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Factors associated with perceptions of dignity and well‐being among older people living in residential care facilities in Sweden. A national cross‐sectional study
Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing.
Dalarna University, School of Information and Engineering, Statistics.ORCID iD: 0000-0002-3183-3756
Dalarna University, School of Health and Welfare, Caring Science/Nursing.ORCID iD: 0000-0001-8069-9402
Division of Nursing Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden;Theme Inflammation and Ageing, Unit Nursing Ageing Karolinska University Hospital Huddinge Sweden;Research and Development UnitStockholms Sjukhem Stockholm Sweden.ORCID iD: 0000-0002-9421-3941
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2022 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 30, no 5, p. e2350-e2364Article in journal (Refereed) Published
Abstract [en]

The care of older people living in residential care facilities (RCFs) should promote dignity and well-being, but research shows that these aspects are lacking in such facilities. To promote dignity and well-being, it is important to understand which associated factors to target. The aim of this study was to examine the associations between perceived dignity and well-being and factors related to the attitudes of staff, the care environment and individual issues among older people living in RCFs. A national retrospective cross-sectional study was conducted in all RCFs for older people within 290 municipalities in Sweden. All older people 65 years and older (n = 71,696) living in RCFs in 2018 were invited to respond to the survey. The response rate was 49%. The survey included the following areas: self-rated health, indoor-outdoor-mealtime environment, performance of care, attitudes of staff, safety, social activities, availability of staff and care in its entirety. Data were supplemented with additional data from two national databases regarding age, sex and diagnosed dementia. Descriptive statistics and ordinal logistic regression models were used to analyse the data. Respondents who had experienced disrespectful treatment, those who did not thrive in the indoor-outdoor-mealtime environment, those who rated their health as poor and those with dementia had higher odds of being dissatisfied with dignity and well-being. To promote dignity and well-being, there is a need to improve the prerequisites of staff regarding respectful attitudes and to improve the care environment. The person-centred practice framework can be used as a theoretical framework for improvements, as it targets the prerequisites of staff and the care environment. As dignity and well-being are central values in the care of older people worldwide, the results of this study can be generalised to other care settings for older people in countries outside of Sweden.

Place, publisher, year, edition, pages
2022. Vol. 30, no 5, p. e2350-e2364
Keywords [en]
care environment; dignity; older people; person-centred care; person-centred practice framework; residential care facility; well-being
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:du-39056DOI: 10.1111/hsc.13674ISI: 000727785800001PubMedID: 34877717Scopus ID: 2-s2.0-85120697563OAI: oai:DiVA.org:du-39056DiVA, id: diva2:1620340
Available from: 2021-12-15 Created: 2021-12-15 Last updated: 2023-03-17Bibliographically approved
In thesis
1. Promoting dignity and well-being in residential care facilities: Older persons’ perceptions and experiences of important aspects and associated factors
Open this publication in new window or tab >>Promoting dignity and well-being in residential care facilities: Older persons’ perceptions and experiences of important aspects and associated factors
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objective: The overall aim of this thesis was to increase knowledge regarding the perceptions and experiences of aspects and factors associated with perceived dignity and well-being among older persons living in residential care facilities. Study I describes residents’ perceptions and experiences regarding important aspects of experiencing dignity and well-being. Study II examines the associations between perceptions of dignity and well-being and the attitudes of staff, the indoor-outdoor-mealtime environments and individual factors for residents. Study III examines the same associations as Study II over a three-year period. Study IV examines residents’ perceptions of empowerment, person-centred climate and life satisfaction before and after a caregiver intervention concerning the Swedish national fundamental values of dignity and well-being. 

Methods: The studies were performed in residential care facilities in Sweden. The participants were residents living in these facilities. Study I is a qualitative study that used semi-structured interviews to collect data. Data were analysed using qualitative content analysis. Study II, a cross-sectional study, and Study III, a longitudinal study, are based on national questionnaire data from the Swedish National Board of Health and Welfare. Data from 2016, 2017 and 2018 were used and analysed using descriptive statistics and ordinal logistic regression models. Study IV is a cluster-randomized controlled trial with a pre-and post-test design. Data were collected using the Patient Empowerment Scale, the Person-centred Climate Questionnaire – patient version, the Life Satisfaction Questionnaire and the EQ-5D questionnaire. Data were analysed using descriptive statistics, the Chi-square test, the Wilcoxon signed-rank test, the Mann-Whitney U test and generalized estimating equation models.

Findings: To experience dignity and well-being it was important for residents to feel that they still matter. To feel this, it was vital to be able to manage daily life, to have influence and to belong to a social context (I). Residents who had experienced disrespectful attitudes of staff, who did not thrive in the indoor-outdoor-mealtime environments, who rated their health and mobility as poor, and who were diagnosed with dementia had higher odds of being dissatisfied with aspects of dignity and well-being (II). These associations were persistent over a three-year period (III). After an intervention concerning the Swedish national fundamental values of dignity and well-being, the residents in the intervention group reported higher scores for perceived empowerment, person-centred climate and life satisfaction (IV).

Conclusion: To promote dignity and well-being, the attitudes of staff, the indoor-outdoor-mealtime environments and the individual factors of poor health, poor mobility and a dementia diagnosis need to be targeted. The Person-centred practice framework, targeting the prerequisites of staff and the care environment, could be used as a theoretical framework for designing improvement strategies that aim to promote dignity and well-being. First-line managers and registered nurses in residential care facilities have different knowledge and skills. They therefore need to work together as a team when developing improvement strategies that aim to promote the dignity and well-being of residents. In addition, residents should be included on the team given their knowledge regarding what is important for promoting dignity and well-being.

Place, publisher, year, edition, pages
Falun: Dalarna University, 2022
Series
Dalarna Doctoral Dissertations ; 19
Keywords
dignity, intervention, older persons, person-centred care, person-centred practice framework, residential care facilities, well-being
National Category
Nursing
Identifiers
urn:nbn:se:du-39632 (URN)978-91-88679-34-5 (ISBN)
Public defence
2022-04-22, FÖ6, Falun, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2022-03-18 Created: 2022-02-21 Last updated: 2023-08-17Bibliographically approved

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Roos, CharlotteAlam, MoududSwall, AnnaMarmstål Hammar, Lena

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