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Almevall A, Juuso P, Melander C, Zingmark K. Exploring the meaning of a good life for older widows with extensive need of care: a qualitative in-home interview study. Int J Qual Stud Health Well-being 2024; 19:2322757. [PMID: 38431864 PMCID: PMC10911179 DOI: 10.1080/17482631.2024.2322757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Studies of older women's life transitions is rare but gains relevance as the aging population, with older women as the majority, expands. PURPOSE To explore the meaning of a good life for older widows with extensive home care needs. MATERIALS AND METHODS Semi-structured interviews were carried out with eleven women, aged 80 and over (82-95 years, mean 90) residing at home with extensive care needs (≥4 daily sessions, averaging 2.5-6 hours, mean 3). Data were analysed by reflexive thematic analysis. RESULTS The theme "This Day in My Home, the frame of my life" reflects the women's experience of a good life. A good day imbued them with hope, trust and security, carrying them forward with the assurance that night would usher in a new day. However, there were moments when life was merely about navigating daily challenges. During such days, the women felt trapped in time, unsafe and lonely. CONCLUSION A day at home may seem static, yet it mirrors life's dynamism, evolving with shifting circumstances. Older widows navigate challenges while maintaining their sense of self, independence, and connection to home. These findings have implications for aged care, recognizing the multifaceted aspects of life and the centrality of home.
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Affiliation(s)
- Ariel Almevall
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden
| | - Päivi Juuso
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden
| | - Catharina Melander
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden
| | - Karin Zingmark
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden
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Orzechowski M, Skuban-Eiseler T, Ajlani A, Lindemann U, Klenk J, Steger F. User Perspectives of Geriatric German Patients on Smart Sensor Technology in Healthcare. SENSORS (BASEL, SWITZERLAND) 2023; 23:9124. [PMID: 38005512 PMCID: PMC10675452 DOI: 10.3390/s23229124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023]
Abstract
With consideration of the progressing aging of our societies, the introduction of smart sensor technology can contribute to the improvement of healthcare for older patients and to reductions of the costs of care. From the clinical and medico-ethical points of view, the advantages of smart sensor technology are copious. However, any ethical evaluation of an introduction of a new technology in medical practice requires an inclusion of patients' perspectives and their assessments. We have conducted qualitative, semi-structured, exploratory interviews with 11 older patients in order to gain their subjective opinions on the use of smart sensor devices for rehabilitation purposes. The interviews were analyzed using methods of qualitative content and thematic analyses. In our analysis, we have focused on ethical aspects of adoption of this technology in clinical practice. Most of the interviewees expressed their trust in this technology, foremost because of its accuracy. Several respondents stated apprehension that the use of smart sensors will lead to a change in the patient-healthcare professional relationship. Regarding costs of introduction of smart sensors into healthcare, interviewees were divided between health insurance bearing the costs and individual participation in corresponding costs. Most interviewees had no concerns about the protection of their privacy or personal information. Considering these results, improvement of users' technology literacy regarding possible threats connected with putting smart sensors into clinical practice is a precondition to any individual application of smart sensors. This should occur in the form of extended and well-designed patient information adapted to individual levels of understanding. Moreover, application of smart sensors needs to be accompanied with careful anamnesis of patient's needs, life goals, capabilities, and concerns.
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Affiliation(s)
- Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89081 Ulm, Germany; (T.S.-E.); (A.A.); (F.S.)
| | - Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89081 Ulm, Germany; (T.S.-E.); (A.A.); (F.S.)
| | - Anna Ajlani
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89081 Ulm, Germany; (T.S.-E.); (A.A.); (F.S.)
- Department of Sociology with a Focus on Innovation and Digitalization, Institute of Sociology, Johannes Kepler University Linz, 4040 Linz, Austria
| | - Ulrich Lindemann
- Department of Geriatrics, Robert Bosch Hospital, 70376 Stuttgart, Germany; (U.L.); (J.K.)
| | - Jochen Klenk
- Department of Geriatrics, Robert Bosch Hospital, 70376 Stuttgart, Germany; (U.L.); (J.K.)
- Institute of Epidemiology and Medical Biometry, Ulm University, 89081 Ulm, Germany
- Department of Health Sciences and Healthcare Education, IB University of Health and Social Sciences, Study Center Stuttgart, 70178 Stuttgart, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89081 Ulm, Germany; (T.S.-E.); (A.A.); (F.S.)
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Skuban-Eiseler T, Orzechowski M, Denkinger M, Kocar TD, Leinert C, Steger F. Artificial Intelligence-Based Clinical Decision Support Systems in Geriatrics: An Ethical Analysis. J Am Med Dir Assoc 2023; 24:1271-1276.e4. [PMID: 37453451 DOI: 10.1016/j.jamda.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To provide an ethical analysis of the implications of the usage of artificial intelligence-supported clinical decision support systems (AI-CDSS) in geriatrics. DESIGN Ethical analysis based on the normative arguments regarding the use of AI-CDSS in geriatrics using a principle-based ethical framework. SETTING AND PARTICIPANTS Normative arguments identified in 29 articles on AI-CDSS in geriatrics. METHODS Our analysis is based on a literature search that was done to determine ethical arguments that are currently discussed regarding AI-CDSS. The relevant articles were subjected to a detailed qualitative analysis regarding the ethical considerations Supplementary Datamentioned therein. We then discussed the identified arguments within the frame of the 4 principles of medical ethics according to Beauchamp and Childress and with respect to the needs of frail older adults. RESULTS We found a total of 5089 articles; 29 articles met the inclusion criteria and were subsequently subjected to a detailed qualitative analysis. We could not identify any systematic analysis of the ethical implications of AI-CDSS in geriatrics. The ethical considerations are very unsystematic and scattered, and the existing literature has a predominantly technical focus emphasizing the technology's utility. In an extensive ethical analysis, we systematically discuss the ethical implications of the usage of AI-CDSS in geriatrics. CONCLUSIONS AND IMPLICATIONS AI-CDSS in geriatrics can be a great asset, especially when dealing with patients with cognitive disorders; however, from an ethical perspective, we see the need for further research. By using AI-CDSS, older patients' values and beliefs might be overlooked, and the quality of the doctor-patient relationship might be altered, endangering compliance to the 4 ethical principles of Beauchamp and Childress.
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Affiliation(s)
- Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany; kbo-Isar-Amper-Klinikum Region München, München-Haar, Germany.
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Michael Denkinger
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany; AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
| | - Thomas Derya Kocar
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany; AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
| | - Christoph Leinert
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany; AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
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Spencer L. Epistemic Injustice in Late-Stage Dementia: A Case for Non-Verbal Testimonial Injustice. SOCIAL EPISTEMOLOGY 2022; 37:62-79. [PMID: 36816431 PMCID: PMC9928428 DOI: 10.1080/02691728.2022.2103474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The literature on epistemic injustice has thus far confined the concept of testimonial injustice to speech expressions such as inquiring, discussing, deliberating, and, above all, telling. I propose that it is time to broaden the horizons of testimonial injustice to include a wider range of expressions. Controversially, the form of communication I have in mind is non-verbal expression. Non-verbal expression is a vital, though often overlooked, form of communication, particularly for people who have certain neurocognitive disorders. Dependency upon non-verbal expression is a common feature of some forms of neurocognitive disorders such as 'intellectual disabilities', autism and late-stage dementia. According to the narrow definition of testimonial injustice currently championed in the literature, people who express non-verbally are exempt from testimonial injustice. However, when we consider cases where meaningful communications from non-verbal people are dismissed or ignored in virtue of identity prejudice, there seems to be a distinct testimonial harm at play. Using late-stage dementia as a case study, I argue that the definition of testimonial injustice should be expanded to include all communicative practices, whether verbal or non-verbal, to encompass the epistemic harms inflicted upon some of the most marginalised in our society.
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Affiliation(s)
- Lucienne Spencer
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Smith E, Carter M, Walklet E, Hazell P. Investigating the experiences of individuals in recovery from problem substance use and their perceptions of the COVID-19 pandemic. DRUGS AND ALCOHOL TODAY 2021. [DOI: 10.1108/dat-01-2021-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose
This paper aims to explore how enforced forms of social isolation arising from the first COVID-19 lockdown influenced experiences of problem substance use, relapse and coping strategies for recovery in individuals engaging with harm reduction recovery services.
Design/methodology/approach
A qualitative semi-structured interview design was adopted for this research. Seven participants were recruited from a harm reduction recovery organisation. During their initial interview, participants volunteered information regarding their experience of the first lockdown due to emerging concerns of the COVID-19 pandemic. Participants completed a second semi-structured interview at the end of the first lockdown regarding their experience of enforced isolation during this time.
Findings
Three themes identified from the analysis were isolation resulting in hindered human capabilities; adjusting to a new normal: an individual experience; and unexpected benefits to recovery resulting from isolation. While some participants reported boredom, loneliness and relapse events, others reported that the national response to the virus did not adversely affect them as they had already adjusted to living in a state of anxiety, isolation and uncertainty. These findings illuminate negative, neutral and positive aspects of substance use recovery throughout the COVID-19 lockdown as well as highlighting the complex and individualised role that social connectedness plays in relapse occurrence.
Originality/value
Participants reported differences in how they were affected by the pandemic, leading to theoretical implications for the effect of social isolation on recovery. For this reason, individuals with a history of dependency should be considered potentially vulnerable to the effects of enforced isolation and should be supported accordingly.
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Sævareid TJL, Thoresen L, Gjerberg E, Lillemoen L, Pedersen R. Improved patient participation through advance care planning in nursing homes-A cluster randomized clinical trial. PATIENT EDUCATION AND COUNSELING 2019; 102:2183-2191. [PMID: 31200952 DOI: 10.1016/j.pec.2019.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To improve patient participation in advance care planning in nursing homes where most patients have some degree of cognitive impairment. METHODS This was a pair-matched cluster randomized clinical trial with eight wards in eight Norwegian nursing homes. We randomized one ward from each of the matched pairs to the intervention group. We included all patients above 70. The primary outcome was prevalence of documented patient participation in end-of-life treatment conversations. The intervention included implementation support using a whole-ward approach where regular staff perform advance care planning and invite all patients and next of kin to participate. RESULTS In intervention group wards the patients participated more often in end-of-life treatment conversations (p < 0.001). Moreover, the patient's preferences, hopes AND worries (p = 0,006) were more often documented, and concordance between provided TREATMENT and patient preferences (p = 0,037) and next of kin participation in advance care planning with the patient (p = 0,056) increased. CONCLUSION Improved patient participation - also when cognitively impaired - is achievable through advance care planning in nursing homes using a whole-ward approach. PRACTICE IMPLICATIONS Patients with cognitive impairment should be included in advance care planning supported by next of kin. A whole-ward approach may be used to implement advance care planning. TRIAL REGISTRATION ISRCTN registry (ID ISRCTN69571462) - retrospectively registered.
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Affiliation(s)
- Trygve J L Sævareid
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
| | - Lisbeth Thoresen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway; Department of Health Sciences, University of Oslo, Forskningsveien 3A Harald Schjelderups hus, 0373, Oslo, Norway.
| | - Elisabeth Gjerberg
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
| | - Lillian Lillemoen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
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van der Geugten W, Goossensen A. Dignifying and undignifying aspects of care for people with dementia: a narrative review. Scand J Caring Sci 2019; 34:818-838. [PMID: 31750569 PMCID: PMC7754132 DOI: 10.1111/scs.12791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/13/2019] [Indexed: 12/04/2022]
Abstract
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.
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Affiliation(s)
| | - Anne Goossensen
- Chair Informal Care and Care Ethics and Endowed Chair of Volunteers and End-of-Life Care, University of Humanistic Studies, Utrecht, The Netherlands
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Melander CA, Kikhia B, Olsson M, Wälivaara BM, Sävenstedt S. The Impact of Using Measurements of Electrodermal Activity in the Assessment of Problematic Behaviour in Dementia. Dement Geriatr Cogn Dis Extra 2018; 8:333-347. [PMID: 30386370 PMCID: PMC6206949 DOI: 10.1159/000493339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/28/2018] [Indexed: 11/19/2022] Open
Abstract
Background A major and complex challenge when trying to support individuals with dementia is meeting the needs of those who experience changes in behaviour and mood. Aim To explore how a sensor measuring electrodermal activity (EDA) impacts assistant nurses’ structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions. Methods Fourteen individuals with dementia wore a sensor that measured EDA. The information from the sensor was presented to assistant nurses during structured assessments of problematic behaviours. The evaluation process included scorings with the instrument NPI-NH (Neuropsychiatric Inventory-Nursing Home version), the care interventions suggested by assistant nurses to decrease problematic behaviours, and the assistant nurses’ experiences obtained by focus group interviews. Results The information from the sensor measuring EDA was perceived to make behavioural patterns more visual and clear, which enhanced assistant nurses’ understanding of time-related patterns of behaviours. In turn, this enhancement facilitated timely care interventions to prevent the patterns and decrease the levels of problematic behaviour. Conclusion With the addition of information from the sensor, nursing staff could target causes and triggers in a better way, making care interventions more specific and directed towards certain times throughout the day to prevent patterns of problematic behaviours.
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Affiliation(s)
- Catharina A Melander
- Division of Nursing, Department of Health Sciences, Luleå, Luleå University of Technology, Luleå, Sweden
| | - Basel Kikhia
- Faculty of Health and Sport Sciences, Centre for EHEALTH, University of Agder, Grimstad, Norway
| | - Malin Olsson
- Division of Nursing, Department of Health Sciences, Luleå, Luleå University of Technology, Luleå, Sweden
| | - Britt-Marie Wälivaara
- Division of Nursing, Department of Health Sciences, Luleå, Luleå University of Technology, Luleå, Sweden
| | - Stefan Sävenstedt
- Division of Nursing, Department of Health Sciences, Luleå, Luleå University of Technology, Luleå, Sweden
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