The significance of meaningful and enjoyable activities for nursing home resident's experiences of dignity
There were about 100 000 residents in nursing homes in Scandinavia in 2015. In Norway, there were 39 674 beds in nursing homes in 2015 1; in Sweden 20 143 beds in 2014 2, and in Denmark, there were 40 068 beds in nursing homes in 2015 3. In all countries, the number of beds has decreased in recent years, but there are still thousands of persons living in nursing homes in Scandinavia. Recent research based on input reported by nursing staff and relatives of patients shows that residents living in nursing homes experience indignity and inadequate care as challenging 4. Research also mirrors staff reports of inadequate care, abuse and neglect in nursing homes especially in the staff's encounter with resident aggression and in conflict situations 6. Furthermore, in a study of nursing staffs’ reported experiences of patient neglect and inadequate care, 91 per cent reported having observed inadequate care and 87 per cent reported they had provided inadequate care themselves. Examples of inadequate care reported where acts of negligent and behaviour of an emotional nature 4. Nåden et al. 7 reveal indignity in the care of nursing home residents as reported by relatives. They report that lack of appropriate nursing care in nursing homes caused the residents to feel abandoned, deprived of the feeling of belonging, a lack of personal confirmation and deprived of dignity as a result of physical and psychological humiliation. The preamble of the International Council of Nurses’ Code of Ethics places emphasis inter alia on dignity: Inherent in nursing is a respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect (8: p. 36). In an editorial, Gallagher 9 claims that more research on dignity deficits in care is needed in order to understand what contributes to these deficits. It is equally important to understand what factors may promote dignity in care for older people. Gallagher refers to the UK Health Commission (10: p. 9) statement of the ethical importance of dignity: All users of health and social care services need to be treated with dignity and respect. However, some older people can be particularly vulnerable and it is essential that extra attention is given to making sure that givers’ of care treat them with dignity at all times and in all situations.
However, an understanding of dignity in healthcare provision for older persons and an awareness of how to promote it is not straightforward. Macklin 11 initiated the debate in BMJ in which she claimed dignity constitutes nothing less than respect for autonomy. As such, she saw dignity as a useless concept. Despite this debate, Norway introduced a ‘dignity guarantee’ for residents in nursing homes in 2010 12, whereby the nursing home resident's right to have his/her dignity respected is guaranteed. This is in line with The NHS Constitution in Britain in the Health Act of 2009 whereby all residents have the right to be treated with dignity and respect in accordance with basic human rights 13. In the present study, a research group in Scandinavia explored dignity as experienced by older people living in nursing homes and explored the connection between activity and dignity in nursing home residents.
Health authorities in Scandinavian countries stress the importance of activities in daily life 14. Activities are also considered important to promote health in later stages of life 14.