Dignity, rights and capabilities in clinical rehabilitation

Opportunities for a meaningful life for working-aged adults with neurological conditions living in residential aged care facilities: A review of qualitative research

Introduction

The aim of this review was to identify and synthesise findings from all published qualitative research investigating the experiences of working-aged adults with neurological conditions living in residential aged care facilities.

Methods

A qualitative metasynthesis approach was used. Two authors independently screened all citations and critically appraised all included studies. Data extraction and analysis was undertaken using conceptual description and interpretive explanation. Sensitivity analysis was used to ensure credibility of review findings.

Findings

Seven studies were identified, with varying relevance to this review. Five themes were identified that described the experiences of working-aged adults regarding contributors and barriers to social participation and personal growth. These related to: (1) safety; (2) dignity; (3) dependency; (4) flexibility; and (5) the ‘size’ of one’s physical and social world.

Conclusions

All people should have the option to live in private residences rather than institutional care should they choose to do so. However, if residential aged care is the only option available, more efforts are needed to ensure that these facilities are sufficiently resourced, have appropriately trained staff, and are encouraged to be creative and flexible in their service delivery to meet the individual needs of their residents, particularly working-aged adults with neurological conditions.

Rehabilitation for Survivors of the 1994 Genocide in Rwanda: What Are the Lessons Learned?

Rehabilitation remains a significant concern among survivors of the 1994 genocide in Rwanda. Rehabilitation falls under tertiary prevention, which is a core function of public health. Despite efforts to introduce various rehabilitation programmes for genocide survivors in Rwanda, these initiatives have often proved inadequate in meeting their long-term needs. The failure of the Rwandan Government, international community, United Nations, and other Non-Government Organisations (NGOs) calls into serious question their commitment to international human rights laws. Rehabilitation should be regarded as a free-standing human right for genocide survivors and a human rights-based approach to the rehabilitative process should incorporate measurable outcomes based on an agreed ethical framework. The author calls upon the international community to reiterate its concerns about genocide survivors and reaffirm its commitments to human rights. The main issues discussed in this article are: the long-term needs of survivors of the 1994 genocide; what is already provided, and the gaps; how Stucki's Rehabilitation Cycle framework (a problem-solving tool) can help improve current provision; the role of the international community, NGOs, and genocide survivors' organisations in advancing rehabilitation; and the need for a human rights-based approach to rehabilitation. A strong recognition of the right to rehabilitation is crucial. An ethical framework related to the human rights-based approach should also assist in setting outcomes that can be measured against agreed standards, ensuring: rights that have been violated are identified; the accountability of each service provider in promoting rehabilitation; rehabilitation which is inclusive and non-discriminatory; participation by encouraging collaboration with survivors rather than doing things for them; and empowerment by enabling survivors to understand their rights and have the confidence to challenge or question when their rights have been violated.

Indignity, exclusion, pain and hunger: the impact of musculoskeletal impairments in the lives of children in Malawi

PURPOSE

To develop a conceptual model representing the impact of musculoskeletal impairments (MSIs) in the lives of children in Malawi.

METHOD

A total of 169 children with MSIs (CMSIs), family and other community members participated in 57 interviews, focus groups and observations. An inductive approach to data analysis was used to conceptualise the impact of MSIs in children's day-to-day lives.

RESULTS

The main themes that emerged were Indignity, Exclusion, Pain and Hunger. Indignity represents various affronts to children's sense of inherent equal worth as human beings, for example when bullied by peers. Exclusion refers to CMSIs being excluded from three core daily activities: school, play and household chores. Some CMSIs experienced Pain, for example as an outcome of striving to participate. Children with severe mobility impairments were at increased risk of Hunger, having less access to food outside the home and placing a burden of care on the family that could restrict household productivity. Household Poverty was therefore included in the model, as this household impact was inseparable from the impact on CMSIs.

CONCLUSION

It is recommended that rehabilitation interventions are planned and evaluated with consideration to their impact on Exclusion, Indignity, Pain, Hunger and Household Poverty using multi-faceted partnerships.