A qualitative study on the experience and needs of dignity-conserving care for the disabled elderly people in nursing homes

doi:10.3761/j.issn.0254-1769.2023.24.009

Abstract

Abstract:

Objective This study aimed to explore the experience and needs of dignity-conserving care of disabled elderly people in nursing homes，and to provide a basis for formulating a quality evaluation system for dignity-conserving care. Methods This descriptive qualitative study，involving a semi-structured in-depth interview of 13 disabled elderly people based on purposive sampling，was conducted from August to November 2022 at a nursing home in Hangzhou. Based on the harmony nursing theory，the directional content analysis method was performed in order to summarize and extract themes from the interview texts. Results The dignity-conserving care experience and needs of disabled elderly people were extracted and classified into 5 themes，including physical safety（physical health maintenance，privacy protection，hygiene and image maintenance），psychological health （psychological counseling，psychological support），social communication（well communication environment，harmonious way of communication），spiritual culture（self-realization，respect for faith），needs of dignity-conserving care （individualized health needs，activity participation needs，dignified communication needs，spiritual needs of respecting the elderly ）. Conclusion When conducting the dignity-conserving care，nursing homes should pay attention to the physical health of the disabled elderly，actively maintain the image and privacy of the disabled elderly people，pay attention to the needs of psychological health，provide psychological counseling and support，strengthen the construction of barrier-free environments and cultural environments，build mutual respect way of communication，fully respect the religious beliefs of disabled elderly people，promote the realization of self-value of disabled elderly people，broaden the channels of personalized service and activity participation，strengthen the interaction of the dignity and spirit of the respect for the elderly of nursing homes，comprehensively improve the quality of dignity-conserving care in nursing homes.

Key words: Dignity, Nursing Home, Disability, Aged, Qualitative Research, Nursing Care

摘要：

目的探讨养老机构中的失能老年人对尊严照护的体验及需求，旨在为构建该人群尊严照护质量评价体系和干预方案提供依据。方法采用描述性质性研究的方法，按照目的抽样法，于2022年8月—11月，选取杭州市某养老机构的13例失能老年人进行半结构式深入访谈，并以和谐护理理论为框架，采用定向内容分析法归纳和提炼主题。结果将失能老年人尊严照护的体验及需求提炼为5个主题：躯体安全（躯体健康维护、隐私保护、卫生与形象保持）；心理健康（心理疏导、心理支持）；社会交往（良好的交往环境、融洽的交往方式）；精神文化（自我实现、尊重信仰）；尊严照护需求（个性化健康需求、活动参与需求、尊严沟通需求、敬老精神需求）。结论养老机构护理人员在实施尊严照护时，应关注失能老年人躯体健康状况，维护失能老年人的隐私和形象，重视失能老年人心理健康，给予心理疏导和支持，加强无障碍环境及人文环境的建设，构建相互尊重的交往方式，促进失能老年人实现自我价值，拓宽失能老年人个性化服务与活动的参与渠道，强化养老机构尊严沟通与敬老精神建设，综合提升养老机构的尊严照护质量。

关键词: 尊严, 养老机构, 失能, 老年人, 质性研究, 护理

CHEN Lingshan, SHEN Cuizhen, ZHU Qianyin, MU Tingyu. A qualitative study on the experience and needs of dignity-conserving care for the disabled elderly people in nursing homes[J]. Chinese Journal of Nursing, 2023, 58(24): 3004-3010.

陈灵杉, 沈翠珍, 朱倩寅, 沐婷玉. 养老机构失能老年人尊严照护体验及需求的质性研究[J]. 中华护理杂志, 2023, 58(24): 3004-3010.

Figures/Tables 1

References 25

[1]	李建伟, 吉文桥, 钱诚. 我国人口深度老龄化与老年照护服务需求发展趋势[J]. 改革, 2022(2):1-21.
	Li JW, Ji WQ, Qian C. The development trend of China’s deep aging and demand for elderly care services[J]. Reform, 2022(2):1-21.
[2]	朱雪雪, 张玉, 刘宏宇, 等. 健康老龄化下的失能老人医养整合[J]. 中国老年学杂志, 2019, 39(20):5128-5130.
	Zhu XX, Zhang Y, Liu HY, et al. The integration of medical care for disabled elderly under healthy aging[J]. Chin J Geron-tol, 2019, 39(20):5128-5130.
[3]	崔晓芳, 张建华. 养老机构失能老人入住体验的质性研究[J]. 护理研究, 2021, 35(12):2228-2233.
	Cui XF, Zhang JH. Check-in experience of the disabled elderly in nursing homes:a qualitative research[J]. Chin Nurs Res, 2021, 35(12):2228-2233.
[4]	Dong D, Cai Q, Zhang QZ, et al. Dignity and its related factors among older adults in long-term care facilities:a cross-sectional study[J]. Int J Nurs Sci, 2021, 8(4):394-400.
[5]	张虹, 沈军, 喻秀丽. 352名医养结合机构失能老人长期照护需求现状及影响因素分析[J]. 护理学报, 2020, 27(21):7-10.
	Zhang H, Shen J, Yu XL. Current status of long-term care needs of disabled elders in medical and nursing institutions and its influence factors:a 352-case study[J]. J Nurs, 2020, 27(21):7-10.
[6]	强万敏. 终末期癌症患者尊严照护的研究进展[J]. 中国护理管理, 2018, 18(3):320-325.
	Qiang WM. The research progress of dignity-conserving care for end-stage cancer patients[J]. Chin Nurs Manag, 2018, 18(3):320-325.
[7]	李峥, 刘华平, 康晓凤, 等. 传统文化视角下和谐护理理论的构建[J]. 中华护理杂志, 2016, 51(9):1034-1038.
	Li Z, Liu HP, Kang XF, et al. Development of Harmony Nursing Theory based on Confucianism and Daoism beliefs[J]. Chin J Nurs, 2016, 51(9):1034-1038.
[8]	卢美玲, 罗志芹. 中重度尊严缺失晚期癌症患者尊严维护需求的质性研究[J]. 护理学杂志, 2019, 34(20):79-82.
	Lu ML, Luo ZQ. A qualitative study on needs for maintenance of dignity in patients with advanced cancer experiencing moderate to severe loss of dignity[J]. J Nurs Sci, 2019, 34(20):79-82.
[9]	Fekonja Z, Kmetec S, Lorber M, et al. Experiences with dignity among older people confined to beds living in a nursing home:a qualitative descriptive study[J]. J Nurs Manag, 2022, 30(7):2362-2369. DOI URL
[10]	国家医保局办公室, 民政部办公厅. 关于印发《长期护理失能等级评估标准(试行)》的通知[EB/OL].(2021-08-03)[2023-06-20]. https://www.gov.cn/zhengce/zhengceku/2021-08/06/con-tent_5629937.htm.
	The office of the National Medical Insurance Administration,The general office of the ministry of civil affairs. Notice on the issuance of long-term care disability grade assessment standards(Trial)[EB/OL]. (2021-08-03)[2023-06-20]. https://www.gov.cn/zhengce/zhengceku/2021-08/06/content_5629937.htm.
[11]	Hsieh HF, Shannon SE. Three approaches to qualitative content analysis[J]. Qual Health Res, 2005, 15(9):1277-1288. DOI URL
[12]	柳家贤, 周英, 李浩然, 等. 医养结合型养老机构失能老人人文关怀体验的质性研究[J]. 护士进修杂志, 2020, 35(5):455-458.
	Liu JX, Zhou Y, Li HR, et al. A qualitative research on humanistic care experience of disabled elderly in medical and nursing care institutions[J]. J Nurses Train, 2020, 35(5):455-458.
[13]	Holmberg B, Hellström I, Österlind J. Elements of assisted bodily care:ethical aspects[J]. Nurs Ethics, 2020, 27(6):1377-1395. DOI URL
[14]	姚莉珮, 张培莉, 丁永霞. 小丑照护对养老院老年人情绪的影响[J]. 中华护理杂志, 2020, 55(11):1685-1690. DOI URL
	Yao LP, Zhang PL, Ding YX, et al. Study on the effect of clown care on mood in the elderly in nursing homes[J]. Chin J Nurs, 2020, 55(11):1685-1690. DOI URL
[15]	孟爽. 养老机构老年人述情障碍现状及其与归属感的相关性研究[D]. 唐山: 华北理工大学, 2020.
	Meng S. Study on the status of alexithymia and relationship between alexithymia and sense of belongingin elderly care institutions[D]. Tangshan: North China University of Science and Technology, 2020.
[16]	李扬, 李振华, 张扬. 失能老年人及探访家属对老年护理医院照护体验与需求的质性研究[J]. 中国初级卫生保健, 2022, 36(7):112-115.
	Li Y, Li ZH, Zhang Y. A qualitative study on nursing home care experience and needs of disabled elderly and visiting family members[J]. Chin Prim Health Care, 2022, 36(7):112-115.
[17]	Kisvetrová H, Tomanová J, Hanáčková R, et al. Dignity and predictors of its change among inpatients in long-term care[J]. Clin Nurs Res, 2022, 31(2):274-283. DOI URL
[18]	Lee SY, Hung L, Chaudhury H, et al. Staff perspectives on the role of physical environment in long-term care facilities on dementia care in Canada and Sweden[J]. Dementia, 2021, 20(7):2558-2572. DOI URL
[19]	Puente-Fernández D, Lozano-Romero MM, Montoya-Juárez R, et al. Nursing professionals’ attitudes,strategies,and care prac-tices towards death:a systematic review of qualitative studies[J]. J Nurs Scholarsh, 2020, 52(3):301-310. DOI URL
[20]	王二娇, 白玺, 肖树芹. 日本失能老年人恢复自立照护的介绍及启示[J]. 中华护理杂志, 2023, 58(3):380-384. DOI URL
	Wang EJ, Bai X, Xiao SQ, et al. Introduction of self-supporting care in Japan and its enlightenment to the nursing care of disabled elderly in China[J]. Chin J Nurs, 2023, 58(3):380-384. DOI URL
[21]	王水莲, 陈丽敏, 张云逸. 医养结合型养老机构入住老人生存质量[J]. 中国老年学杂志, 2021, 41(7):1531-1535.
	Wang SL, Chen LM, Zhang YY. The quality of life of the elderly living in the medical-nursing combined pension institutions[J]. Chin J Gerontol, 2021, 41(7):1531-1535.
[22]	王佳慧, 董屿, 刘琰, 等. 辽宁省老年人康养服务需求调查[J]. 中国医科大学学报, 2022, 51(12):1109-1115.
	Wang JH, Dong Y, Liu Y, et al. Survey on health care ser-vices needs for older adults in Liaoning Province[J]. J China Med Univ, 2022, 51(12):1109-1115.
[23]	Roos C, Alam M, Swall A, et al. Factors associated with older persons’ perceptions of dignity and well-being over a three-year period. A retrospective national study in residential care facilities[J]. BMC Geriatr, 2022, 22(1):515. DOI
[24]	Avestan Z, Pakpour V, Rahmani A, et al. The correlation bet-ween respecting the dignity of cancer patients and the quality of nurse-patient communication[J]. Indian J Palliat Care, 2019, 25(2):190-196. DOI URL
[25]	宁艳, 王高翔, 殷召雪, 等. 中国空巢老人机构养老意愿及其倾向、使能和需求影响因素分析[J]. 中国公共卫生, 2022, 38(10):1237-1240.
	Ning Y, Wang GX, Yin ZX, et al. Predisposing,enabling and demand factors of preference for institution-based care among Chinese elderly empty-nesters[J]. Chin J Public Health, 2022, 38(10):1237-1240.