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Upholding Older Adults' Innate and Inherent Dignity within a Caring Context
Sophiahemmet University.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In the ethical ideals of autonomy and integrity reducing the level of abstraction is necessary in order to more easily be able to follow them in every day care practices. This is especially true concerning the effort of upholding older adult patients dignity. Creative intervention programs may help to increase health care professionals ethical competence. In the first study (I) 12 older adults experiences of care are described, with special reference to their integrity. In addition, four student nurses were interviewed and participant observations were performed in order to describe the health care professionals integrity- promoting or non-promoting behaviours. The findings confirmed, in relation to a theoretical model, which determined ten categories of integrity related to the self-concept the complexity of the concept, but they also indicated that in relation to older patients a further category should be included namely one relating to their social self Therefore, the purpose of the second study (II) was to deepen the understanding of the identified eleventh category, social self, and how it may effect the ethical care in older adult patients. Two themes were identified: Social exchange, which was described as the older adult informants wish to be respected for their needs of meaningful social and human contacts, but also for their needs of meaningful social activities. Social experiences included the older informants wish to be respected for their needs of talking about themselves, recalling and sharing memories, moreover, to be respected for their needs of being a part of the world outside the hospital. Thus, the findings indicate the relevance of the new identified category. In the third study (III) the aim was to achieve a deeper understanding of an older cognitively intact mans lived experiences of being a patient in a geriatric context, where the majority of the patients were cognitively impaired. An earlier qualitative interview from study I was used and analysed from a phenomenological approach that illustrated health care professionals lack of meeting and confirming individual patients needs to be met as unique individuals with personal preferences, own resources and the ability to take charge over their own life. The health care professionals care actions tended to depend upon the needs of the cognitively impaired. In the fourth study (IV) the aim was to teach ethics from an activating instructional approach and then to evaluate whether or not this was a practicable strategy to influence individual health care members attitudes as well as their ethical caring behaviour with a special focus on the patients autonomy and integrity. A 6 and 12 months follow up was performed including group-interviews and participant observations. The findings indicate that the attitudes of individual participants had actually changed into a more patient-centred perspective and that their caring behaviour agreed to their attitudes. Based on real- life care situations taken from the fields of geriatrics, where the majority of the patients were cognitively impaired the aim of the fifth study (V) was to examine the relationship between autonomy and integrity resulting from the interactions between the individual health care member and the patients. These findings indicate that the relationship was ethically complex and that they were inseparable for maintaining a patients dignity. Consequently, this meant that if the health care professionals respected the older adult patients autonomy their integrity was protected and thereby, their innate and inherent dignity.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2002. , 73 p.
Keyword [en]
Autonomy, Integrity, Dignity, Geriatric health care, Cognitively intact patients, Teaching ethics, An activating instructional approach
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-137ISBN: 91-7349-337-6 (print)OAI: oai:DiVA.org:shh-137DiVA: diva2:314353
Public defence
2002-10-31, 09:00 (English)
Opponent
Supervisors
Available from: 2010-04-27 Created: 2010-03-12 Last updated: 2016-06-09Bibliographically approved
List of papers
1. The experiences of elderly people in geriatric care with special reference to integrity
Open this publication in new window or tab >>The experiences of elderly people in geriatric care with special reference to integrity
2000 (English)In: Nursing Ethics, ISSN 0969-7330, Vol. 7, no 6, 503-19 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to obtain an increased understanding of the experiences of elderly people in geriatric care, with special reference to integrity. Data were collected through qualitative interviews with elderly people and, in order to obtain a description of caregivers' integrity-promoting or non-promoting behaviours, participant observations and qualitative interviews with nursing students were undertaken. Earlier studies on the integrity of elderly people mainly concentrated on their personal and territorial space, so Kihlgren and Thorsén opened up the possibility of considering the concept of integrity from a broader view by recognizing its relationship to the larger framework of the self-concept. Based on this, findings in the present study indicate that elderly people's integrity relating to their corporal self were the least violated. On the other hand, their psychological, information and cultural selves were the most exposed. The study also identified a further dimension (i.e. one relating to social self), which should be included in the concept of integrity because respecting elderly people's social self reduces their feelings of loneliness, isolation and seclusion. In summary, the results indicate that the concept of integrity is complex and has several dimensions.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-80 (URN)11221392 (PubMedID)
Available from: 2010-03-02 Created: 2010-02-24 Last updated: 2010-04-27Bibliographically approved
2. The 'Social self': the 11th category of integrity - implications for enhancing geriatric care
Open this publication in new window or tab >>The 'Social self': the 11th category of integrity - implications for enhancing geriatric care
2003 (English)In: Journal of Applied Gerontology, ISSN 0733-4648, Vol. 22, no 2, 289-309 p.Article in journal (Refereed) Published
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-77 (URN)
Available from: 2010-03-02 Created: 2010-02-23 Last updated: 2010-04-27Bibliographically approved
3. Confirming older adult patients' views of who they are and would like to be
Open this publication in new window or tab >>Confirming older adult patients' views of who they are and would like to be
2002 (English)In: Nursing Ethics, ISSN 0969-7330, Vol. 9, no 4, 416-31 p.Article in journal (Refereed) Published
Abstract [en]

This article reveals a 91-year-old cognitively intact man's lived experiences of being cared for in a geriatric context in which the majority of the patients were cognitively impaired. A narrative patient story was analysed phenomenologically. The findings indicate that this patient's basic needs for ethical care were not met. The staff did not see him as a unique individual with his own preferences, resources and abilities to master his life. In order to survive this lack of ethical care, he played the role of an 'old cognitively impaired man', which provided him with at least the understanding and attention the cognitively impaired patients received from the staff. The findings also indicate that ethical care is independent of whether or not older cognitively intact and impaired patients stay or live in the same unit, but it is more dependent on a caregiver's ability to respect and confirm each and every patient for who he or she is and would like to be.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-79 (URN)12219404 (PubMedID)
Available from: 2010-03-02 Created: 2010-02-23 Last updated: 2010-04-27Bibliographically approved
4. The activating instructional approach: a practical strategy for teaching ethical geriatric health care
Open this publication in new window or tab >>The activating instructional approach: a practical strategy for teaching ethical geriatric health care
2004 (English)In: International Nursing Perspectives, ISSN 1592-6478, Vol. 4, no 1, 21-32 p.Article in journal (Other academic) Published
National Category
Pedagogy
Identifiers
urn:nbn:se:shh:diva-74 (URN)
Available from: 2010-03-02 Created: 2010-02-23 Last updated: 2010-04-27Bibliographically approved
5. Autonomy and integrity: upholding older adult patients' dignity
Open this publication in new window or tab >>Autonomy and integrity: upholding older adult patients' dignity
2004 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 45, no 1, 63-71 p.Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study was to deepen understanding of the relationship between autonomy and integrity in interactions between patients and individual health care workers in real-life care situations. METHOD: The data reported here are from a 6- and 12-month follow-up of the teaching of ethics to health care professionals working with older people. The data collection method used was participant observation. Health professionals' caring behaviour in everyday situations was observed from the point of view of patients' autonomy and integrity. Theoretical frameworks relating to autonomy and integrity were used to analyse the data. FINDINGS: The structural framework was useful for identifying the two concepts and their relationship in everyday situations. The data suggest that the two concepts are ethically complex. Autonomy is grounded in respect for patients' ability to choose, decide and take responsibility for their own lives. Autonomy varies within and between individuals and is dependent on context and on those involved. It stresses the intrinsic value of patients, which marks their worth independently of others. Integrity, however, is bound to patients' very existence, no matter what their physical and mental conditions, and must be respected regardless of their ability to act autonomously. CONCLUSION: The concepts of autonomy and integrity appear to presuppose one another and to be indivisible if older adult patients' dignity is to be maintained. This implies that when patients' autonomy is supported their integrity is protected and, consequently, their dignity upheld.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-75 (URN)14675302 (PubMedID)
Available from: 2010-03-03 Created: 2010-02-23 Last updated: 2010-04-27Bibliographically approved

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