dignity and incontinence - amazon s3 · pdf fileneed for nursing care leads to reduced...
TRANSCRIPT
Dignity and Incontinence
Prof. Dr. Wilfried Schlüter, Prof. Dr. Katharina Oleksiw
1
Contents
1. Objectives
2. Fundamental understanding of "Dignity"
3. Research design
4. Results
5. Conclusions
6. Courses of action
2
Objectives
What significance does incontinence have on thepersonality of the person affected?
How do the persons affected feel about incontinence care?
What is the experience of the care givers in incontinencecare?
What is the need for change regarding the factors andconditions having an adverse effect on dignity?
What is the role of the expert standard “Encouragingurinary continence in care giving”?
3
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Fundamental understanding of "Dignity"
Functions of Dignity
Determination of 'being'
Protective Funktion
Constructive role
Need for nursing care leads to reduced cognition of function
in the person
Compensation by care givers
Preconditions:
Knowledge, thoughtfulness and professional discretion of thecare givers regarding the individuality of the persons
4
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Research design (1)
Method: Partly-structured qualitative interviews
Sample:
25 residents (57-95 years)
20 attending care givers
Setting: 7 different long-term care facilities
Ensuring voluntary participation and data protection
5
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Research design (2)
Pre-test
Transcription of interviews + coding
Qualitative content analysis according to Mayring(Mayring,P. (2008): Qualitative Inhaltsanalyse. Grundlagen und Techniken. 10. Aufl. Weinheim; Basel: Beltz)
Analysis of the documentation using checklist
Research log for relevant observations
6
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
ResultsDignity
Factors and conditions supporting dignity
Residents
Psycho-social factors
Quality of care
Professional treatment
Communication
Structural
Basic conditions
Care givers
Psycho-social factors
Quality of care
Professional treatment
Communication
Structural
Basic conditions
Factors and conditions having an adverse effect on dignity
Residents
Psycho-social factors
Quality of care
Professional treatment
Tabooing
Structural
Basic conditions
Economic aspects
Care givers
Psycho-social factors
Quality of care
Professional treatment
Communication and tabooing
Structural
Basic conditions
Economic aspects
7
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors supporting dignityPsycho-social factors
- Independence -
Residents (RS) Care givers (CG)
Use of existing self-helppotential
Encouraging independence in RS
8
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors supporting dignityPsycho-social factors
- Participation -
Residents (RS) Care givers (CG)
Development of participationstrategies, e.g. Adequate incontinence
material Frequent visits to the toilet
Recognising the individual limiting factors
Enabling participation
9
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors supporting dignityPsycho-social factors
- Emotional health -
Residents (RS) Care givers (CG)
Satisfaction Accepting incontinence
material (ICM) Influence of ICM on the
feeling of self-worth
Accepting the feeling of embarrassment
Recognition of adaption and acceptance of incontinence
10
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors supporting dignityPsycho-social factors
- Handling desires/needs -
Residents (RS) Care givers (CG)
Acceptance of wishes andfreedom to decide Choice of incontinence
material Individual times for visits to
the toilet Care givers of the same
gender
11
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors supporting dignity- Quality of care -
Residents (RS) Care givers (CG)
Need-based incontinence material
Self-care Gender-specific care Personal continuity Clothing that makes nursing
simpler
Personal continuity Mutual trust with RS
12
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors supporting dignity- Professional treatment -
Residents (RS) Care givers (CG)
Acknowledging the private space of the RS
Empathy Toilet training is carried out Talk on the use of incontinence
material during nursing visits
13
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors supporting dignityCommunication
- Communication between RS and CG -
Residents (RS) Care givers (CG)
Considering personal wishes Keeping in mind the feeling
of embarrassment
14
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors supporting dignity- Structural basic conditions -
Residents (RS) Care givers (CG)
Keeping the incontinencematerial (ICM) in RS room
Separate room Own, separate toilet
Separate room ensures the safe-keeping of privacy
Mobile screen Keeping the ICM in RS room Occupancy signal Adapting the occupancy
structure
15
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
ResultsDignity
Factors and conditions supporting dignity
Residents
Psycho-social factors
Quality of care
Professional treatment
Communication
Structural
Basic conditions
Care givers
Psycho-social factors
Quality of care
Professional treatment
Communication
Structural
Basic conditions
Factors and conditions having an adverse effect on dignity
Residents
Psycho-social factors
Quality of care
Professional treatment
Tabooing
Structural
Basic conditions
Economic aspects
Care givers
Psycho-social factors
Quality of care
Professional treatment
Communication and tabooing
Structural
Basic conditions
Economic aspects
16
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors having an adverse effect on dignityPsycho-social factors
- Independence -
Residents (RS) Care givers (CG)
Dependence on CG andhis/her help
Being under control ofanother person
17
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors having an adverse effect on dignityPsycho-social factors
- Participation -
Residents (RS) Care givers (CG)
Individual factors for limitingparticipation, e.g. Inadequate material Frequent visits to the toilet Fear
18
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors having an adverse effect on dignityPsycho-social factors
- Emotional health -
Residents (RS) Care givers (CG)
Resignation Embarrassment Fear Disregard Patronising behaviour Duress
Recognition of adaption toand acceptance ofincontinence
19
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors having an adverse effect on dignityPsycho-social factors- Stresses on the residents -
Residents (RS) Care givers (CG)
Involuntary urination Inadequate incontinence
material Effects of shortage of staff
Involuntary urination Inadequate incontinence
material Nuisance caused by the smell
20
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors having an adverse effect on dignityCommunication and tabooing
- Tabooing -
Residents (RS) Care givers (CG)
The topic of incontinence is often kept under wraps
Recognising the tabooing by RS
Tabooing through verbal customisation
Only functional communication in the team
21
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Factors having an adverse effect on dignity- Structural basic conditions -
Residents (RS) Care givers (CG)
Dormitory RS rooms without separate
toilet
Lack of a mobile screen A mobile screen not used
22
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Conclusions (1)
Tabooing of the topic among the affected and care givers
Simple functional view of incontinence, ICM plays a
significant role
High empathy among the care givers
Frequently inconsiderate treatment by care givers
23
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Conclusions (2)
High financial loads on persons affected
Development of coping strategies for daily life, often
resignation and 'lumping' the situation
Not possible to always consider dignity
National expert standard is hardly used
24
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Courses of action (1)
Sensitising management
Sensitising colleagues regarding dignified treatment
Breaking the mental block
Sensible use of language
Optimising structural basic conditions
25
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
Courses of action (2)
Using national expert standard
Concerted advanced training programmes and ensuring retention of acquired knowledge
Instructions for reflection/evaluation
Optimising communication within the team and with residents
Monitoring the colleagues directly during nursing activities
26
1. Objectives – 2. Fundamental understanding of „Dignity“ – 3. Research Design – 4. Results – 5. Conclusions – 6.Courses of action
„When one dreams alone, it is only a
dream. When many dream together,
this is the beginning of a new
reality.”
(Friedensreich Hundertwasser)
Your contact for further advice and information
Prof. Dr. Wilfried Schlüter
Prof. Dr. Katharina Oleksiw
Konsul-Smidt-Str. 92
D-28217 Bremen
phone: +49-421-39879057
+49-171-3641521
e-mail: [email protected]
28