Prevention of Unethical Actions in Nursing Homes

2008 ◽  
Vol 15 (4) ◽  
pp. 536-548 ◽  
Author(s):  
Eva Merethe Solum ◽  
Åshild Slettebø ◽  
Solveig Hauge
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Communicative Competence ◽  
Participant Observation ◽  
Discourse Ethics ◽  
Self Determination ◽  
Theoretical Interpretation ◽  
Ethical Problems ◽  
Daily Care ◽  
Moral Problems

Ethical problems regularly arise during daily care in nursing homes. These include violation of patients' right to autonomy and to be treated with respect. The aim of this study was to investigate how caregivers emphasize daily dialogue and mutual reflection to reach moral alternatives in daily care. The data were collected by participant observation and interviews with seven caregivers in a Norwegian nursing home. A number of ethical problems linked to 10 patients were disclosed. Moral problems were revealed as the caregivers acted in ways that they knew were against patients' interest. We used a theoretical interpretation according to Habermas' discourse ethics on the importance of dialogue when deciding moral courses of action for patients. This theory has four basic requirements: communicative competence, equality, self-determination, and openness about motives.

Ethics of Assisted Autonomy in the Nursing Home: Types of Assisting Among Long-Term Care Nurses

1996 ◽  
Vol 3 (3) ◽  
pp. 224-235 ◽  
Author(s):  
June M. Whitler
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Personal Autonomy ◽  
Self Determination ◽  
Decisional Capacity ◽  
Term Care ◽  
Ethical Implications

Twenty-five long-term care nurses in eight nursing homes in central Kentucky were inter viewed concerning ways in which they might assist elderly residents to preserve and enhance their personal autonomy. Data from the interviews were analysed using grounded theory methodology. Seven specific categories of assisting were discovered and described: personalizing, informing, persuading, shaping instrumental circumstances, considering, mentioning opportunities, and assessing causes of an impaired capacity for decision-making. The ethical implications of these categories of assisting for clinical prac tice are examined. Although nurses recognized the importance of resident autonomy, the majority of them failed consistently to employ the categories of assistance to foster resi dent self-determination and most of them held an inadequate understanding of the con cepts of consent and decisional capacity. To assure confidentiality, pseudonyms are used in the following cases and discussions for all names of nurses, residents and facilities.

scholarly journals ‘Like a prison without bars’

2013 ◽  
Vol 20 (8) ◽  
pp. 881-892 ◽  
Author(s):  
Anne Kari T Heggestad ◽  
Per Nortvedt ◽  
Åshild Slettebø
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Participant Observation ◽  
Qualitative Interviews ◽  
Qualitative Design ◽  
Personal Dignity ◽  
Hermeneutic Approach

The aim of this article is to investigate how life in Norwegian nursing homes may affect experiences of dignity among persons with dementia. The study had a qualitative design and used a phenomenological and hermeneutic approach. Participant observation in two nursing home units was combined with qualitative interviews with five residents living in these units. The study took place between March and December 2010. The residents feel that their freedom is restricted, and they describe feelings of homesickness. They also experience that they are not being seen and heard as individual autonomous persons. This lack of freedom, experiences of homesickness and feelings of not being confirmed and respected as individual autonomous persons may be a threat to their personal dignity. In order to protect and enforce the dignity of persons with dementia living in nursing home, we should confirm them as whole and as individual persons, and we should try to make the nursing homes less institutional and more home like.

scholarly journals Being a Nursing Home Resident: A Challenge to One's Identity

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Maria Riedl ◽  
Franco Mantovan ◽  
Christa Them
Keyword(s):  
Social Networks ◽  
Content Analysis ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Resident ◽  
Life Experience ◽  
Nursing Home Residents ◽  
Self Determination ◽  
First Year ◽  
Study Participants

Going into a nursing home can turn out to be a critical life experience if elderly people are afraid of losing their independence and identity after having moved into a nursing home. In order to find out what nursing home residents need in their first year after having moved into a nursing home to maintain their identity and self-determination, 20 problem-orientated interviews with residents of three nursing homes in the Austrian province of Salzburg were conducted and analysed based on content analysis according to Mayring. The participants of this study resist against having decisions taken away from them and fight for their independence and identity. In order to be able to cope with these strains, they need the help of family members, professionals, and identity-forming conversations in new social networks in the nursing home. The study participants draw enough strength from their faith in order to fight for their independence. They develop a new identity close to their previous identity by maintaining autonomy and mobility with a clear focus on the future.

Facilitating resident community in nursing homes: a slippery slope? An analysis on collectivistic and individualistic approaches

2017 ◽  
Vol 22 (5) ◽  
pp. 469-482 ◽  
Author(s):  
Gudmund Ågotnes ◽  
Christine Øye
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Social Life ◽  
Participant Observation ◽  
Nursing Home Residents ◽  
Unintended Consequences ◽  
Institutional Setting ◽  
The Social ◽  
The Difference ◽  
Everyday Life Activities

Residents in nursing homes are old and frail and are dependent on constant care, medical, or otherwise, by trained professionals. But they are also social beings, secluded in an institutional setting which is both total and foreign. In this setting, most of the residents most of the time must relate to other residents: other residents are the nursing home residents’ peers, companions, and perhaps even significant others. In this article, we will discuss how resident communities in nursing homes are influenced by the approaches of nursing home staff. Two nursing homes have been included in this article—one from Canada and one from Norway. Participant observation was conducted at these two nursing homes, predominantly focusing on everyday-life activities. The cases from Norway and Canada are illustrative of two very different general approaches to residents: one collectivistic and one individualistic. These general approaches produce different contexts for the formation and content of resident communities, greatly affecting nursing home residents. The significance of these approaches to resident community is profound and also somewhat unanticipated; the approaches of staff provide residents with different opportunities and limitations and also yield unintended consequences for the social life of residents. The two different general approaches are, we suggest, “cultural expressions,” conditioned by more than official preferences and recommendations. The difference between the institutions is, in other words, anchored in ideas and ideologies that are not explicitly addressed.

scholarly journals Food Matters

2002 ◽  
Vol 19 (5-6) ◽  
pp. 207-226 ◽  
Author(s):  
Hans Harbers ◽  
Annemarie Mol ◽  
Alice Stollmeyer
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
The Netherlands ◽  
Social Activities ◽  
Daily Care ◽  
People With Dementia ◽  
Force Feeding ◽  
Common Practices ◽  
Public Debates ◽  
Food And Drink

In public debates about the desirability of force feeding in the Netherlands the inclination of people with dementia to refrain from eating and drinking tends to be either taken as their gut-way of expressing their will, or as a symptom of their disease running its natural course. An ethnographic inquiry into daily care, however, gives a quite different insight in fasting by relating it to common practices of eating and drinking in nursing homes. In a nursing home eating and drinking are important social activities that may be shaped quite differently. And while necessary for survival, food and drink also have other qualities: taste, temperature, texture, smell. Whether we want it or not, in the end we all die. But with different modes of care come different modes of dying and of living.

Humanizing Nursing Home Environments: The Relevance of Hospice Principles

1983 ◽  
Vol 15 (4) ◽  
pp. 263-284 ◽  
Author(s):  
Anne Munley ◽  
Cynthia S. Powers ◽  
John B. Williamson
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Homes ◽  
Participant Observation ◽  
Task Orientation ◽  
Home Environments ◽  
Social Death ◽  
Hospice Movement ◽  
Care Of Elderly

At the heart of the rapidly growing American hospice movement is a philosophy of care that emphasizes patient individuality and responsiveness to total needs of the dying and their families. To date, the response to this model of terminal care has been favorable. The hospice is viewed as a humanizing mode of health care with a capacity to enhance the quality of life experienced by persons defined as terminal. Data gleaned from participant observation in an American hospice program by one of the authors supports this view. The hospice has the potential to provide a social context for humane, personalized death in which maximum effort can be made to control pain in all its forms: physical, psychological, social, and spiritual. Sociological literature has been much harsher in its assessment of the quality of life in nursing homes. Such discussions frequently include references to nursing home environments as fostering loss of autonomy and social death. This paper suggests that the hospice approach to care of the dying includes several elements that can be utilized to improve the quality of life in nursing homes: a total needs emphasis, increased patient autonomy, open discussion of death, a community ideology, a team orientation that cuts across levels of staff hierarchy, a role blurring of caregivers, focus on patients and families as the unit of care, and mutually beneficial integration of hospice with the outside community. There are, however, crucial differences between a hospice and a nursing home which may hamper direct transference of humanizing hospice principles, e.g., hospice patients are defined as terminal; staff, thus, can be motivated to put forth their best because of perceived time limits. There are also important differences in the characteristics of patient populations, length of stay, economic constraints, ability to attract volunteers, and emphasis on task-orientation. The time has come to apply increased ingenuity to adapting humanizing hospice principles to the care of elderly in nursing homes.

Uitbraak COVID-19 in de verpleeghuiszorg

2020 ◽  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Informal Caregivers ◽  
Rapid Review ◽  
Daily Routine ◽  
Term Care ◽  
Care Facilities

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study. Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems. The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.

Predictors of Mortality in Board and Care Homes

1997 ◽  
Vol 36 (1) ◽  
pp. 77-87 ◽  
Author(s):  
Nicholas G. Castle
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Social Services ◽  
Long Term Care ◽  
Significant Proportion ◽  
The Elderly ◽  
Term Care ◽  
Care Facilities ◽  
Board And Care

Long-term care institutions have emerged as dominant sites of death for the elderly. However, studies of this trend have primarily examined nursing homes. The purpose of this research is to determine demographic, functional, disease, and facility predictors and/or correlates of death for the elderly residing in board and care facilities. Twelve factors are found to be significant: proportion of residents older than sixty-five years of age, proportion of residents who are chair- or bed-fast, proportion of residents with HIV, bed size, ownership, chain membership, affiliation with a nursing home, number of health services provided other than by the facility, the number of social services provided other than by the facility, the number of social services provided by the facility, and visits by Ombudsmen. These are discussed and comparisons with similar studies in nursing homes are made.

scholarly journals A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial

2021 ◽  
pp. 1-13
Author(s):  
Julie L. O’Sullivan ◽  
Sonia Lech ◽  
Paul Gellert ◽  
Ulrike Grittner ◽  
Jan-Niklas Voigt-Antons ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Nursing Home ◽  
Nursing Homes ◽  
Psychotropic Medication ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Objectives: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. Design: Cluster-randomized controlled trial. Setting: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). Participants: N = 162 residents with dementia. Intervention: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. Measurements: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer’s Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. Results: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI −3.54, 2.33 for TBI and .36 points, 95% CI −3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen’s d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. Conclusions: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

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