Dignity in relationships and existence in nursing homes’ cultures

Introduction: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. Background: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of existence, as well as compassion in relieving suffering, and ontological interdependency. Aim: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. Research design: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. Participants and research context: Focus group interviews with caregivers in nursing homes. Ethical considerations: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. Findings: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. Discussion: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. Conclusions: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others.publishedVersio

Family Caregivers' Experiences in Nursing Homes: Narratives on Human Dignity and Uneasiness

This qualitative study focused on dignity in nursing homes from the perspective of family caregivers. Dignity is a complex concept and central to nursing. Dignity in nursing homes is a challenge, according to research. Family caregivers are frequently involved in their family members’ daily experiences at the nursing home. Twenty-eight family caregivers were included in this Scandinavian cross-country, descriptive, and explorative study. A phenomenological-hermeneutic approach was used to understand the meaning of the narrated text. The interpretations revealed two main themes: “One should treat others as one would like others to treat oneself” and “Uneasiness due to indignity.” Dignity was maintained in experiences of respect, confidence, security, and charity. Uneasiness occurred when indignity arose. Although family caregivers may be taciturn, their voices are important in nursing homes. Further investigation of family caregivers’ experiences in the context of nursing homes is warranted

Maintaining dignity in vulnerability : A qualitative study of the residents' perspective on dignity in nursing homes

Author's accepted version (post-print)

Dignity and existential concerns among nursing homes residents from the perspective of their relatives

Aims and objectives: The aim of this cross-country Scandinavian study was to explore how residents in nursing homes experience that their dignity is promoted and attended to. This is one part of the Scandinavian project in which we interviewed residents, relatives and staff members. Background: The main subject concerns the dignity of residents of nursing homes for older people. This article brings forward results from interviews of relatives on how they experience that the dignity is met, promoted and attended to for their next of kin. Design: The study was qualitative with a hermeneutic approach. Methods: Qualitative research interviews of 28 relatives of residents at six participating nursing homes in Scandinavia. The results derive from analysis of the interviews using Kvale’s three levels of interpretation; self-understanding, common sense and a theoretical understanding. Results: The following themes emerged, from the perspective of the relatives, concerning what was deemed important to the resident according his existential needs and concerns: a). To have a comfortable, homely and practical room. b). To have close contact with family, friends and with the staff. c). To have aesthetic needs and concerns attended to. d). To have ethical needs and intrinsic values attended to. e). To have cultural and spiritual needs and concerns attended to. Conclusion: The results provide more substance to the theme and are all important in terms of the residents’ feeling of worthiness and dignity. In general it seemed that the relatives experienced a positive encounter with the staff, but it was also mentioned that staff members were not confronted about episodes that were undignified and disgraceful. This could be a sign or expression that they were worried that negative responses or complaints could lead to a kind of reprisal against the resident and to indignit

Causes of Patient Nonattendance at Medical Appointments: Protocol for a Mixed Methods Study

BackgroundApproximately one-third of patient appointments in Danish health care result in failures, leading to patient risk and sizable resource waste. Existing interventions to alleviate no-shows often target the patients. The underlying reason behind these interventions is a view that attendance or nonattendance is solely the patient’s problem. However, these interventions often prove to be ineffective and can perpetuate social biases and health inequalities, leaving behind patients who are more vulnerable or disadvantaged (in terms of social, economical, and linguistic factors, etc). A more holistic understanding of no-shows is needed to optimize processes, reduce waste, and support patients who are vulnerable. ObjectiveThis study aims to gain a deep and more comprehensive understanding of the causes, mechanisms, and recurring patterns and elements contributing to nonattendance at Danish hospitals in the Region of Southern Denmark. It emphasizes the patient perspective and analyzes the relational and organizational processes surrounding no-shows in health care. In addition, the study aims to identify effective communicative strategies and organizational processes that can support the development and implementation of successful interventions. MethodsThe study uses mixed quantitative-qualitative methods, encompassing 4 analytical projects focusing on nonattendance patterns, patient knowledge and behavior, the management of hospital appointments, and in situ communication. To address the complexity of no-shows in health care, the study incorporates various data sources. The quantitative data sources include the electronic patient records, Danish central registries, Danish National Patient Registry, and Register of Medicinal Product Statistics. Baseline characteristics of patients at different levels are compared using chi-square tests and Kruskal-Wallis tests. The qualitative studies involve observational data, individual semistructured interviews with patients and practitioners, and video recordings of patient consultations. ResultsThis paper presents the protocol of the study, which was funded by the Novo Nordisk Foundation in July 2022. Recruitment started in February 2023. It is anticipated that the quantitative data analysis will be completed by the end of September 2023, with the qualitative investigation starting in October 2023. The first study findings are anticipated to be available by the end of 2024. ConclusionsThe existing studies of nonattendance in Danish health care are inadequate in addressing relational and organizational factors leading to hospital no-shows. Interventions have had limited effect, highlighting the Danish health care system’s failure to accommodate patients who are vulnerable. Effective interventions require a qualitative approach and robust ethnographic data to supplement the description and categorization of no-shows at hospitals. Obtaining comprehensive knowledge about the causes of missed patient appointments will yield practical benefits, enhancing the safety, coherence, and quality of treatment in health care. International Registered Report Identifier (IRRID)PRR1-10.2196/4622

Access to effective healthcare: effective self-management support for patients with a chronic condition and a low social economic status: a systematic review

Background: access to effective healthcare is in particular challenging for vulnerable and socially disadvantaged patients. Patients with chronic conditions are over-represented in these lower socioeconomic (LSES) groups. No generic review integrating the evidence on Self-Management support interventions in LSES patients with different chronic conditions exists