Autonomy in nursing homes:Viewpoints of residents with physical impairments and staff

Introduction: Although the importance of maintaining autonomy for nursing home residents is recognised, little is known about this process in daily practice. Aim: The aim was to explore how residents maintain autonomy and how staff acts in relation to the autonomy of residents. Method: Shadowing, a non-participative observational method, including a short interview at the end, was used. Seventeen residents with physical impairments living in two different nursing homes were shadowed in their own environment during daily activities. Moreover, fifteen staff members, working in the same nursing homes, were shadowed. Field notes of the shadowing were typed out and the recorded interviews were transcribed verbatim resulting in a report per respondent. These were coded and thematically analysed. Results: Residents maintained autonomy by; ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. Four activities of staff were identified; ‚getting to know each older adult as a person and responding to her/his needs‘, ‚encouraging an older adult to self-care‘, ‚stimulating an older adult to make choices‘ and ‚being aware of interactions‘. Discussion and Conclusion: Maintaining autonomy requires effort from both residents and staff. Although most residents with physical impairments experience restrictions in their autonomy because of the care-environment they live in, residents seemed to maintain autonomy in daily life. Moreover, staff consider it important to strengthen the autonomy of residents and use different activities to enhance autonomy. Relevance for research and practice: These insights help to improve autonomy of nursing home residents because the perspectives of both residents and staff are included. Therefore, the next step is to transfer these insights towards nursing home practice in such a way that it enhances staff and older adults to better maintain autonom

Identifying sources of strength: resilience from the perspective of older people receiving long-term community care

This study seeks to explore the sources of strength giving rise to resilience among older people. Twenty-nine in-depth interviews were conducted with older people who receive long-term community care. The interviews were subjected to a thematic content analysis. The findings suggest that the main sources of strength identified among older people were constituted on three domains of analysis; the individual-, interactional and contextual domain. The individual domain refers to the qualities within older people and comprises of three sub-domains, namely beliefs about one’s competence, efforts to exert control and the capacity to analyse and understand ones situation. Within these subdomains a variety of sources of strength were found like pride about ones personality, acceptance and openness about ones vulnerability, the anticipation on future losses, mastery by practising skills, the acceptance of help and support, having a balanced vision on life, not adapting the role of a victim and carpe-diem. The interactional domain is defined as the way older people cooperate and interact with others to achieve their personal goals. Sources of strength on this domain were empowering (in)formal relationships and the power of giving. Lastly, the contextual domain refers to a broader political-societal level and includes sources of strength like the accessibility of care, the availability of material resources and social policy. The three domains were found to be inherently linked to each other. The results can be used for the development of positive, proactive interventions aimed at helping older people build on the positive aspects of their lives

Wanneer voel je je thuis?: op zoek naar het thuisgevoel van mensen met dementie

Het is zo belangrijk: je thuis voelen in je eigen huis. Maar thuisgevoel is ook een lastig te omschrijven begrip, zeker voor mensen met dementie. Om zicht te krijgen op wat het thuisgevoel van mensen met dementie inhoudt, hebben onderzoekers van Fontys Hogescholen een kleinschalig onderzoekproject uitgevoerd waarbij gebruikgemaakt werd van een creatieve werkvorm: het zogeheten ‘moodboard’. Ondanks het toenemend aantal kwetsbare ouderen dat in de toekomst zelfstandig thuis zal blijven wonen, zullen verpleeghuizen naar verwachting belangrijke woonzorgvormen blijven. Dan zal er echter wel wat moeten veranderen, want momenteel is verblijf in een verpleeghuis voor veel mensen nu niet bepaald een ideaal van de oude dag. Nederlandse verpleeghuizen hebben een negatief imago en worden te vaak gezien als kille, steriele gebouwen waar weinig tijd is voor persoonlijke aandacht. Daarom is het belangrijk dat bij de (ver)bouw van verpleeghuizen rekening wordt gehouden met wat mensen het gevoel geeft ergens thuis te zijn. Om hier meer zicht op te krijgen is binnen het nieuwe meerjarige project van Fontys Hogescholen – ‘Verpleeghuis van de Toekomst’ (VETO) geheten – onderzoek gedaan naar wat dit thuisgevoel voor bewoners met dementie inhoudt

Balancing risk prevention and health promotion: Towards a harmonizing approach in care for older people in the community

Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the pathways that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others’ perspective, and have a dialogue with each other, taking the life narrative of clients into account. Keywords: Health promotion, Risk prevention, Narratives, Older people, Salutogenesis, Sense of coherenc

Autonomy in nursing homes: Viewpoints of residents with physical impairments and staff

Introduction: Although the importance of maintaining autonomy for nursing home residents is recognised, little is known about this process in daily practice. Aim: The aim was to explore how residents maintain autonomy and how staff acts in relation to the autonomy of residents. Method: Shadowing, a non-participative observational method, including a short interview at the end, was used. Seventeen residents with physical impairments living in two different nursing homes were shadowed in their own environment during daily activities. Moreover, fifteen staff members, working in the same nursing homes, were shadowed. Field notes of the shadowing were typed out and the recorded interviews were transcribed verbatim resulting in a report per respondent. These were coded and thematically analysed. Results: Residents maintained autonomy by; ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. Four activities of staff were identified; ‚getting to know each older adult as a person and responding to her/his needs‘, ‚encouraging an older adult to self-care‘, ‚stimulating an older adult to make choices‘ and ‚being aware of interactions‘. Discussion and Conclusion: Maintaining autonomy requires effort from both residents and staff. Although most residents with physical impairments experience restrictions in their autonomy because of the care-environment they live in, residents seemed to maintain autonomy in daily life. Moreover, staff consider it important to strengthen the autonomy of residents and use different activities to enhance autonomy. Relevance for research and practice: These insights help to improve autonomy of nursing home residents because the perspectives of both residents and staff are included. Therefore, the next step is to transfer these insights towards nursing home practice in such a way that it enhances staff and older adults to better maintain autonom