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Promoting dignity and well-being in residential care facilities: Older persons’ perceptions and experiences of important aspects and associated factors
Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing.ORCID iD: 0000-0003-4449-2417
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 [en]
dignity, intervention, older persons, person-centred care, person-centred practice framework, residential care facilities, well-being
National Category
Nursing
Identifiers
URN: urn:nbn:se:du-39632ISBN: 978-91-88679-34-5 (print)OAI: oai:DiVA.org:du-39632DiVA, id: diva2:1639500
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
List of papers
1. Promoting the person-centred aspects of dignity and well-being: learning from older persons’ experiences of living in residential care facilities
Open this publication in new window or tab >>Promoting the person-centred aspects of dignity and well-being: learning from older persons’ experiences of living in residential care facilities
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2023 (English)In: Working with Older People, ISSN 1366-3666, E-ISSN 2042-8790, Vol. 27, no 3, p. 219-229Article in journal (Refereed) Published
Abstract [en]

Purpose – Dignity and well-being are key aspects of the legislation and policies that regulate care of olderpersons worldwide. In addition, care of older persons should be person-centred. Dignity and well-being aredescribed as results of person-centred care (PCC). The purpose of this study was to gain an understanding ofimportant aspects for older persons to experience dignity and well-being in residential care facilities (RCFs).

Design/methodology/approach – This study had a qualitative approach, and individual semi-structuredinterviews were conducted with 20 older persons living in RCFs. Data were analysed using inductive contentanalysis.

Findings – To experience dignity and well-being older persons emphasized the importance ofpreserving their identity. To do this, it was important to be able to manage daily life, to gain support andinfluence and to belong to a social context. However, the findings indicate a need for improvements.

Practical implications – Insights into older persons’ experiences of important aspects for experiencingdignity and well-being in RCFs can be used by first-line managers and registered nurses when designingimprovement strategies to promote PCC.

Originality/value – Dignity and well-being are described as results of PCC. The findings provide anunderstanding of what older persons perceive as important for experiencing dignity and well-being inRCFs. The findings are useful when designing improvement strategies to promote PCC.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2023
Keywords
Care, Dignity, Older persons, Person-centred care, Person-centred practice framework, Residential care facility, Well-being, Residential care
National Category
Nursing
Identifiers
urn:nbn:se:du-42824 (URN)10.1108/wwop-08-2022-0034 (DOI)2-s2.0-85137680136 (Scopus ID)
Note

Tidigare version, i manusform, med titeln “'I want to be treated like I still matter': older persons' perceptions and experiences regarding important aspects of experiencing dignity and well-being in residential care facilities" inkluderad som paper i doktorsavhandling "Promoting dignity and well-being in residential care facilities: Older persons’ perceptions and experiences of important aspects and associated factors" (http://urn.kb.se/resolve?urn=urn:nbn:se:du-39632)

Available from: 2022-10-13 Created: 2022-10-13 Last updated: 2023-09-18Bibliographically approved
2. Factors associated with perceptions of dignity and well‐being among older people living in residential care facilities in Sweden. A national cross‐sectional study
Open this publication in new window or tab >>Factors associated with perceptions of dignity and well‐being among older people living in residential care facilities in Sweden. A national cross‐sectional study
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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.

Keywords
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:nbn:se:du-39056 (URN)10.1111/hsc.13674 (DOI)000727785800001 ()34877717 (PubMedID)2-s2.0-85120697563 (Scopus ID)
Available from: 2021-12-15 Created: 2021-12-15 Last updated: 2023-03-17Bibliographically approved
3. Factors associated with older persons’ perceptions of dignity and well-being over a three-year period: A retrospective national study in residential care facilities
Open this publication in new window or tab >>Factors associated with older persons’ perceptions of dignity and well-being over a three-year period: A retrospective national study in residential care facilities
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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.

Keywords
Dignity, Long‑term care, Older persons, Person‑centred care, Person‑centred practice framework, Residential care facilities, Well‑being
National Category
Nursing
Identifiers
urn:nbn:se:du-41706 (URN)10.1186/s12877-022-03205-1 (DOI)000815083800002 ()35739497 (PubMedID)2-s2.0-85132572700 (Scopus ID)
Funder
Dalarna University
Available from: 2022-06-23 Created: 2022-06-23 Last updated: 2023-03-17Bibliographically approved
4. An intervention targeting fundamental values among caregivers at residential facilities: effects of a cluster-randomized controlled trial on residents’ self-reported empowerment, person-centered climate and life satisfaction
Open this publication in new window or tab >>An intervention targeting fundamental values among caregivers at residential facilities: effects of a cluster-randomized controlled trial on residents’ self-reported empowerment, person-centered climate and life satisfaction
2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, no 1, article id 130Article in journal (Refereed) Published
Abstract [en]

Background: In Sweden the national fundamental values for care of older people state that care should ensure that they can live in dignity and with a sense of well-being. Our hypothesis was that a caregiver intervention targeting the national fundamental values would improve perceived empowerment, person-centered climate and life satisfaction among older people living in residential facilities.

Methods: The study was a cluster-randomized controlled trial with a pre- and one post-test design, conducted in 27 units (17 study units) at 12 residential facilities for older people in five municipalities in central Sweden. The units in each municipality were randomly assigned to intervention or control group. The caregiver intervention was carried out using an interpretative approach with eight guided face-to-face seminars, where self-reflection and dialogue were used. Data were collected using questionnaires. The number of residents was 43 (78 %) in the intervention group and 37 (71 %) in the control group. The Chi-square test and Mann-Whitney U-tests were performed to detect differences between groups and Wilcoxon signed rank tests to explore differences in change over time within groups. Furthermore, generalized estimating equation (GEE) models were used to study effects of the intervention controlling for clustering effects.

Results: Primary outcome measures were empowerment, person-centered climate and life satisfaction. In the intervention group, improvements at follow-up were found in residents’ self-reported empowerment (n = 42; p = 0.001, Median difference 4.0, 95 % CI 1.5;6.0), person-centered climate (n = 42; p ≤0.001, Median difference 8.0, 95 % CI 4.5;11. 4) and life satisfaction regarding the factor quality of everyday activities (n = 40; p = 0.033, Median difference 9.7, 95 % CI 1.0;21.9) while disempowerment decreased (n = 43; p = 0.018, Median difference -1.3, 95 % CI -2.0;0.0). In the control group person-centered climate decreased (n = 37; p = 0.002, Median difference -8.5, 95 % CI -13.6;-3.0) and quality of everyday activities (n = 36; p = 0.012, Median difference -11.6, 95 % CI-21.7;-3.4). Change over time between groups was significant for empowerment (p = 0.001, Median difference 6.0, 95 % CI 3.0;9.0), disempowerment (p = 0.006, Median difference -2.0, 95 % CI -4.0;-1.0) and person-centered climate (p ≤ 0.001, Median difference 16.0, 95 % CI 9.7;23.0) and for life satisfaction regarding the factor quality of everyday activities (p = 0.002, Median difference 22.1, 95 % CI 8.2;37.4). Results of GEE confirmed earlier results; revealed interaction effects for empowerment (parameter estimate -5.0, 95 % CI -8.3;-1.8), person-centered climate (parameter estimate -16.7, 95 % CI -22.4;-10.9) and life satisfaction regarding the factor quality of everyday activities (parameter estimate -25.9, 95 % CI -40.3;-11.5).

Conclusion: When the Swedish national fundamental values were put into practice increases in empowerment, person-centered climate and quality of everyday activities were found among older people with intact cognitive ability living in residential facilities. Limitations to consider are the differences between the two groups at baseline, drop-outs and that neither the data collector nor the outcome assessors were blinded to group assignment of participants. 

Keywords
Empowerment, Experimental design, Living in dignity, Person-centered climate, Residential facilities for older people, A sense of well-being, Life satisfaction
National Category
Nursing
Identifiers
urn:nbn:se:du-39631 (URN)10.1186/s12877-016-0306-2 (DOI)
Funder
University of Gävle
Available from: 2022-02-21 Created: 2022-02-21 Last updated: 2022-02-23Bibliographically approved

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