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Dignity in the end of life care: what does it mean to older people and staff in nursing homes?
Örebro University, School of Health and Medical Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The discussion of a palliative care and a dignified death has almost exclusively been applied to people dying of cancer. As people are getting older and are living longer, nursing homes have become an important place for end-of-life care and death. Dignity is a concept often used in health care documents but their meaning is rarely clarified.

The main aim of this thesis was to gain a deeper understanding of what dignity meant to older people in end of life care as well as to nursing home staff. The thesis comprises four studies. The first and second study involved older people living in nursing home settings studied from a hermeneutic perspective. In the first study twelve older people in two nursing homes were interviewed two to four times over a period of 18–24 months during 2002–2003. Altogether, 39 interviews were analyzed by a hermeneutic method. Dignity was closely linked to self-image and identity. The themes of unrecognizable body, dependence and fragility constituted threats to dignity. The third theme, inner strength and sense of coherence, seemed to assist the older people in maintaining dignity of identity. In the second study the aim was to acquire a deeper understanding of how three older women from study I, created meaning in everyday life at the nursing home. A secondary analysis was carried out and showed meaning in everyday life was created by an inner dialogue, communication and relationships with others. The third study was to explore nursing home staff members’ experience of what dignity in end-of –life care means to older people and to themselves.

Totally 21 interviews with staff were carried out and analyzed through a qualitative content analysis. The meaning of older people’s dignity was conceptualized as feeling trust, which implied being shown respect. Staff members’ dignity was conceptualized as maintaining self-respect. Dignity was threatened in situations where staff experienced themselves and the older people as being ignored and thereby marginalized. The fourth study was carried out through focus groups discussions with 20 staff members about seven older peoples dying death and care. The analyses showed that conversations and discussions about death were rare. Death was surrounded by silence. It was disclosed that the older dying person’s thoughts and attitudes of death were not explicitly known. A dignified death meant alleviation of bodily suffering and pain and meaningfulness. The staff’s ethical reasoning mainly concerned their experience of a gap between their personal ideals of what a dignified end of life should include and what they were able to provide in reality, which could result in conscious stress. Staff members need training and support. End of life care demands competence and teamwork.

A challenge for future care of older people would be to develop a nursing home environment in which human dignity is promoted.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2008. , 49 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 19
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-2120ISBN: 978-91-7668-566-2 (print)OAI: oai:DiVA.org:oru-2120DiVA: diva2:135912
Public defence
2008-05-23, Hörsal P1, Prismahuset, Fakultetsgatan 1, Örebro, 13:00
Opponent
Supervisors
Available from: 2008-05-02 Created: 2008-05-02 Last updated: 2011-05-18Bibliographically approved
List of papers
1. Views on dignity of elderly nursing home residents
Open this publication in new window or tab >>Views on dignity of elderly nursing home residents
2006 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, 130-146 p.Article in journal (Refereed) Published
Abstract [en]

Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence.

Keyword
dignity, dignity and end-of-life care, nursing and dignity, palliative care and dying, self-image
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15602 (URN)10.1191/0969733006ne851oa (DOI)000235684100005 ()
Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2011-05-18Bibliographically approved
2. Three nursing home residents speak about meaning at the end of life
Open this publication in new window or tab >>Three nursing home residents speak about meaning at the end of life
2008 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 1, 97-109 p.Article in journal (Refereed) Published
Abstract [en]

This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in two nursing homes in Sweden. A secondary analysis was carried out on data obtained from three of the primary participants interviewed over a period of time (18-24 months), with a total of 12 interviews carried out using an inductive hermeneutic approach. The study reveals that sources of meaning were created by having a sense of: physical capability, cognitive capability, being needed, and belonging. Meaning was created through inner dialogue, communication and relationships with others. A second finding is that the experience of meaning can sometimes be hard to realize.

Keyword
dying, end of life, meaning, older people, palliative care
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15603 (URN)10.1177/0969733007083938 (DOI)000254219700011 ()
Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2011-05-18Bibliographically approved
3. Dignity as experienced by nursing home staff
Open this publication in new window or tab >>Dignity as experienced by nursing home staff
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15604 (URN)
Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2016-12-01Bibliographically approved
4. Nursing home staff's reasoning about death and dying
Open this publication in new window or tab >>Nursing home staff's reasoning about death and dying
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15605 (URN)
Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2016-12-01Bibliographically approved

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