Maintaining Continuity of Self by Recognition in Care Settings (original) (raw)
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Becoming a resident in a long-term care facility challenges older people’s continuity of self in two major ways. Firstly, as they leave behind their previous home, neighborhood, and often their social surroundings, older people have to change their life-long lifestyles, causing fears of the loss of one’s self. Secondly, modern-day care facilities have some features of ‘total’ institutions that produce patient-like role expectations and thus challenge older people’s selves. Our ethnographic study in a geriatric hospital and a sheltered home in Finland aims to find out what features of daily life either support or challenge older people’s continuity of self. A philosophical reading of the concept of recognition is used to explore how various daily practices and interactions support recognizing people as persons in long-term care. Categories of institution-centered and person-centered features are described to illustrate multiple ways in which people are recognized and misrecognized. The discussion highlights some ways in which long-term care providers could use the results of the study.
Ten Forms of Recognition and Misrecognition in Long-Term Care for Older People
Sats, 2018
During last decades, theories of mutual recognition have been intensively debated in social philosophy. According to one of the main theorists in the field, Axel Honneth, the entire social world may be based on interpersonal recognition (such as mutual respect, esteem and care). Our aim is to study what it would take that residents in long-term care would become adequately interpersonally recognized. We also examine who could be seen as bearing the responsibility for providing such recognition. In this paper, we distinguish ten aspects of recognition. We suggest that in order to support residents' dignity, long-term care should be arranged in a way that preserves residents' full personhood regardless of their cognitive or other abilities: the mere fact that they are human persons is a ground for recognition as a person. But further, in good care residents' personal characteristics and residents' ties to significant others are also recognized to enable them to feel loved, esteemed and respected.
Resident-staff interactions: a challenge for quality residential aged care
Australasian Journal on Ageing, 2003
Objectives: This paper describes one facet of a study to develop and implement a “best practice model” of residential care for older people. The purpose of this facet of the larger study was to describe the current interactional context of a residential aged care facility.Method: A total of 2,848 observations of resident-staff interactions were made and coded according to Baltes' observational schedule. Coder inter-rater reliability was maintained at 90% (Cohen's Kappa).Results: Residents were alone 40% of the time they were observed. The dominant pattern of staff interaction with residents was to not engage in direct verbal or nonverbal communication or physical contact. The dominant response by staff to resident independence was to make no response. The dominant staff response to resident dependence was to support that dependence.Conclusions: Residential aged care practice continues to be focused on technology, and tasks and interactions between residents and staff continue to be dependency-supporting.
International Journal of Older People Nursing, 2010
The aim of this study was to explore 'patient participation' in everyday activities for persons with dementia living in special care units in nursing homes. Studies about how 'patient participation' appears in the context of special care units for persons with dementia are lacking. The study has an explorative design. Grounded theory was chosen. Data collection was carried out by means of open observations and additional conversations with residents and personnel. Simultaneously, data analysis was performed with open, axial and selective coding. The findings showed that 'patient participation' concerned 'A matter of presence' as the core category. The other categories described as 'presence of personnel' and 'presence of residents', were strongly connected to the core category as well as to each other. Presence of personnel comprised three levels; being there in body, which required physical presence; being there in mind, which required presence with all senses based on knowledge and competence; and being there in morality which was understood as being fully present, as it was based on humanistic values and included the two other levels. Presence of residents comprised 'ability and wish' and 'adaptation'. The presence of the personnel had a huge impact on the ability and will to participate of the residents. Organizational conditions concerning leadership, amount of personnel and routines as well as housing conditions concerning architecture and shared accommodation, could stimulate or hinder 'patient participation'. The study highlighted the great impact of the personnel's presence in body, mind and morality on the participation capacity of the residents. The great importance of the nurse leaders was stressed, as they were responsible for organizational issues and served as role models. Group supervision of the personnel and their leaders would be an implication to propose, as these kinds of reflection groups offer opportunities to reflect on values, actions and routines.
The assisted presentations of self in nursing home life
Social Science & Medicine, 2016
In this paper, based on ethnographic data from five nursing homes, we introduce the concept of assisted self-presentation as an analytical tool for exploring how different care practices affect nursing home residents' dignity and sense of self. Practices of assisted self-presentation are geared at recognizing and preserving the individuality and autonomy of residents in situations where it may otherwise come under threat or be misrecognized. Sufficient or appropriate forms of attentiveness to residents' selves and sense of dignity is thus a matter of finding the right balance between intervening too much or too little in residents' production of their physical or social appearance. Here, staff-members' knowledge and recognition of the individuality of residents is essential. Whereas intervening too much in residents' appearance or performance of self might be perceived and experienced as pacifying, infantilizing, or as paternalistic overbearingness, intervening too little might be seen as neglectfulness or inhumane. Since practices of assisted self-presentation refer to a kind of social action, which will always be contingent upon the specific capacities and conditions of performing actors, it allows for the simultaneous recognition of failed or perverted work practices as well as promising practices through which residents' selves are successfully recognized.
2013
hen things go wrong in the residential care of older people, individual workers may well be held responsible. This article investigates the organisational factors that are also at play, and that shape the practice of staff. Organisational factors include: z z Skill mix, training and numbers of staff z z Management and procedures z z Characteristics of the resident group z z Infrastructure of the organisation (for example, the building and its upkeep) z z Contextual factors (including organisational culture, and changes from outside the care home). The authors reviewed the literature about abuse and neglect in institutional care of older people and then carried out qualitative research in eight different care homes in different areas in England. Older people were actively involved in the research process as peer researchers and as members of an advisory panel so that the research would stay focused on their priorities. The authors found that although care homes faced similar pressures, demands and circumstances, these were dealt with differently in different homes. Good care can fluctuate quickly as one factor affects others. In some homes the responses of staff had helped to limit the problems caused by fluctuations. Organisational factors, however, could prevent people from providing good care. Recommendations for care homes were to pay close attention to how organisational factors could be interacting to affect care quality. Care homes should ask staff and residents for their insights to spot organisational problems. Individual issues could be tackled and staff encouraged and supported to adapt and innovate. Figure 3. Changing residents' needs and infrastructure problems at Iris House Adapt the building z z Changeinresidentpopulation z z Focusonmorecomplexphysicalneeds Care safety issues for staff z z Adaptationdesignproblems z z Populationchangesmorequicklythanthebuilding Fluctuation in care quality z z Staffinjured z z Increasingpressureonstaff Keypoints z z Goodqualitycaredependsonarangeoforganisationalfactors,which includeskillmix,trainingandnumbersofstaff;managementand procedures;characteristicsoftheresidentgroup;infrastructureofthe organisation;contextualfactors z z Organisationalfactorsinteracttoenhanceorobstructthequalityofcare thatstaffcanprovide z z Residents,relativesandstaffoftenhavekeyinsightsaboutorganisational problems z z Clearexpectationsofgoodcaremightbeunderminedbyorganisational dynamics,butcanhelpresidents,relativesandstaffgivetheirinsights
A Description of Staff-resident Interactions in Assisted Living
Clinical Nursing Research, 2020
Positive social and care interactions are vital to understand and successfully accomplish the daily care needs of the residents in assisted living (AL) and optimize their quality of life. The purpose of this study was to explore and describe the staff-resident interactions in AL. This descriptive analysis utilized baseline data in a randomized trial that included 379 residents from 59 AL facilities. The majority of the interactions observed were positive; almost 25% were neutral or negative. Most interactions were care-related (31.9%) or one-on-one (27.4%), occurred with nursing (40.2%) or support staff (e.g., dining aide; 24.6%), and involved close interpersonal distance (64.6%). Future research should focus on the transition of neutral or negative interactions to positive and explore the factors that might influence neutral and negative interactions. Additionally, innovative approaches are needed to optimize interactions amid physical distancing in the context of the COVID-19 pand...
They are the reason I come to work”: The meaning of resident–staff relationships in assisted living
Journal of Aging Studies, 2009
This article aims to provide understanding of how direct care workers (DCWs) in assisted living facilities (ALFs) interpret their relationships with residents and to identify factors that influence the development, maintenance, quality, and meaning of these relationships. Qualitative methods were used to study two ALFs (35 and 75 beds) sequentially over seven months. Researchers conducted in-depth interviews with 5 administrative staff and 38 DCWs and conducted 243 hours of participant observation during a total of 99 visits. Data were analyzed using a grounded theory approach. Results showed that the emotional aspect of caregiving provides meaning to DCWs through both the satisfaction inherent in relationships and through the effect of relationships on care outcomes. Within the context of the wider community and society, multiple individual-and facility-level factors influence DCW strategies to create and manage relationships and carry out care tasks and ultimately find meaning in their work. These meanings affect their job satisfaction and retention.