities

OBJECTIVES

This study explores healthcare professionals' perceptions in rural German long-term care facilities, focusing on integrated health systems. The aim is to understand experiences, challenges, and preferences.

METHODS

Twenty nurses and paramedics participated in in-depth interviews. Thematic analysis was applied to transcripts, revealing key themes: acute healthcare provision, interdisciplinary collaboration, telemedicine use, and preferences for the future healthcare landscape.

RESULTS

Themes highlighted factors influencing acute care situations and the crucial role of interdisciplinary collaboration. Integrated care was infrequently encountered despite high demand in rural long-term care facilities.

CONCLUSIONS

Though uncommon, integrated healthcare remains crucial in addressing long-term care facility residents' complex needs. Healthcare professionals express a strong demand for integrated care in rural areas, citing potential benefits for resident wellbeing, healthcare effectiveness, and job satisfaction. The findings guide healthcare organizations in developing institutional-level strategies for integrated care integration, emphasizing its importance in rural settings.

Perception of dignity in older men and women in the early stages of dementia: a cross-sectional study

BACKGROUND

Dementia is a serious problem in old age, that impacts an individual's ability to function and may threaten personal dignity. Given the variable features of the illness and the diversity of life experiences, many factors may contribute to the perception of dignity by men and women with dementia. The purpose of the study was to explore the factors that contribute to dignity and its domains in men and women with dementia.

METHODS

This cross-sectional study involved 316 community-dwelling patients with early-stage dementia (aged ≥ 60) (PwD). We assessed the participants' sociodemographic and social involvement characteristics, health-related variables (pain, depression, physical performance, visual and hearing impairments), attitude to aging, and self-sufficiency in the activities of daily living (ADL). These factors were investigated as independent variables for the perception of dignity and of its domains in men and women.

RESULTS

Multivariate regression analysis showed that PwD experienced minor dignity problems in the early stages of dementia. In both men and women higher rates of depression, negative attitudes to aging, and pain were associated with reductions in the perception of dignity. In men, but not in women visual impairment had a negative effect on overall dignity, and on the associated domains of 'Loss of Autonomy' and 'Loss of Confidence'. In women, lowered self-sufficiency in ADL contributed to reduced self-perception of dignity and in the associated domains of 'Loss of Purpose of Life', 'Loss of Autonomy', and 'Loss of Confidence'. Sociodemographic and social involvement characteristics, hearing impairment, and physical performance did not influence the participants' self-perception of dignity.

CONCLUSION

The results suggested that several common factors (depression, attitudes to aging, and pain) contribute to the perception of dignity in both men and women. Other factors, visual impairments in men, and self-sufficiency in ADL in women, appear to be more gender specific. These differences might relate to their specific gender roles and experiences. The self-perception of dignity in PwD can be helped by supporting the individual, to the extent that their illness allows, in maintaining activities that are important to their gender roles, and that preserve their gender identity.

TRIAL REGISTRATION

NCT04443621.

Dignity and its related factors among older adults in long-term care facilities: A cross-sectional study

Objectives

This study aimed to explore the dignity and related factors among older adults in long-term care facilities.

Methods

Cross-sectional data were obtained from a sample of 253 Chinese older adults dwelling in long-term care facilities. Dignity among older adults was measured using the Dignity Scale, and its potential correlates were explored using multiple linear regressions.

Results

Results showed that the total score of the Dignity Scale is 151.95 ± 11.75. From high to low, the different factors of dignity among older adults in long-term care facilities were as follows: caring factors (4.83 ± 0.33), social factors (4.73 ± 0.41), psychological factors (4.66 ± 0.71), value factors (4.56 ± 0.53), autonomous factors (4.50 ± 0.57), and physical factors (4.38 ± 0.55). A higher score of the Dignity Scale was associated with higher economic status, fewer chronic diseases, less medication, better daily living ability and long-time lived in cities.

Conclusion

Older adults with low economic status, more chronic diseases, and poor daily living ability, taking more medications, or the previous residence in rural areas seem to be most at low-level dignity in long-term care facilities and thus require more attention than their peers.

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

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.

Dignity and Predictors of Its Change Among Inpatients in Long-Term Care

The purpose of this study was to identify any differences in the dignity evaluation of geriatric inpatients after 1 month of hospitalization in a long-term care wards (LTC) and predictors of this change. This follow-up study included 125 geriatric inpatients who filled the Patient Dignity Inventory (PDI-CZ), Geriatric Depression Scale, Barthel Index, and Mini-Mental State Examination. In the initial measurement, the patients rated of PDI-CZ item “Not able to perform tasks of daily living” the worst. One month after, the items “Not able to perform tasks of daily living,” “Not able to attend to bodily functions,” and “Not feeling worthwhile or valued” were improved. Patients with higher education, for whom self-sufficiency improved and depression decreased, rated their dignity more positively 1 month after the hospitalization in LTC. Our findings suggest that these factors are important for the maintenance of the dignity of older adults hospitalized in LTC.

Dignifying and undignifying aspects of care for people with dementia: a narrative review

Background

The progressive disease trajectory makes people with dementia increasingly vulnerable and gradually more dependent on others which can lead to admission to a nursing home. Special interest in dignity in people with dementia has led to a growing body of knowledge towards promoting or hindering their dignity.

Aim

The aim of this narrative review was to synthesise dignifying and undignifying aspects of formal and informal care for people with dementia within nursing homes.

Method

The electronic databases CINAHL, SCOPUS, PSycInfo and PubMed were systematically searched with the terms ‘dementia’ and ‘dignity’, complemented with the use of snowballing and reference check. A total of 789 unique items were found. The search and selection process was structured by the PRISMA framework, and both authors formulated the criteria of eligibility. A methodological check was performed using the critical appraisal tool of Hawker. This process led to inclusion of 29 articles which were reviewed with the help of the guidelines for narrative synthesis by Popay et al.

Findings

The emerged dignifying and undignifying aspects of formal and informal care are characterised by either a successful or unsuccessful process of adjustment towards changing abilities, preferences and care needs of people with dementia. Three themes appeared as undignifying aspects of care: ‘Stigmatisation and objectivation’, ‘Scarcity and hastiness’ and ‘Impending estrangement and misunderstanding’. Four themes were identified as dignifying aspect of care: ‘Personalisation’, ‘Respect, attentiveness and encouragement’, ‘Attention for physical care and bodily gestures’, and ‘Foster belonging’. Literature synthesis showed mostly relational aspects of care concerning dignity in people with dementia. Formal and informal caregivers are important in maintaining and promoting their dignity.

Concept synthesis of dignity in care for elderly facility residents

BACKGROUND

Protecting the dignity of elderly residents of facilities and providing dignified care can be difficult. Although attempts have been made from several aspects, dignity is considered an area in which less real impact has been made in both theory and practice.

OBJECTIVE

The objective of this study is to characterize the concept of dignity in care for elderly subjects in residential facilities from a practical perspective through concept synthesis.

RESEARCH DESIGN

This study includes in-depth interviews with residents of elderly facilities and a literature review.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 12 residents of seven facilities in three prefectures in Japan were recruited via purposive sampling, and 27 interviews were conducted. Each digitally recorded interview was transcribed verbatim. The interview data were analyzed based on hermeneutic phenomenological research. The literature was searched using PubMed, CINAHL, and Web of Science with combinations of terms such as dignity, elderly, and residential facilities and then selected according to the predefined inclusion criteria. The descriptions about dignity in the included studies were divided into codes and compared with the results of the interviews.

ETHICAL CONSIDERATIONS

This study was approved by the institutional review board of Nagoya University's Graduate School of Medicine.

FINDINGS AND DISCUSSION

There were 1728 data codes for the interviews from which four themes were generated. In the literature review, 3716 titles were searched, and 28 articles were selected. Combining these results, five following themes and a conceptual matrix were obtained: individual dignity not affected by others; dignified care in a narrow sense; elements of the staff side; dignity in relation to family members, friends, society, and other residents; and dignity in relation to nursing care facilities and the nursing care system.

CONCLUSION

According to the established matrix, we must consider the role of the care system, facility, family, and society in providing care with dignity and the individual dignity to residents and dignity in daily care.