Upholding Older Adults' Innate and Inherent Dignity within a Caring Context

Sammanfattning: In the ethical ideals of autonomy and integrity reducing the level of abstraction is necessary in order to more easily be able to follow them in every day care practices. This is especially true concerning the effort of upholding older adult patients dignity. Creative intervention programs may help to increase health care professionals ethical competence. In the first study (I) 12 older adults experiences of care are described, with special reference to their integrity. In addition, four student nurses were interviewed and participant observations were performed in order to describe the health care professionals integrity- promoting or non-promoting behaviours. The findings confirmed, in relation to a theoretical model, which determined ten categories of integrity related to the self-concept the complexity of the concept, but they also indicated that in relation to older patients a further category should be included namely one relating to their social self Therefore, the purpose of the second study (II) was to deepen the understanding of the identified eleventh category, social self, and how it may effect the ethical care in older adult patients. Two themes were identified: Social exchange, which was described as the older adult informants wish to be respected for their needs of meaningful social and human contacts, but also for their needs of meaningful social activities. Social experiences included the older informants wish to be respected for their needs of talking about themselves, recalling and sharing memories, moreover, to be respected for their needs of being a part of the world outside the hospital. Thus, the findings indicate the relevance of the new identified category. In the third study (III) the aim was to achieve a deeper understanding of an older cognitively intact mans lived experiences of being a patient in a geriatric context, where the majority of the patients were cognitively impaired. An earlier qualitative interview from study I was used and analysed from a phenomenological approach that illustrated health care professionals lack of meeting and confirming individual patients needs to be met as unique individuals with personal preferences, own resources and the ability to take charge over their own life. The health care professionals care actions tended to depend upon the needs of the cognitively impaired. In the fourth study (IV) the aim was to teach ethics from an activating instructional approach and then to evaluate whether or not this was a practicable strategy to influence individual health care members attitudes as well as their ethical caring behaviour with a special focus on the patients autonomy and integrity. A 6 and 12 months follow up was performed including group-interviews and participant observations. The findings indicate that the attitudes of individual participants had actually changed into a more patient-centred perspective and that their caring behaviour agreed to their attitudes. Based on real- life care situations taken from the fields of geriatrics, where the majority of the patients were cognitively impaired the aim of the fifth study (V) was to examine the relationship between autonomy and integrity resulting from the interactions between the individual health care member and the patients. These findings indicate that the relationship was ethically complex and that they were inseparable for maintaining a patients dignity. Consequently, this meant that if the health care professionals respected the older adult patients autonomy their integrity was protected and thereby, their innate and inherent dignity.