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Caring in nursing homes to promote autonomy and participation
Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för vårdvetenskap, Med-Vårdvetenskap. Uppsala University, Sweden.
Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för vårdvetenskap, Med-Vårdvetenskap. Uppsala University, Sweden.
Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för vårdvetenskap, Med-Vårdvetenskap. Uppsala University, Sweden.
Uppsala University, Sweden.
2019 (engelsk)Inngår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, nr 1, s. 280-292, artikkel-id 969733017703698Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care.

OBJECTIVE: The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation.

RESEARCH DESIGN: A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was inspired by Giorgi's method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed.

FINDINGS: The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses' awareness of older people's frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons' wishes were aspects that relied on registered nurses' trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people's right to autonomy and participation in nursing homes. Registered nurses' strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people.

DISCUSSION AND CONCLUSION: Awareness of older people's frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people's and healthcare personnel's perspectives, to promote autonomy and participation for residents in nursing homes.

sted, utgiver, år, opplag, sider
2019. Vol. 26, nr 1, s. 280-292, artikkel-id 969733017703698
Emneord [en]
Autonomy, nursing home, older people, participation, phenomenology, registered nurse
HSV kategori
Identifikatorer
URN: urn:nbn:se:hig:diva-23918DOI: 10.1177/0969733017703698ISI: 000458874900027PubMedID: 28425315Scopus ID: 2-s2.0-85041591391OAI: oai:DiVA.org:hig-23918DiVA, id: diva2:1091381
Prosjekter
Äldres autonomi och delaktighetTilgjengelig fra: 2017-04-26 Laget: 2017-04-26 Sist oppdatert: 2019-08-12bibliografisk kontrollert
Inngår i avhandling
1. Autonomy and Participation in Care For Older People: Descriptions by Older People, Registered Nurses, Case Managers, First Line Managers and Local Authorities Senior Medicine Advisors
Åpne denne publikasjonen i ny fane eller vindu >>Autonomy and Participation in Care For Older People: Descriptions by Older People, Registered Nurses, Case Managers, First Line Managers and Local Authorities Senior Medicine Advisors
2018 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Overall aim: To describe the essence of autonomy and participation for older people in care, and how to promote this in care for them.

Method: A descriptive design with a phenomenological approach. Sixteen older people (I) and 13 registered nurses (II) participated in individual face-to-face interviews (I and II). Twelve case/care managers and supervisors participated in a focus group interview, they were grouped by profession, case managers, first line managers and local authority senior medicine advisors, four in each group and interviewed once (III and IV). The data analyses were guided by Giorgi’s descriptive phenomenological method (I and II) and the systematic text condensation by Malterud (III and IV).

Findings: The informants were in agreement that maintaining older people’s health and wellbeing promote autonomy and participation, and supportive relationships are relevant (I–IV). Older people focused on everyday life experiences they made by choice and managing on their own, as strengthening self-esteem and self-identity (I). The registered nurses focused on caring for frail older people and their need for acknowledgement in everyday care. They noted that of providing choices as enable older people to have joyful everyday life experiences (II). The managers and supervisors focused on informed consent, and legislation, and offered solutions to securing a meaningful everyday life by caring for older people’s wishes and needs. They also spoke of the risk the severe consequences could result from older people’s decision-making and their health conditions (III). Relatives were respected as a resource and attended to in everyday care for older people but the focus was the older person in their present life situation and their individual rights (IV).

Conclusion: Promoting to autonomy and participation for older people were maintained health and wellbeing, and the possibility to manage on their own terms. Informed consent, shared decision-making, supportive relationships and acknowledgement of relatives in the life-changing situations were ways to promote autonomy and participation. To promote autonomy and participation in care for older people is also to provide for choices that are meaningful to the older person at end of life in a joyful and permissive atmosphere.

sted, utgiver, år, opplag, sider
Uppsala: Acta Universitatis Upsaliensis, 2018. s. 68
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, E-ISSN 1651-6206 ; 1449
Emneord
Autonomy, Participation, Older People, Chronic Illness, Healthcare, RN, CM, FLM, LASMA, Relatives, Municipal Care, Phenomenology
HSV kategori
Identifikatorer
urn:nbn:se:hig:diva-26531 (URN)978-91-513-0295-9 (ISBN)
Disputas
2018-05-22, Universitetshuset sal IX, Biskopsgatan 3, Uppsala, 13:15 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2018-05-03 Laget: 2018-05-03 Sist oppdatert: 2020-03-25bibliografisk kontrollert

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