What facilitates the delivery of dignified care to older people? A survey of health care professionals

Developing a Conceptual Framework for an Age-Friendly Health System: A Scoping Review

BACKGROUND

Population aging is usually associated with increased health care needs. Developing an age-friendly health system with special features, structure, and functions to meet the special needs of older people and improving their health status and quality of life is essential. This study aimed to develop a conceptual framework for an age-friendly health system, which would offer a conceptual basis for providing the best possible care for older people in health system to let them experience a successful, healthy, and active aging.

METHODS

A scoping review was used to design the conceptual framework based on Arksey and O'Malley's model, including six stages, with the final stage of using expert's opinions to improve and validate the initial framework. The health system model of Van Olmen, was selected as the baseline model for this framework. Then, by reviewing the available evidence, the characteristics of an age-friendly health system were extracted and incorporated in the baseline mode.

RESULTS

Using the electronic searching, initially 12 316 documents were identified, of which 140 studies were selected and included in this review study. The relevant data were extracted from the 140 studies by two reviewers independently. Most studies were conducted in 2016-2020, and mostly were from United States (33.6%). To have an age-friendly health system, interventions and changes should be performed in functions, components and objectives of health systems. This system aims to provide evidence-based care through trained workforces and involves older people and their families in health policy-makings. Its consequences include better health acre for older people, with fewer healthcare-related harms, greater care satisfaction and increased use of cost-effective health services.

CONCLUSION

To meet the needs of older people, health systems should make interventions in their functions for better performance. In line with these changes, other parts of society should work in harmony and set the health of older people as a top priority to ensure they can have a successful aging.

Social Innovation Toward a Meaningful Everyday Life for Nursing Home Residents: An Ethnographic Study

Background: The literature shows that innovation, which includes culture change, may be important to create a meaningful everyday life for nursing home residents. However, there is a gap in how social innovation practices may contribute to this. The theoretical discourse for the study is person-centered care.

Aim: The main aim was to explore phenomena within social innovation that can contribute to improving nursing home residents’ everyday lives.

Design and Method: This study uses an ethnographic design with observations and interviews in two nursing homes in Southern Norway.

Findings: The main theme was that social innovation within working practices in nursing homes includes phenomena that contribute to a meaningful everyday life for the residents. This main theme includes five subthemes: (1) opening the nursing home to the surroundings; (2) expanding and strengthening the community of practice; (3) facilitating customized activities; (4) ensuring sufficient nutrition and facilitating enjoyable mealtimes; and (5) preventing unrest and disturbing behavior.

Conclusion: The study reveals that innovation practices grounded in person-centered care in nursing homes may contribute to opening the nursing home to the community and establishing a common community practice for all members of the nursing home. This enables residents to experience meaningful everyday life through customized activities, sufficient nutrition, and a pleasant milieu during mealtimes. Disturbing behavior is also prevented, making it possible to promote meaningful lives in nursing homes.

Role of Dignity in Mental Healthcare: Impact on Ageism and Human Rights of Older Persons

The global demographic shift toward an aging population is predicted to result in a significant burden of mental health conditions and psychosocial disability. There has been a greater awareness of ageism and its toxic effects creating a paradigm shift to include a human right, ethical, and social justice-based approach to augment the biomedical model of mental healthcare. The concept of dignity lies at the heart of human rights and must be a central concept integrated into public health and mental healthcare. Dignity denotes the self-respect and worthiness of an individual as well as social consideration of his/her identity. Dignity in older persons is multi-dimensional and includes several factors such as privacy, independence, inclusion, autonomy, etc. There are several determinants such as frailty, dependence, sensory, cognitive impairment and socioeconomic vulnerabilities, which tend to compromise dignity in the elderly and hence their fundamental rights. One such construct is that of ageism which comprises stereotypes, prejudice and discrimination based on age. Ageism and related forms of stigma impair dignified healthcare in older persons and deprive them of their rights. Mental health professionals are uniquely positioned to incorporate the strategies to promote dignity in their clinical care and research as well as advocate for related social/health policies based on a human rights approach. These intersections are discussed in this paper in light of the United Nations Convention on Rights of the Older Persons.

Social dignity for marginalized people in public healthcare: an interpretive review and building blocks for a non-ideal theory

Jacobson (Social Science & Medicine 64:292-302, 2007) finds two distinct meanings of "dignity" in the literature on dignity and health: (1) intrinsic human dignity and (2) social dignity constituted through interactions with caregivers. Especially the latter has been central in empirical health research and warrants further exploration. This article focuses on the social dignity of people marginalized by mental illness, substance abuse and comparable conditions in extramural settings. 35 studies published between 2007 and 2017 have addressed this issue, most of them identifying norms for social dignity: civilized interactions, non-stigmatizing treatment, treatment as unique individuals, being taken seriously, maintaining a positive identity, experiencing independence, relating to others, and participating in daily life. We argue that these norms belong to ideal theory, whereas we agree with Robeyns (Social Theory and Practice 34:341-362, 2008) and others that improving practice is better served by non-ideal theory. Towards this end, we derive from the literature four building blocks for a non-ideal theory of dignity: (1) avoid violations of dignity rather than seeking to promote it; (2) dignity is not a goal to be reached; it requires ongoing effort; (3) promoting dignity is a balancing act; contradictory norms can make it impossible to realize; and (4) dignity can be undermined by organizational and discursive constraints.

Qualitative perspectives of nurse managers on mixed-gender accommodation in a regional hospital in Australia

AIMS

To explore and analyse the current bed management processes and understand the perspectives of nurse managers on mixed-gender accommodation in a regional hospital in Australia.

BACKGROUND

Mixed-gender accommodation was introduced to help manage the increasing demand for hospital beds. Yet, some health services identify same-gender accommodation better aligns with patient-centredness.

METHOD

This qualitative research was conducted at a public hospital in regional Australia and focused on the experience in the general wards. Eight nurse managers were selected using purposeful sampling. Data were collected through face-to-face semi-structured interviews and thematically analysed.

RESULTS

Three main themes were identified: current admission processes-managing admissions, bed allocation considerations, patient involvement and managing mixed-gender rooms; impacts on patients-participant views, patient experience and bathrooms; and barriers and facilitators-capacity, infrastructure, safety and risk, bed swapping and organisational factors.

CONCLUSIONS

The study demonstrates a lack of structure and patient-centredness with mixed-gender allocation processes. Local organisational guidelines are suggested to support improvement in patient-centred inpatient hospital accommodation.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study will help nursing leaders drive positive change concerning bed allocations and support advocacy for patient rights. Future studies should explore the patient perspective of mixed-gender accommodation.

The significance of meaningful and enjoyable activities for nursing home resident's experiences of dignity

BACKGROUND

Living in a nursing home may be challenging to the residents' experience of dignity. Residents' perception of how their dignity is respected in everyday care is important.

AIM

To examine how nursing home residents experience dignity through the provision of activities that foster meaning and joy in their daily life.

METHOD

A qualitative design was used and 28 individual semistructured interviews conducted with nursing home residents from six nursing homes in Denmark, Norway and Sweden. The data were analysed with qualitative content analysis. Independent ethical committees in all participating countries granted their approval for the study.

FINDINGS

The participants highlight two dimensions of the activities that foster experiences of dignity in nursing homes in Scandinavia. These two categories were (i) fostering dignity through meaningful participation and (ii) fostering dignity through experiencing enjoyable individualised activities.

CONCLUSION

Activities are important for residents to experience dignity in their daily life in nursing homes. However, it is important to tailor the activities to the individual and to enable the residents to take part actively. Nurses should collect information about the resident's preferences for participation in activities at the nursing home.