Social Innovation Toward a Meaningful Everyday Life for Nursing Home Residents: An Ethnographic Study.

Background: The literature shows that innovation, which includes culture change, may be important to create a meaningful everyday life for nursing home residents. However, there is a gap in how social innovation practices may contribute to this. The theoretical discourse for the study is person-centered care. Aim: The main aim was to explore phenomena within social innovation that can contribute to improving nursing home residents' everyday lives. Design and Method: This study uses an ethnographic design with observations and interviews in two nursing homes in Southern Norway. Findings: The main theme was that social innovation within working practices in nursing homes includes phenomena that contribute to a meaningful everyday life for the residents. This main theme includes five subthemes: (1) opening the nursing home to the surroundings; (2) expanding and strengthening the community of practice; (3) facilitating customized activities; (4) ensuring sufficient nutrition and facilitating enjoyable mealtimes; and (5) preventing unrest and disturbing behavior. Conclusion: The study reveals that innovation practices grounded in person-centered care in nursing homes may contribute to opening the nursing home to the community and establishing a common community practice for all members of the nursing home. This enables residents to experience meaningful everyday life through customized activities, sufficient nutrition, and a pleasant milieu during mealtimes. Disturbing behavior is also prevented, making it possible to promote meaningful lives in nursing homes.

Conflicting rationales: leader's experienced ethical challenges in community health care for older people.

BACKGROUND: Ethical challenges arise in all types of care, and leaders need to be aware of how to resolve these challenges. Healthcare systems tend to be organised around medical conditions, and the patient is often faced with a series of uncoordinated visits to multiple specialties. Ideally, care should be organised around the patient's needs. AIM: The purpose of this article was to highlight some ethical challenges perceived by leaders with responsibility for management and service distribution, finance and ensuring quality of community health services for older people. METHOD: This study had a qualitative design with a qualitative content analysis of one focus group with six leaders that met four times in total. Leaders from the community healthcare sector in one Norwegian municipality were included, representing both nursing homes and home-based health care. The study followed the intentions of the Declaration of Helsinki and standard ethical principles. The Norwegian Social Science Data Services approved the study. All participants voluntarily gave written informed consent. FINDINGS: The main theme that emerged from this study was the ethical challenge leaders felt in the form of an inherent conflict between a caring rationale versus economic or technological rationales. Four categories emerged: (i) Management: quality versus economy; (ii) Prioritisation: fair distribution of healthcare services; (iii) Responsibility: considering individuals' needs versus the needs of the whole community; and (iv) Welfare technology: possibilities and challenges. CONCLUSION: Leaders' responsibilities in community health care for older people need to strike a balance between ethical principles in the management of limited resources.

To be a trained and supported volunteer in palliative care - a phenomenological study.

BACKGROUND: It has been found that including volunteers in palliative care is a positive contribution to seriously ill patients. It is, however, recommended that the volunteers are trained and supported. The aim of this study was to describe a group of trained and supported volunteers' lived experiences as volunteers in palliative care within the community health care services. METHODS: This study adopted a descriptive phenomenological approach featuring individual interviews with nine volunteers. The interviews were analysed using the descriptive phenomenological research method according to Giorgi. RESULTS: Being a volunteer in palliative care was both a positive and meaningful experience. It was a privilege being able to help those in need, which yielded positive returns. As a volunteer, it was important to be present for the ill persons and to follow them in their various physical and psychical states, which also implied that the volunteer had to face and deal with challenging situations. However, volunteers stated it was crucial to possess knowledge and life experience, as well as a clarified role, and they stressed the importance of being followed up by a mentor. CONCLUSIONS: The findings showed that trained and supported volunteers among seriously ill or dying people within the realm of community health care services play an independent and important role in the palliative care team. A coordinator in palliative care is especially suitable for training and supporting the volunteers.

Ethical challenges in care for older patients who resist help.

BACKGROUND: Situations where patients resist necessary help can be professionally and ethically challenging for health professionals, and the risk of paternalism, abuse and coercion are present. RESEARCH QUESTION: The purpose of this study was to examine ethical challenges in situations where the patient resists healthcare. RESEARCH DESIGN: The method used was clinical application research. Academic staff and clinical co-researchers collaborated in a hermeneutical process to shed light on situations and create a basis for new action. PARTICIPANTS AND RESEARCH CONTEXT: Four research groups were established. Each group consisted of six to eight clinical co-researchers, all employees with different health profession backgrounds and from different parts of the municipal healthcare services, and two scientific researchers. ETHICAL CONSIDERATIONS: The study was conducted in compliance with ethical guidelines and principles. Participants were informed that participation was voluntary and that confidentiality would be maintained. They signed a consent form. FINDINGS: The findings showed that the situations where patients opposed help related to personal hygiene, detention in an institution and medication associated with dental treatment. The situations were perceived as demanding and emotionally stressful for the clinicians. DISCUSSION: The situations can be described as everyday ethics and are more characterised by moral uncertainty and moral distress than by being classic ethical dilemmas. CONCLUSION: Norwegian legislation governing the use of force seems to provide decision guidance with the potential to reduce uncertainty and moral stress if the clinicians' legal competence had been greater.