Daily functioning support - a qualitative exploration of rehabilitative approach in acute hospitalised care.

OBJECTIVES: Hospitalised patients are at risk of temporary or permanent loss of functioning which impacts their future independence. Implementation of a rehabilitative approach in everyday nursing in the acute care setting may produce good therapeutic results and promote independent daily living of patients. Thus, the aim of the study was to explore and understand the patterns of a rehabilitative approach in acute hospital wards from the perspective of interdisciplinary team members. Specifically, our aim was to identify the factors promoting and preventing a rehabilitative approach. METHOD: We conducted four focus group interviews with 21 participants, including multidisciplinary team members from acute hospital wards. Data were analysed with conventional inductive content analysis. RESULTS: The findings highlighted that the rehabilitative approach, as a personal way of working and personal working attitude, was a part of comprehensive nursing. The main goals of the rehabilitative approach were to support the physical functioning of the patients and their independent initiative and individuality during clinical care in hospital ward. The promoting and preventing factors that influenced the development of the rehabilitative approach consisted of personal factors, organisational factors and the physical settings of the hospital wards. CONCLUSION: The findings of this study indicate that the rehabilitative approach in nursing focused on supporting the physical functioning, independence and self-confidence of the patient. The staff highlighted that interdisciplinary teamwork was one feature of the rehabilitative approach. The rehabilitative approach in nursing should be established as a part of everyday activity in clinical practice.

Ethical dilemmas related to the use of safety technology in service house environments.

BACKGROUND: The use of technology in care of older adults has increased rapidly in recent years and is anticipated to increase further in the future. Technological devices and appliances have been developed to promote the safety and independence of older adults living in different settings. However, technology may also be perceived as a threat, and using technology could involve characteristics that may restrict especially patients' autonomy. AIMS AND METHODS: The aim of this study was to explore ethical dilemmas as experienced and expressed by older adults living in service house environment and their family members. The study was carried out in two service house units in Southwest Finland by conducting thematic interviews of service home residents aged 80-92 years (n = 12) and their relatives (n = 5). The interview data were analysed using inductive content analysis to identify similarities and differences across the data. The findings were categorised under three categories: supervision vs. privacy, fear of losing human contact, autonomy and freedom. FINDINGS: The participants appreciated the homely environment they had and preferred increasing the amount of staff over increasing technological surveillance. However, the residents were willing to accept also technological systems and solutions if they strengthened one's feeling of security. Fear of losing human contacts and one's privacy due to implementation technological systems was expressed by the older adults. Both the residents and their relatives emphasised the autonomy of the older adult in decision-making concerning the use of technological services. CONCLUSIONS: In conclusion, thorough discussion about autonomy, freedom and privacy is needed before applying new technologies to service house environments. Possibilities for drafting a 'technological will' where the resident could define under what circumstances technology can be used in his/her case and who can decide about it should be explored in the future.

Maintenance of patients' integrity in long-term institutional care.

This study aimed to describe and compare the views of nurses and older patients' relatives on factors restricting the maintenance of patient integrity in long-term care. The purposive sample comprised 222 nurses and 213 relatives of older patients in four Finnish long-term care institutions. The data were collected using a self-developed questionnaire addressing five sets of factors relating to patients, relatives, nurses, the organization and society. The maintenance of patient integrity was restricted by: (1) social factors, including lack of respect for long-term geriatric care and lack of adequate resources; (2) patient factors relating to forgetfulness; and (3) factors relating to nurses and relatives in maintaining patient integrity. Better maintenance of patient integrity requires that more consideration is paid to issues of social respect and to the availability of adequate resources. Closer attention must be given to patients who are forgetful and unable to take part in decision making.

Nurses perceptions of older patients integrity in long-term institutions.

AIM: This article reports on a study into nurses' perceptions of how the integrity of older patients is maintained in long-term care institutions in Finland. BACKGROUND: Patient integrity is an important aspect of ethical decision-making in nursing care and respect for integrity is central to good care. Problems may occur in the maintenance of older patients' integrity because of reduced communication skills and decision-making authority. Data collection was by means of a purpose-designed structured questionnaire in a sample of 222 nurses from four purposively selected long-term institutions in 2004. The response rate was 74%. The questionnaire consisted of a background data sheet and integrity items in three categories: psychological, physical and social integrity. RESULTS: The nurses gave the highest ratings for the maintenance of physical integrity, particularly for respectful and gentle touching. Nonetheless, according to nurses patients were often tied to their bed or chair. The second highest ratings were give to the maintenance of social integrity. Most nurses felt that the patients had good contact with the outside world, mainly family members. On the other hand loneliness was a more common problem for older people in institutions. The maintenance of psychological integrity received the lowest rating. Satisfaction with the job and with the quality of service provided correlated positively with the nurses' views on the maintenance of patient integrity. CONCLUSION: Nurses take the view that patient integrity is maintained reasonably well in long-term institutions. There are, however, some problematic areas that require special attention, particularly in the maintenance of psychological integrity. Future research needs to look at how patients and their relatives view the situation and to explore different training delivery options that can help raise the ethical quality of nursing care.

Maintaining the integrity of older patients in long-term institutions: relatives' perceptions.

AIM: To study relatives' views on how the integrity of older patients is maintained in long-term institutions in Finland. BACKGROUND: aintaining patient integrity is considered a key prerequisite for good quality care and treatment and a characteristic of ethical care. Institutionalization, dependence on others and vulnerability may all threaten the integrity of the older patient and, in this sense, pose ethical problems. DESIGN/METHODS: The data for this descriptive and explorative survey were collected by questionnaires from 213 relatives of older patients in four long-term institutions in Finland. The response rate was 78%. Data were analysed using statistical methods. RESULTS: Relatives rated the maintenance of patient integrity quite highly. The highest ratings were recorded for the maintenance of physical integrity and the lowest to the maintenance of psychological integrity. The main source of problems were patients' and/or relatives' wishes concerning elimination. There were also shortcomings in the provision of intimacy. Relatives who thought that admission to the long-term institution had been problematic, either for the patient or for themselves, felt that patient integrity was poorly maintained. CONCLUSION: The findings highlight the importance of nurses' efforts in long-term care facilities to preserve the integrity of patients and to maintain close contact and cooperation with relatives. Although relatives generally were quite pleased with how patient integrity was maintained, the results also provide evidence on problems that may threaten patient integrity. RELEVANCE TO CLINICAL PRACTICE: Greater emphasis should be placed on the need for cooperation between older patients, their relatives and nursing staff, especially before admission to long-term care. Furthermore, increased efforts are needed in maintaining the integrity of older patients and in reducing ethically problematic situations.

Long-term nursing care of elderly people: identifying ethically problematic experiences among patients, relatives and nurses in Finland.

The aim of this study was to explore ethically problematic situations in the long-term nursing care of elderly people. It was assumed that greater awareness of ethical problems in caring for elderly people helps to ensure ethically high standards of nursing care. To obtain a broad perspective on the current situation, the data for this study were collected among elderly patients, their relatives and nurses in one long-term care institution in Finland. The patients (n = 10) were interviewed, while the relatives, (n = 17) and nurses (n = 9) wrote an essay. Interpretation of the data was based on qualitative content analysis. Problematic experiences were divided into three categories concerning patients' psychological, physical and social integrity. In the case of psychological integrity, the problems were seen as being related to treatment, self-determination and obtaining information; for physical integrity, they were related to physical abuse and lack of individualized care; and for social integrity, to loneliness and social isolation. This study provided no information on the prevalence of ethical problems. However, it is clear from the results that patient integrity warrants more attention in the nursing care of elderly patients.