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Promoting living in dignity and with a sense of well-being among older people living in residential facilities – older people’s perspective
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala universitet. (Vårdvetenskap)
2017 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The Swedish national fundamental values state that care of older people who are living in residential facilities should ensure that they live in dignity and with a sense of well-being. The overall aim of this licentiate thesis was to study, from older residents’ perspective, the effects of a caregiver intervention intended to put the Swedish national fundamental values into practice and to describe residents’ perceptions of what promotes the values: living in dignity and having a sense of well-being. The licentiate thesis is based on two studies, one using a descriptive design (Study I) and the other a cluster-randomized controlled trial with a pre- and one post-test design (Study II). Data were collected using interviews and questionnaires. The results showed that to promote dignity and well-being, it was important for residents to maintain their independence despite reduced abilities; to feel secure about care/services and certain about receiving assistance when it was needed; to maintain and create social relationships and to have a feeling of being at home (Study I). The intervention, aimed at putting the Swedish national fundamental values into practice, increased the self-reported empowerment, person-centered climate and life satisfaction regarding everyday activities of residents in the intervention group. There were significant interaction effects (differences in change over time between the intervention and control group) for empowerment, person-centered climate and life satisfaction regarding the factor everyday activities (Study II). Several conclusions can be drawn from the studies: In order to experience dignity and a sense of well-being, it was important for residents to maintain their independence, social relationships and their feeling of being at home. A caregiver intervention aimed at putting the Swedish national fundamental values into practice can improve everyday life among older residents. It is important that staff work alongside residents and that staff be given appropriate structural conditions, in the form of time, when putting the Swedish national fundamental values into practice.

Place, publisher, year, edition, pages
Uppsala: Uppsala universitet, 2017. , 55 p.
Keyword [en]
Dignity, empowerment, life satisfaction, older people, person-centered climate, residential facilities, Swedish national fundamental values, well-being
National Category
Nursing
Identifiers
URN: urn:nbn:se:hig:diva-23777OAI: oai:DiVA.org:hig-23777DiVA: diva2:1083284
Presentation
2017-01-26, Boströmrummet, Uppsala, 13:00
Supervisors
Projects
NVÄ
Available from: 2017-05-02 Created: 2017-03-20 Last updated: 2017-05-08Bibliographically approved
List of papers
1. An intervention targeting fundamental values among caregivers at residential facilities: Effects of a cluster-randomized controlled trial on residents' self-reported empowerment, person-centered climate and life satisfaction.
Open this publication in new window or tab >>An intervention targeting fundamental values among caregivers at residential facilities: Effects of a cluster-randomized controlled trial on residents' self-reported empowerment, person-centered climate and life satisfaction.
2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, no 1, 130Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In Sweden the national fundamental values for care of older people state that care should ensure that they can live in dignity and with a sense of well-being. Our hypothesis was that a caregiver intervention targeting the national fundamental values would improve perceived empowerment, person-centered climate and life satisfaction among older people living in residential facilities.

METHODS: The study was a cluster-randomized controlled trial with a pre- and one post-test design, conducted in 27 units (17 study units) at 12 residential facilities for older people in five municipalities in central Sweden. The units in each municipality were randomly assigned to intervention or control group. The caregiver intervention was carried out using an interpretative approach with eight guided face-to-face seminars, where self-reflection and dialogue were used. Data were collected using questionnaires. The number of residents was 43 (78 %) in the intervention group and 37 (71 %) in the control group. The Chi-square test and Mann-Whitney U-tests were performed to detect differences between groups and Wilcoxon signed rank tests to explore differences in change over time within groups. Furthermore, generalized estimating equation (GEE) models were used to study effects of the intervention controlling for clustering effects.

RESULTS: Primary outcome measures were empowerment, person-centered climate and life satisfaction. In the intervention group, improvements at follow-up were found in residents' self-reported empowerment (n = 42; p = 0.001, Median difference 4.0, 95 % CI 1.5;6.0), person-centered climate (n = 42; p ≤0.001, Median difference 8.0, 95 % CI 4.5;11.4) and life satisfaction regarding the factor quality of everyday activities (n = 40; p = 0.033, Median difference 9.7, 95 % CI 1.0;21.9) while disempowerment decreased (n = 43; p = 0.018, Median difference -1.3, 95 % CI -2.0;0.0). In the control group person-centered climate decreased (n = 37; p = 0.002, Median difference -8.5, 95 % CI -13.6;-3.0) and quality of everyday activities (n = 36; p = 0.012, Median difference -11.6, 95 % CI-21.7;-3.4). Change over time between groups was significant for empowerment (p = 0.001, Median difference 6.0, 95 % CI 3.0;9.0), disempowerment (p = 0.006, Median difference -2.0, 95 % CI -4.0;-1.0) and person-centered climate (p ≤ 0.001, Median difference 16.0, 95 % CI 9.7;23.0) and for life satisfaction regarding the factor quality of everyday activities (p = 0.002, Median difference 22.1, 95 % CI 8.2;37.4). Results of GEE confirmed earlier results; revealed interaction effects for empowerment (parameter estimate -5.0, 95 % CI -8.3;-1.8), person-centered climate (parameter estimate -16.7, 95 % CI -22.4;-10.9) and life satisfaction regarding the factor quality of everyday activities (parameter estimate -25.9, 95 % CI -40.3;-11.5).

CONCLUSION: When the Swedish national fundamental values were put into practice increases in empowerment, person-centered climate and quality of everyday activities were found among older people with intact cognitive ability living in residential facilities. Limitations to consider are the differences between the two groups at baseline, drop-outs and that neither the data collector nor the outcome assessors were blinded to group assignment of participants.

TRIAL REGISTRATION: The study was registered in ISRCTN92658034 in January 2013.

Keyword
A sense of well-being, Empowerment, Experimental design, Life satisfaction, Living in dignity, Person-centered climate, Residential facilities for older people
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-22156 (URN)10.1186/s12877-016-0306-2 (DOI)000379253200003 ()27387954 (PubMedID)2-s2.0-84977266195 (Scopus ID)
Available from: 2016-07-14 Created: 2016-07-14 Last updated: 2017-05-02Bibliographically approved

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