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Ontological Security in Nursing Homes for Older Persons – Person-Centred Care is the Power of Balance

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The Swedish national guidelines for elderly care describe how older persons should be able to trust that their care is permeated with security. Different theoretical perspectives can be found that describe what creates security. Many studies have been done about security. However, few studies have explicitly asked older persons what security in nursing homes means to them. The aim of the study was to describe how older persons in nursing homes talked and reflected about security in their daily lives. Nine older persons were interviewed in, in-depth interviews one to three times and the resulting data was analysed using content analysis. The older persons adapted to having their own needs and those of the other older persons met and to the staff routines which created a sense of security. At the same time, they longed for security in which they could trust themselves and create their own daily life. Further to have a sense of belonging and of being liked for created an internal, interpersonal and external security. This can be linked to an ontological security which means having a sense of confidence in the continuity of self-identity and order in events, a being in the world. Person-centred instead of institution- centred care can provide the balance of power that allows the older person to obtain ontological security in which the staff's ability to create a relationship with the older persons becomes crucial.
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... Sense of security has been depicted by older persons as having three aspects: internal, interpersonal and external security (21). Having an internal sense of security was described by older persons as being able to create one's daily life and make choices depending on their own needs and desires. ...
... The older persons' interpersonal sense of security was related to their adaptation to the healthcare professionals' routines. Their external sense of security was on the other hand, related to having access to healthcare professionals 24 hours a day (21). Likewise, access to healthcare professionals has been reported to increase the sense of security for patients receiving palliative home care and for older persons at home after being discharged from the hospital (22,23). ...
... Decreased external resources such as functional ability and family relations can lead to insecurity (24,25). Furthermore, having access to and being able to contact healthcare professionals when needed has been described as important for a sense of security in older persons (21)(22)(23). It is shown that older persons' sense of security can increase when using mHealth to report health information (51), but it is necessary to take the older persons preferences into consideration and incorporate them in the new technologies (52). ...
Article
The study's rationale: The need for home care among older persons is increasing, and mHealth is evolving to help meet the challenge. When developing an app to help maintain their health, it is essential to incorporate older persons' preferences. Aims and objectives: To describe and evaluate the experiences of self-care support and sense of security among older persons using an interactive app to report health concerns. Methodological design and justification: The study had a descriptive and evaluative design. Qualitative and quantitative methods were applied to achieve a broader understanding. Ethical issues and approval: Ethical approval was obtained from the Regional Ethical Review Board. The older persons received verbal and oral information about the study and gave written informed consent. Research methods: Questionnaires (n = 17 older persons) answered at baseline, end of the intervention and at a 6-month follow-up were analysed with statistical analysis. Interviews (n = 17 older persons) conducted at the end of the intervention were analysed using a qualitative directed approach. Measurements and intervention: The questionnaire included the Appraisal of Self-care Agency Scale and a question concerning sense of security. For 3 months, the older persons used an app for regular reporting of health concerns. The app included self-care advice, graphs and a risk assessment model that generated alerts directly to the nurses. Results: The older persons described how self-care and sense of security increased at the end of intervention, but statistically, it was shown to decrease afterwards. Study limitations: The small sample size for statistical analysis. Conclusions: This study shows that an app can be a complementary tool to conventional home care that can increase older persons' sense of security and self-care ability. The results mirror the older persons' awareness that the support they received with the app was only temporary. Larger studies are needed for generalisation.
... People who are dependent on home health care are not always getting the help they need [16]. Older people have to move to nursing homes because in their ordinary housing they lack a sense of security; furthermore, due to physical or cognitive impairment, they can have difficulty managing routine activities and keeping up with daily life [17]. Their sense of insecurity may be relative to the time of day, with the greatest levels occurring in the evenings and nights. ...
... There is, according to Mead, a clear division of body and soul when the body cannot be trusted [52,53]. Other research shows that good mobility and functional capacity give a sense of freedom and control [17], which is important for a sense of security [45,46]. Having reduced mobility may cause difficulties interacting with the environment, managing habits and routines, and living as usual. ...
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Background: Today many older persons in ordinary housing receive home health care. It is stipulated that the care is to provide security; however, deficiencies in home health care are reported in many countries. It may be difficult to implement a sense of security among older persons receiving home health care in ordinary housing, especially during the evenings and nights, due to a lack of knowledge. Methods: This study is part of a larger project with a participatory appreciative action and reflection (PAAR) approach. We invited older persons, relatives, nurse assistants, registered nurses, and their managers to co-create knowledge with us on how conditions for a sense of security can be created during evenings and nights among older persons receiving home health care in ordinary housing. We performed thematic analysis of the data. Results: Five subthemes were developed that gave structure to two main themes. The first main theme, To confirm the self-image, has the following subthemes: To see the home as a reflection of the person's identity and To maintain self-determination. The second main theme, To create interaction in a sheltered place, has these subthemes: To undress the power, To create control and lifelines, and To create a good sleeping environment. The two themes interact and are each other's conditions. The person's self-image must be confirmed in order to create interaction in a sheltered place and through the interaction, the self-image is confirmed. Conclusion: Conditions necessary for older persons to have a sense of security are living in a familiar environment, having habits and routines maintained, and having self-determination. Other conditions are equality, the prevention of falls, and an individualized sleeping environment. Older people's self-determination should be honored, and they should not being excluded from decision-making. We need to ask them if the conditions are sufficient and their sense of security is great enough to allow them to continue living in their ordinary housing.
... The third dimension is security related to the life you live, with factors outside affecting the individual, an external security. Security has been described by adults as having inner peace and faith in themselves [3]. Security was also described as having the ability to integrate with other people as well as being safe in new routines and roles. ...
... Security may be that home care is available and that palliative care can be provided at home [7]. Person-centred care can strengthen the sense of security, taking into account the individual's life-world and values, and the ability to create a relationship [3]. Feeling seen, respected and trusted can also create a sense of security. ...
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Background: Security is a human need and the home can offer a form of security, while it can be reduced closer to end-of-life. Many patients are cared for at the end-of-life stage in their homes, and the number is expected to increase. The public health nurse works to promote good and safe palliative home care. Aim: The study’s aim is to describe how public health nurses can create a sense of security for adult patients in palliative home care. Method: Eight public health nurses working in municipal home care were interviewed in the year 2016 in Sweden. Content analysis was used. Results: The content analysis resulted in five main categories: patient and relatives, communication, staff, nursing planning and organisation. The results showed that the public health nurses created a relationship with patients and relatives through communication and continuity. Moreover, they were available and worked in a team towards common goals. The public health nurses’ qualifications, confidence in their professional role, and experience of how care should be organised could create a sense of security for the patient and relatives. Conclusions: The conclusion is that to understand the patient’s life-world requires time and competence development in palliative care. Cooperation between municipal and county councils should be improved to create a sense of security in palliative home care.
... In such scenarios, the role of trained institutional caregivers is very important in providing person centered care to promote emotional engagement and a sense of security amongst the older people. 16 The physiological and psychological changes in older people demands clear and technical understanding by a caregiver to appropriately respond to the needs. This is well supported by an Irish study finding, which suggested the holistic and individualized care promotes quality of life of old people. ...
Article
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Objectives: The growing number of older people due to demographic transition is paving the way for nongovernmental organizations and the private sector for mushrooming of old age homes (OAHs). These homes function either free or fee for services and the services provided at these OAHs determines the quality of life of older people. The aim of the study was to explore the stakeholders' perception on the quality of services offered to people living in OAHs. Methods: A descriptive qualitative study design was used to explore stakeholders' perception of elderly living experiences in old age homes. Three OAH were selected through purposive sampling for the study. Data collected from February-March 2015 through the structured interview guide. Participants' for FGDs were recruited through universal sampling, while purposive sampling was used for KIIs selection. Researcher ensured all ethical considerations for the entire study period. Results: Two major themes were drawn including the reasons and experiences of older people living in OAH, secondly the need for caregivers' academic competencies. Majority of KIIs and FGDs reported common responses under the two themes. Also the elderly experiences varied from living comfortably to being depressed. KIIs and caregivers' FGD participants' strongly urged the need for caregivers' training and institutional accreditation. Conclusion: The results of the study on the older people's experiences and challenges of living in OAHs, strongly propose community support system and credentialing of the caregivers for age appropriate care. Moreover the capacity building of academia for offering specialized training in gerontology and geriatrics is also highlighted. Keywords: Caregivers; Elderly; Institutionalization; Old Age Homes, Geriatric health and wellbeing. (JPMA 70: 2205; 2020)
... Evidence has indicated that learned helplessness, depression, fear, feeling of guilt, shame, and post-traumatic stress syndrome, which are caused by elder abuse, provide the ground for emotional distress (34). Studies have also demonstrated that in cases individual-centered care is missing and replaced with institution-centered care, resulting in routine care services, limited opportunity to take communication and psychological dimensions into account, lower time, and lower engagement with elderly patients, they adapt with and surrender to the situation, eventually leading to depression and emotionlessness (35). Solomon (1990) mentioned three psychological factors for development of learned helplessness in healthcare centers, including healthcare providers' attitudes, interactions between healthcare providers and elderly patients, and injustice resulting from stereotypes. ...
... However, we mean this perspective can be harmful. Older adults can adapt to the staffs lack of time and give up their own participation and needs and by that the staff regain control over time which can result in an institutions-centered care instead of person-centered care [44]. ...
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