[Autonomy, privacy and the implementation of the principle of "informed consent" with regard to nursing intervention from the view point of the aged]. / Autonomie, Privatheit und die Umsetzung des Prinzips der "informierten Zustimmung" im Zusammenhang mit pflegerischen Interventionen aus der Perspektive des älteren Menschen.

The aim of this study was to describe patient autonomy, privacy and the implementation of the principle of informed consent in the care of elderly patients in facilities experienced by themselves. This study is part of the BIOMED 2 project "Patients' autonomy and privacy in nursing interventions" supported by the European Commission. Interview data (n = 95) were collected among elderly people in German facilities for geriatrics and in nursing homes. The results showed there was a lack of opportunity by the elderly people to make self-determined decisions. The principle of "informed consent" was hardly realised. The participants felt their privacy was not respected in multi-bedded rooms and in situations of dressing and eliminating. One can proceed on the assumption that the lack of information, the need of help and the fixed organizing structures of the facilities are the reasons why elderly people play a rather passive role as patients. It might be possible to improve the autonomy of elderly people if the nurses as an advocate supported them to make self-determined decisions. The implementation of the principle of informed consent with regard to nursing interventions would promote both autonomy and respect of privacy. Furthermore, one can assume that the autonomy and quality of life of elderly people could be promoted if the organizing structures of the facilities were more flexible.

Changes in reflex excitability following isometric contraction in humans.

Enhancement of muscle stretch following isometric contraction has been thought to occur as a result of inhibitory reflex mechanisms. Experiments with electrical stimulation (H-reflex) have demonstrated maximal H-reflex suppression during force relaxation followed by gradual recovery over the following 20 s. There has been considerable speculation as to whether electrical and mechanical stimulation elicit similar response behaviour. The present study examined postisometric reflex modulation following both stimulation modalities. In ten subjects dorsiflexion stimuli varying in speed and amplitude were applied after 30% and 60% maximal voluntary contraction (MVC). Modulation of the mechanically and electrically evoked responses following isometric plantarflexion was investigated. Reflex responses following both stimulation modalities were depressed during the course of force relaxation. A rather fast recovery was observed in mechanical stimulation. Postisometric response modulation was neither altered by the amount of isometric plantarflexion, nor by the amplitude of the applied stretch stimulus. With increasing velocity of the applied dorsiflexion, however, the shape of the reflex modulation persisted, but the magnitude of the responses was significantly enhanced. In electrical stimulation, however, recovery was delayed. It is suggested that postisometric reflex modulation is due to presynaptic inhibition. Moreover, possible peripheral mechanisms resulting from alpha-gamma-coactivation may also affect the stretch receptor itself because of inherent stiffness properties. The latter possibility particularly would explain the differences between mechanical and electrical stimulus modalities. With respect to practical implications, the very fast recovery (< 400 ms) of the stretch responses to control values strongly contradicts the interpretation that after isometric precontraction, suppression of reflex activity might be used for more efficient stretching of the tendomuscle system.