If dependency makes vulnerable: Nursing home residents' claims for dignity-conserving nursing care - A narrative literature review Abstract. Introduction: Due to an increase in the very old population, it is important to know what is needed in order to support older people's needs regarding dignity-conserving nursing care when living in a nursing home. Aim: The aim of this article is to gather information on how nursing home residents feel respected and protected in regards of their dignity. Methods: A narrative literature review was conducted in the databases CINAHL Complete and PubMed. Six qualitative studies met the inclusion criteria and were compared regarding similarities. Results: The protection of dignity is jeopardized not only by the residents' dependency, but also by nurses, social environment, and society. To protect their own dignity, residents wanted to be perceived as individuals and be treated with respect. Additionally, they wanted to be as independent as possible and take part in meaningful activities. Discussion: Facilitation of staff members as well as flat, peripheral leadership structures are important in order to protect the residents' dignity. The residents' needs regarding social and societal participation has been additionally challenged due to the Covid-19 pandemic. At the same time, the pandemic enforced innovations that may help protect nursing home residents' dignity. Conclusions: These findings can help nurses to protect the dignity of nursing home residents in their daily lives and in the implementation of care measures.

https://digitalcollection.zhaw.ch/bitstream/11475/26899/2/2023_Widmer-etal_Wenn-Abhaengigkeit-verletzlich-macht_akzeptiertesManuskript.pdf

[If dependency makes vulnerable: Nursing home residents' claims for dignity-conserving nursing care - A narrative literature review].


The small house model of long-term care (LTC) is identified internationally by several model names. Although some differences exist between the characteristics of these models (e.g., number of residents, degree of resident freedom, facility design), there are 3 recurring components: functional units with a small group of residents, replication of familiar domestic routines, and some form of decentralized staff. 
The key philosophic difference between the small house model and the traditional LTC model is the heavy focus on person-centred care. This approach to care in the small house model is firmly rooted in freedom of choice and autonomy for the residents. 
Small house models eliminate the strict delineation of roles; staff at all levels are included in the decision-making process. Self-managed and universal work teams are prominent features of the small house model. Frontline staff with strong interpersonal skills are essential for successful implementation. 
No strong trend emerges from the literature with respect to the impact of the small house model on resident-centred outcomes compared with more traditional models of LTC. This is likely due to lack of consistency in the outcomes that are measured and variability among the different small house models. This finding is consistent with other reviews on the topic. 
Literature exploring the Canadian experience with small house models is limited. The majority of identified studies used data from the US or European jurisdictions, which potentially limits its generalizability to the Canadian context. 


The Small House Model to Support Older Adults in Long-Term Care

Long term care for older people is a highly regulated sector providing accommodation, health, and social care to vulnerable older adults. Older adults in New Zealand are among the highest users of long term care services globally. Traditionally those requiring specialist care for dementia are housed apart from other residents. In an example of organizational innovation, 1 provider relocated residents to a secure village where residents requiring specialist dementia care would be desegregated. We utilized a critical realist case study to explain the role of intersectoral collaboration among government agencies in supporting the transition while managing risk and ensuring regulatory compliance

https://journals.sagepub.com/doi/pdf/10.1177/00469580221144079

Organizational Innovation in Long Term Care Enabled by Collaboration Between Government Agencies: A Critical Realist Case Study

Zusammenfassung. Einleitung: Aufgrund der zunehmenden Hochaltrigkeit ist es wichtig in Erfahrung zu bringen, was es braucht, damit Menschen nach einem Umzug in ein Pflegeheim ein würdevolles Leben führen können. Ziel: Diese Arbeit will die Bedürfnisse von Pflegeheimbewohnenden erfassen, um herauszufinden, wie sie sich in ihrer Würde respektiert und geschützt fühlen. Methode: Es wurde ein narrativer Literaturreview in den Datenbanken CINAHL Complete und PubMed durchgeführt und sechs qualitative Studien eingeschlossen, deren Ergebnisse hinsichtlich gemeinsamer Themen einander gegenübergestellt wurden. Ergebnisse: Der Schutz der Würde wird nicht nur durch die Abhängigkeit der Bewohnenden bedroht, sondern auch durch das Pflegepersonal, das soziale Umfeld und die Gesellschaft. Bewohnenden war es wichtig, als individuelle Person angesehen und respektvoll behandelt zu werden, möglichst selbstständig und unabhängig zu sein und an bedeutungsvollen Aktivitäten teilzuhaben. Diskussion: Förderung der Mitarbeitenden sowie flache, dezentrale Führungsstrukturen sind zum Schutz der Würde von Bewohnenden wichtig. Bedürfnisse wie soziale und gesellschaftliche Teilhabe wurden durch die Covid-19-Pandemie zusätzlich bedroht. Gleichzeitig brachte die Pandemie Innovationen hervor, die den Schutz der Würde von Pflegeheimbewohnenden stärken können. Schlussfolgerung: Diese Erkenntnisse helfen dem Pflegepersonal im Umgang mit Bewohnenden, im Pflegeheimalltag und während den Pflegehandlungen deren Würde zu schützen.

/pdf/wenn-abhangigkeit-verletzlich-macht-anspruche-von-1s4u5s6g.pdf

Wenn Abhängigkeit verletzlich macht: Ansprüche von Pflegeheimbewohnenden an eine würdevolle Pflege

Context: Residents experiencing pain, anxiety, and distressing behaviours, often in conjunction with mental health diagnoses and dementia, can be challenging for staff in long-term care facilities and may result in jeopardising resident and staff safety, quality of life, staff delivery of care, and overuse of psychotropic medications. Objective: Describe the effects of three holistic interventions (hand portion of the &lsquo;M&rsquo; Technique&reg;, aromatherapy, and energy healing) to reduce pain, anxiety, and distressing behaviours in long-term care residents. Method: Pragmatic secondary analysis of pre- and post-intervention quantitative and qualitative data. Findings: Staff administered a total of 363 individual sessions using the &lsquo;M&rsquo; Technique&reg; for hands, aromatherapy, and/or energy healing to 75 residents who were able to indicate their pain and/or anxiety levels before and after a session. Results indicate significant differences in decreased pain by session, decreased anxiety by session, decreased pain by person, and decreased anxiety by person. Qualitative results, primarily gathered from an additional 1,024 sessions in which residents were unable to use pain and anxiety scales, indicate a decrease in distressing behaviours and overall improvement of milieu. Limitations: We collected data as part of a quality improvement programme without the intent of being published as a research study. It is difficult to assess the reliability and validity of self-reported quantitative pain and anxiety scales for people with dementia. Implications: Holistic interventions, including the &lsquo;M&rsquo; Technique for hands, aromatherapy, and/or energy healing, show promise in reducing pain, anxiety, and distressing behaviours in residents of long-term care facilities, along with improvements in the facilities&rsquo; environment. 

/pdf/holistic-interventions-to-address-pain-anxiety-and-ugurnfjk.pdf

Holistic Interventions to Address Pain, Anxiety, and Distressing Behaviours in Long-Term Care Residents

Transforming nursing homes (NHs) from restrictive institutions to person-centered homes, referred to as NH culture change, is complex and multifaceted. This study, based on a survey of administrato...

https://journals.sagepub.com/doi/pdf/10.1177/01640275211012652

Yinfei Duan

Papers

The Relationships of Nursing Home Culture Change Practices With Resident Quality of Life and Family Satisfaction: Toward a More Nuanced Understanding.