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Factors associated with older persons’ perceptions of dignity and well-being over a three-year period: A retrospective national study in residential care facilities
Dalarna University, School of Health and Welfare, Caring Science/Nursing. Dalarna University, School of Health and Welfare, Care Sciences.
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.
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2022 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 22, no 1, article id 515Article in journal (Refereed) Published
Abstract [en]

Background: Dignity and well-being are central concepts in the care of older people, 65 years and older, world‑wide. The person-centred practice framework identifes dignity and well-being as person-centred outcomes. Older persons living in residential care facilities, residents, have described that they sometimes lack a sense of dignity and well-being, and there is a need to understand which modifable factors to target to improve this. The aim of this study was to examine the associations between perceptions of dignity and wellbeing and the independent variables of the attitudes of staf, the indoor-outdoor-mealtime environments, and individual factors for residents over a three-year period.

Methods: A national retrospective longitudinal mixed cohort study was conducted in all residential care facilities within 290 municipalities in Sweden. All residents aged 65 years and older in 2016, 2017 and 2018 were invited to responded to a survey; including questions regarding self-rated health and mobility, the attitudes of staf, the indooroutdoor-mealtime environments, safety, and social activities. Data regarding age, sex and diagnosed dementia/pre‑scribed medication for dementia were collected from two national databases. Descriptive statistics and ordinal logistic regression models were used to analyse the data.

Results: A total of 13 763 (2016), 13 251 (2017) and 12 620 (2018) residents answered the survey. Most of them (69%) were women and the median age was 88 years. The odds for satisfaction with dignity did not difer over the three-year period, but the odds for satisfaction with well-being decreased over time. Residents who rated their health as good, who were not diagnosed with dementia/had no prescribed medication for dementia, who had not experienced disrespectful attitudes of staf and who found the indoor-outdoor-mealtime environments to be pleasant had higher odds of being satisfed with aspects of dignity and well-being over the three-year period.

Conclusions: The person-centred practice framework, which targets the attitudes of staf and the care environment, can be used as a theoretical framework when designing improvement strategies to promote dignity and well-being. Registered nurses, due to their core competencies, focusing on person-centred care and quality improvement work, should be given an active role as facilitators in such improvement strategies.

Place, publisher, year, edition, pages
2022. Vol. 22, no 1, article id 515
Keywords [en]
Dignity, Long‑term care, Older persons, Person‑centred care, Person‑centred practice framework, Residential care facilities, Well‑being
National Category
Nursing
Identifiers
URN: urn:nbn:se:du-41706DOI: 10.1186/s12877-022-03205-1ISI: 000815083800002PubMedID: 35739497Scopus ID: 2-s2.0-85132572700OAI: oai:DiVA.org:du-41706DiVA, id: diva2:1675677
Funder
Dalarna UniversityAvailable from: 2022-06-23 Created: 2022-06-23 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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