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Care Perceptions among Residents of LTC Facilities Purporting to Offer Person-Centred Care

Published online by Cambridge University Press:  11 April 2016

Leeann Donnelly  and
Michael I. MacEntee
Leeann Donnelly*
Affiliation:
Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia
Michael I. MacEntee
Affiliation:
Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia
*
†La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Dr. Leeann Donnelly Department of Oral Biological & Medical Sciences Faculty of Dentistry University of British Columbia 2199 Wesbrook Mall Vancouver, BC V6T 1Z3 ([email protected])
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Abstract

This study explored qualitatively how residents of long-term care (LTC) facilities feel about and adapt to the care they receive. We interviewed and observed a purposeful selection of elderly residents in seven facilities purporting to provide person-centred care. Interpretative descriptions from 43 personal interviews with 23 participants answered the question: How do residents perceive the care rendered in LTC facilities purporting to offer person-centred care? Three themes emerged: (1) the caring environment; (2) preservation of dignity; and (3) maintenance of personal autonomy. Participants were sympathetic to the nursing staff’s workload, but felt distant from the staff. Participants gave examples of poor care and lack of empathy, human indignities, and violations of personal autonomy caused by institutional policies they felt inhibited their ability to receive care based on their preferences. Overall, they challenged the claims of person-centred care, but adapted to cope with an environment that threatened their dignity and autonomy.

Résumé

Cette étude a exploré d’une manière qualitative comment les résidents des maisons de soins de longue durée (SLD) pensent et s’adaptent aux soins qu’ils reçoivent. Nous avons interrogé et observé un groupe délibérément choisi parmi des personnes âgées dans sept etablissements qui prétendent fournir des soins centrés sur la personne. Les descriptions interprétatives de la part de 43 entrevues personnelles avec 23 participants correspondaient a une réponse à la question: Comment les habitants perçoivent-ils les soins rendus dans les établissements de SLD qui se présentent comme offrant des soins centrés sur la personne? Trois thèmes dominants sont ressortis: (1) l’environnement bienveillant; (2) la préservation de la dignité; et (3) le maintien de l’autonomie personnelle. Les participants étaient sensibles à la charge de travail du personnel infirmier, mais se sentaient éloignés du personnel. Les participants ont donné des exemples de mauvais soins et une manque d’empathie, des indignités humains et des violations de l’autonomie personnelle causées par les politiques institutionnelles qu’ils se sentaient inhibiter leur capacité à recevoir des soins selon leurs propres préférences. En général, ils ont contesté les allégations de soins centrés sur la personne, mais ils s’y sont adaptés pour faire face à un environnement qui menace leur dignité et leur autonomie.

Keywords

aginghuman dignitypersonal autonomyperson-centred carequality of lifeself-assessed carevieillissmentdignité humaineautonomie personnellesoins centrés sur la personnequalité de viesoins de l’auto-association
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 35 , Issue 2 , June 2016 , pp. 149 - 160
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Copyright
Copyright © Canadian Association on Gerontology 2016 

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References

Åberg, A. C., Sidenvall, B., Hepworth, M., O’Reilly, K., & Lithell, H. (2005). On loss of activity and independence, adaptation improves life satisfaction in old age – A qualitative study of patients’ perceptions. Quality of Life Research, 14(4), 1111–1125.CrossRefGoogle ScholarPubMed
Berta, W., Laporte, A., & Kachan, N. (2010). Unpacking the relationship between operational efficiency and quality of care in Ontario long-term care homes. Canadian Journal on Aging, 29(04), 543–556.Google Scholar
Bishop, C. E., & Stone, R. (2014). Implications for policy: The nursing home as least restrictive setting. The Gerontologist, 54(Suppl. 1), S98–S103.Google Scholar
Bradshaw, S. A., Playford, E. D., & Riazi, A. (2012). Living well in care homes: A systematic review of qualitative studies. Age and Ageing, 41, 429–440.CrossRefGoogle Scholar
Bowen, G. A. (2008). Naturalistic inquiry and the saturation concept: A research note. Qualitative Research, 8(1), 137–152.Google Scholar
Browne, C. V., Mokuau, N., & Braun, K. L. (2009). Adversity and resiliency in the lives of native Hawaiian elders. Social Work, 54(3), 325–361.Google Scholar
Brownie, S., & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: A systematic review. Clinical Interventions in Aging, 8, 1–10.Google Scholar
Burack, O. R, Reinhardt, J. P., & Weiner, A. S. (2012). Person-centered care and elder choice: A look at implementation and sustainability. Clinical Gerontologist, 35, 390–403.Google Scholar
Campbell, A. (2014). What are the factors that influence person centred care in public residential care settings for older people? (Doctoral dissertation, National University of Ireland, Galway). Retrieved 13 August 2014 from https://aran.library.nuigalway.ie/xmlui/handle/10379/4443Google Scholar
Caspar, S., O’Rourke, N., & Gutman, G. M. (2009). The differential influence of culture change models on long-term care staff empowerment and provision of individualized care. Canadian Journal on Aging, 28(2), 165–175.CrossRefGoogle ScholarPubMed
Charmaz, K. (2000). Grounded theory: objectivist and constructivist methods. In Denzin, N. K., & Lincoln, Y. S. (Eds.), Handbook of qualitative research (pp. 509–536). London, England: Sage.Google Scholar
Cohn, F. (2001). Existential medicine: Martin Buber and physician-patient relationships. Journal of Continuing Education in the Health Professions, 21(3), 170–181.Google Scholar
Coughlan, R., & Ward, L. (2007). Experiences of recently relocated residents of a long-term care facility in Ontario: Assessing quality qualitatively. International Journal of Nursing Studies, 44, 47–57.Google Scholar
Colón-Emeric, C., Plowman, D., Bailey, D., Corazzini, K., Utley-Smith, Q., Ammarell, N., et al. (2010). Regulation and mindful resident care in nursing homes. Qualitative Health Research, 20, 1283–1294.Google Scholar
Creswell, J. W. (2007). Qualitative inquiry and research design. Choosing among five approaches. Thousand Oaks, CA: Sage.Google Scholar
Division of Aging and Seniors. (1998). Principles of the national framework on aging: A policy guide. Ottawa, ON. Retrieved 11 August 2014 from http://publications.gc.ca/collections/Collection/H88-3-21-1998E.pdfGoogle Scholar
Doty, M. M., Koren, M. J., & Sturla, E. L. (2008). Culture change in nursing homes: How far have we come? Findings from the Commonwealth Fund 2007 national survey of nursing homes. Retrieved 19 August 2014 from http://www.commonwealthfund.org/∼/media/files/surveys/2007/the-commonwealth-fund-2007-national-survey-of-nursing-homes/doty_culturechangenursinghomes_1131-2-pdf.pdfGoogle Scholar
Dubbin, L. A., Chang, J. S., & Shim, J. K. (2013). Cultural health capital and the interactional dynamics of patient-centered care. Social Science and Medicine, 93, 113–120.Google Scholar
Edvardsson, D., Fetherstonhaugh, D., & Nay, R. (2010). Promoting a continuation of self and normality: Person-centred care as described by people with dementia, their family members and aged care staff. Journal of Clinical Nursing, 19, 2611–2618.CrossRefGoogle Scholar
Edvardsson, D., & Innes, A. (2010). Measuring person centered care: A critical comparative review of published tools. The Gerontologist, 50, 834–846.Google Scholar
Flesner, M. K. (2009). Person-centered care and organizational culture in long-term care. Journal of Nursing Care Quality, 24(4), 273–276.Google Scholar
Fram, S. M. (2013). The constant comparative analysis method outside of grounded theory. The Qualitative Report, 18(1), 1–25.Google Scholar
Franklin, L., Ternestedt, B., & Nordenfelt, L. (2006). Views on the dignity of elderly nursing home residents. Nursing Ethics, 13(2), 130–146.Google Scholar
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., et al. (2001). Frailty in older adults: Evidence for a phenotype. Journal of Gerontology, 56(3), 146–156.Google ScholarPubMed
Gattuso, S. (2003). Becoming a wise old woman: Resilience and wellness in later life. Health Sociology Review, 12(2), 171–177.Google Scholar
Georg, D. (2006). Improving the oral health of older adults with dementia/cognitive impairment living in a residential aged care facility. International Journal of Evidence Based Healthcare, 4(1):54–61.Google Scholar
Hill, N. L., Kolanowski, A. M., Milone-Nuzzo, P., & Yevchak, A. (2011). Culture change models and resident health outcomes in long-term care. Journal of Nursing Scholarship, 43, 30–40.Google Scholar
Jacobson, N. (2007). Dignity and health: A review. Social Science and Medicine, 64(2), 292–302.Google Scholar
Jiang, C. Y. W., & MacEntee, M. I. (2013). Opinions of administrators and health-authority inspectors on implementing and monitoring the oral health regulation in long-term care facilities in British Columbia Canadian Journal of Dental Hygiene, 47, 15–23.Google Scholar
Jones, A., & Kelly, D. (2014). Whistle-blowing and workplace culture in older peoples’ care: Qualitative insights from the healthcare and social care workforce. Sociology of Health and Illness, 36(7), 986–1002. doi: 10.1111/1467-9566.12137.CrossRefGoogle ScholarPubMed
Kahn, R. L. (1999). Making the best of it: Adapting to the ambivalence of a nursing home environment. Qualitative Health Research, 9(1), 119–132.Google Scholar
Kane, R. L. (2010). Reimagining nursing homes: The art of the possible. Journal of Aging and Social Policy, 22, 321–333.Google Scholar
Killett, A., Bowes, A., Brooker, D., Burns, D., Kelly, F., La Fontaine, J., et al. (2013). What makes a real difference to resident experience? Digging deep into care home culture: The CHOICE (Care Home Organisations Implementing Cultures of Excellence) Research Report. Retrieved 2 September 2014 from http://www.panicoa.org.uk/sites/default/files/CHOICE_final_report.pdfGoogle Scholar
Kirkevold, M., & Bergland, Å. (2007). The quality of qualitative data: Issues to consider when interviewing participants who have difficulties providing detailed accounts of their experiences. International Journal of Qualitative Studies on Health and Well-Being, 2(2), 68–75. doi: 10.3402/qhw.v2i2.4947 (Retrieved 11 August 2014.)Google Scholar
Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of Advanced Nursing, 69(1), 4–15.Google Scholar
Koren, M. J. (2010). Person-centered care for nursing home residents: The culture-change movement. Health Affairs, 29(2), 312–317.Google Scholar
Kvale, S. (1996). InterViews: An introduction to qualitative research interviewing. Thousand Oaks, CA: Sage.Google Scholar
Lee, D., Yu, D., & Kwong, A. (2009). Quality of life of older people in residential care home: a literature review. Journal of Nursing and Healthcare of Chronic Illnesses, 1(2), 116–125.CrossRefGoogle Scholar
Lemon, B. W., Bengtson, V. L., & Peterson, J. A. (1972). An exploration of the activity theory of aging: Activity types and life satisfaction among in-movers to a retirement community. Journal of Gerontology, 27(4), 511–523.Google Scholar
Liang, J., & Luo, B. (2012). Toward a discourse shift in social gerontology: From successful aging to harmonious aging. Journal of Aging Studies, 26(3), 327–334.Google Scholar
Lopez, S. T. (2006). Culture change management in long-term care: A shop-floor view. Politics Society, 34(1), 55–79.CrossRefGoogle Scholar
Lopez, S. H. (2014). Culture change and shit work: Empowering and overpowering the frail elderly in long-term care. American Behavioural Scientist, 58(3), 435–452.Google Scholar
Martinson, M., & Berridge, C. (2014). Successful aging and its discontents: A systematic review of the social gerontology literature. The Gerontologist, 55(1), 58–69.doi: 10.1093/geront/gnu037gnu037Google Scholar
Mason, M. (2010). Sample size and saturation in PhD studies using qualitative interviews. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research, 11(3). Art. 8, http://nbn-resolving.de/urn:nbn:de:0114-fqs100387Google Scholar
MacEntee, M. I., Thorne, S., & Kazanjian, A. (1999). Conflicting priorities: Oral health in long-term care. Special Care in Dentistry, 19(4), 164–172.Google Scholar
McGilton, K. S., & Boscart, V. M. (2007). Close care provider-resident relationships in long term care environments. Journal of Clinical Nursing, 16, 2149–2157.Google Scholar
McCormack, B., & McCance, T. V. (2006). Development of a framework for person-centred nursing. Journal of Advanced Nursing, 56(5), 472–479.CrossRefGoogle ScholarPubMed
McWilliam, C. L., Brown, J. B., Carmichael, J. L., & Lehman, J. M. (1994). A new perspective on threatened autonomy in elderly persons: The disempowering process. Social Science and Medicine, 38(2), 327–338.Google Scholar
Moser, A., Houtepen, R., & Widdershoven, G. (2007). Patient autonomy in nurse-led shared care: a review of theoretical and empirical literature. Journal of Advanced Nursing, 57(4), 357–365.Google Scholar
Mozley, C. G., Huxley, P., Sutcliffe, C., Bagley, H., Burns, A., Challis, D., et al. (1999). ‘Not knowing where I am doesn’t mean I don’t know what I like’: Cognitive impairment and quality of life responses in elderly people. International Journal of Geriatric Psychiatry, 14(9), 776–783.Google Scholar
Nakashima, M., & Canda, E. R. (2005). Positive dying and resiliency in later life: A qualitative study. Journal of Aging Studies, 19(1), 109–125.CrossRefGoogle Scholar
Nolan, M., Davies, S., & Brown, J. (2006). Transitions in care homes: Towards relationship-centred care using the ‘Senses Framework’. Quality in Ageing and Older Adults, 7, 5–14.Google Scholar
Rader, J., Barrick, A. L., Hoeffer, B., Sloane, P. D., McKenzie, D., Talerico, K. A., et al. (2006). The bathing of older adults with dementia: Easing the unnecessarily unpleasant aspects of assisted bathing. The American Journal of Nursing, 106(4), 40–48.Google Scholar
Rahman, A. N., & Schnelle, J. F. (2008). The nursing home culture change movement: Recent past, present, and future directions for research. The Gerontologist, 48(2), 142–148.Google Scholar
Rahman, A. N., Applebaum, R. A., Schnelle, J. F., & Simmons, S. F. (2012). Translating research into practice in nursing homes: Can we close the gap? The Gerontologist, 52(5), 597–606.Google Scholar
Rodriquez, J (2011). It’s a dignity thing: Nursing home care workers’ use of emotions. Sociological Forum, 26(2), 265–286.Google Scholar
Ryvicker, M. (2009). Preservation of self in the nursing home: Contradictory practices within two models of care. Journal of Aging Studies, 23(1), 12–23.CrossRefGoogle Scholar
Scott, P. A., Välimäki, M., Leino-Kilpi, H., Dassen, T., Gasull, M., Lemonidou, C., et al. (2003). Perceptions of autonomy in the care of elderly people in five European countries. Nursing Ethics, 10(1), 28–38.Google Scholar
Scourfield, P. (2007). Helping older people in residential care remain full citizens. British Journal of Social Work, 37(7), 1135–1152.Google Scholar
Shier, V., Khodyokov, D., Cohen, L. W., Zimmerman, S., & Saliba, D. (2014). What does the evidence really say about culture change in nursing homes? The Gerontologist, 54(Suppl. 1), S6–S16. doi: 10.1093/geront/gnt147Google Scholar
Stolar, G. E., MacEntee, M. I., & Hill, P. (1992). The elderly; their perceived supports and reciprocal behaviours. Journal of Gerontology Social Work, 19, 15–33.Google Scholar
Shepley, M. M., & Song, Y. (2014). Design research and the globalization of healthcare environments. HERD: Health Environments Research & Design Journal, 8(1), 158–198.CrossRefGoogle ScholarPubMed
Shura, R., Siders, R. A., & Dannefer, D. (2011). Culture change in long-term care: Participatory action research and the role of the resident. The Gerontologist, 51, 212–225.Google Scholar
Thomas, W. H. (1996). Life worth living. Acton, MA: VanderWyk and Burnham.Google Scholar
Thorne, S., Kirkham, S. R., & O’Flynn-Magee, K. (2004). The analytic challenge in interpretive description. International Journal of Qualitative Methods, 3(1), 1–11. Retrieved 16 March 2014 from http://www.ualberta.ca/∼iiqm/backissues/3_1/pdf/thorneetal.pdfGoogle Scholar
Tu, W., Wang, R., & Yeh, S. (2006). Relationship between perceived empowerment care and quality of life among elderly residents within nursing homes in Taiwan: A questionnaire survey. International Journal of Nursing Studies, 43, 673–680.Google Scholar
Tyler, D. A. & Parker, V. A. (2011). Nursing home culture, teamwork and culture change. Journal of Research in Nursing 16(1), 37–49.Google Scholar
van Hoof, J., Wetzels, M. H., Dooremalen, A. M. C., Nieboer, M. E., van Gorkom, P. J. L. M., Eyck, A. M. E., et al. (2014). The essential elements for a nursing home according to stakeholders from healthcare and technology: Perspectives from multiple simultaneous monodisciplinary workshops. Journal of Housing for the Elderly, 28(4), 329–356.Google Scholar
Wadensten, B., & Ahlström, G. (2009). The struggle for dignity by people with severe functional disabilities. Nursing Ethics, 16(4), 453–465.Google Scholar
Westerhof, G. J., van Vuuren, M., Brummans, B. H. J. M., & Custers, A. F. J. (2014). A Buberian approach to the co-construction of relationships between professional caregivers and residents in nursing homes. The Gerontologist, 54(3), 354–362.Google Scholar
White, H. K., Corazzini, K., Twersky, J., Buhr, G., McConnell, E., Weiner, M., et al. (2012). Prioritizing culture change in nursing homes: Perspectives of residents, staff, and family members. Journal of American Geriatrics Society, 60, 525–531.Google Scholar
Wild, K., Wiles, J. L., & Allen, R. E. (2013). Resilience: Thoughts on the value of the concept for critical gerontology. Ageing and Society, 33(01), 137–158.Google Scholar
Williams, J., Hadjistavropoulos, T., Ghandehari, O. O., Yao, X., & Lix, L. (2014). An evaluation of a person-centred care programme for long-term care facilities. Ageing and Society, 35(03), 457–488. Available on CJO. 2013 doi: 10.1017/S0144686X13000743Google Scholar
Wilson, C. B. (2008). Using relationships to develop practice that values the contribution of older people, families and staff. International Journal of Older People Nursing, 3(4), 274–277.Google Scholar
Zimmerman, S., Shier, V., & Saliba, D. (2014). Transforming nursing home culture: Evidence for practice and policy. The Gerontologist, 54(Suppl. 1), S1–S5. doi: 10.1093/geront/gnt161Google Scholar