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Elements of assisted bodily care: Ethical aspects
Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC.ORCID iD: 0000-0002-8912-8101
Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Linköpings universitet.ORCID iD: 0000-0001-8007-1770
Ersta Sköndal Bräcke University College, Department of Health Care Sciences.ORCID iD: 0000-0001-9559-1939
2020 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 27, no 6, p. 1377-1395Article in journal (Refereed) Published
Abstract [en]

Background: Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy, and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim having exposedness to assistant nurses’ routines. The provider-receiverin congruence revealed here warrants investigation.

Aim: To describe the elements of assisted bodily care, as performed in a nursing home.

Research design: Data were collected through thirty-nine observations of assisted bodily care, analyzed with qualitative content analysis.

Participants and research context: Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home.

Ethical considerations: The research was conducted in line with the Declaration of Helsinki,further approved by the regional ethics committee.

Findings: Findings show, that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Still, assistant nurses attempt to adapt this work to older persons’wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care.

Discussion: Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. On the contrary, they seem to know older persons well enough to adapt assisted bodily care according to their preferences and support self-determination. This indicates that openness to older persons’ life-worlds may be more important than the amount of time available.

Conclusions: Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could prepare agreement on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all.

Place, publisher, year, edition, pages
2020. Vol. 27, no 6, p. 1377-1395
Keywords [en]
Assistant nurses, Bodily care, Dignity, Ethics, Nursing home
National Category
Nursing Medical Ethics
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
URN: urn:nbn:se:esh:diva-8053DOI: 10.1177/0969733020914348PubMedID: 32378491OAI: oai:DiVA.org:esh-8053DiVA, id: diva2:1423577
Note

Publication status in dissertation: Accepted

Available from: 2020-04-15 Created: 2020-04-15 Last updated: 2023-01-03Bibliographically approved
In thesis
1. När kroppen inte räcker till: Assisterad kroppslig omvårdnad i livets slut på vård- och omsorgsboende
Open this publication in new window or tab >>När kroppen inte räcker till: Assisterad kroppslig omvårdnad i livets slut på vård- och omsorgsboende
2020 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Det övergripande syftet med denna avhandling var att belysa vård i livets slut på vård- och omsorgsboende, med inriktning mot den kroppsliga omvårdnaden, utifrån äldre personers, undersköterskors och anhörigas perspektiv. Avhandlingen bygger på fyra delstudier. Tre analysmetoder användes;innehållsanalys (I & III), fenomenologisk hermeneutik (II) och fenomenografi(IV). Datainsamlingen omfattade individuella intervjuer (I, II & IV) och observation (III). Fynden visar att; (I) undersköterskor känner de äldre personerna och värnar deras självbestämmande, välbefinnande och värdighet. I sitt arbete fokuserar de främst på kroppslig omvårdnad. Äldre personer (II) upplever kroppslig omvårdnad som en assistans, växelvis i form av ett fängelse eller som en njutning. De värnar sitt självbestämmande, men anpassar sig efter de omständigheter som bestäms av andra. Det är främst undersköterskor som utför assisterad kroppslig omvårdnad (III), medan äldre tar del i det de kan, trots nedsatt kroppslig förmåga. Anhöriga räknar med att äldre personer utövar fullt självbestämmande gällande assisterad kroppslig omvårdnad (IV). Själva bidrar de med en assisterad kroppslig omvårdnad som inte innefattar intimhygien, medan de förblir observanta på undersköterskors arbete. Avhandlingen belyser att assisterad kroppslig omvårdnad kan överbrygga äldres kroppsliga begränsningar och leda till välbefinnande när självbestämmandet främjas. Sådan assisterad kroppslig omvårdnad kan utgöra en väsentlig del av en palliativ omvårdnad för äldre personer på vård- och omsorgsboende i livets slut.

Place, publisher, year, edition, pages
Stockholm: Ersta Sköndal Bräcke högskola, 2020. p. 135
Series
Avhandlingsserie inom området Människan i välfärdssamhället, ISSN 2003-3699 ; 4
Keywords
Anhöriga, Autonomi, Äldre personer, Kroppslig omvårdnad, Palliativ vård, Undersköterskor, Vård- och omsorgsboende, Välfärd, Värdighet
National Category
Nursing
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
urn:nbn:se:esh:diva-8055 (URN)978-91-985808-4-6 (ISBN)
Public defence
2020-05-15, 09:00
Opponent
Supervisors
Available from: 2020-04-15 Created: 2020-04-15 Last updated: 2023-09-22Bibliographically approved

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Holmberg, BodilHellström, IngridÖsterlind, Jane

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