Promoting dignity and well-being in residential care facilities : Older persons’ perceptions and experiences of important aspects and associated factors

Abstract: Objective: The overall aim of this thesis was to increase knowledge regarding the perceptions and experiences of aspects and factors associated with perceived dignity and well-being among older persons living in residential care facilities. Study I describes residents’ perceptions and experiences regarding important aspects of experiencing dignity and well-being. Study II examines the associations between perceptions of dignity and well-being and the attitudes of staff, the indoor-outdoor-mealtime environments and individual factors for residents. Study III examines the same associations as Study II over a three-year period. Study IV examines residents’ perceptions of empowerment, person-centred climate and life satisfaction before and after a caregiver intervention concerning the Swedish national fundamental values of dignity and well-being. Methods: The studies were performed in residential care facilities in Sweden. The participants were residents living in these facilities. Study I is a qualitative study that used semi-structured interviews to collect data. Data were analysed using qualitative content analysis. Study II, a cross-sectional study, and Study III, a longitudinal study, are based on national questionnaire data from the Swedish National Board of Health and Welfare. Data from 2016, 2017 and 2018 were used and analysed using descriptive statistics and ordinal logistic regression models. Study IV is a cluster-randomized controlled trial with a pre-and post-test design. Data were collected using the Patient Empowerment Scale, the Person-centred Climate Questionnaire – patient version, the Life Satisfaction Questionnaire and the EQ-5D questionnaire. Data were analysed using descriptive statistics, the Chi-square test, the Wilcoxon signed-rank test, the Mann-Whitney U test and generalized estimating equation models.Findings: To experience dignity and well-being it was important for residents to feel that they still matter. To feel this, it was vital to be able to manage daily life, to have influence and to belong to a social context (I). Residents who had experienced disrespectful attitudes of staff, who did not thrive in the indoor-outdoor-mealtime environments, who rated their health and mobility as poor, and who were diagnosed with dementia had higher odds of being dissatisfied with aspects of dignity and well-being (II). These associations were persistent over a three-year period (III). After an intervention concerning the Swedish national fundamental values of dignity and well-being, the residents in the intervention group reported higher scores for perceived empowerment, person-centred climate and life satisfaction (IV).Conclusion: To promote dignity and well-being, the attitudes of staff, the indoor-outdoor-mealtime environments and the individual factors of poor health, poor mobility and a dementia diagnosis need to be targeted. The Person-centred practice framework, targeting the prerequisites of staff and the care environment, could be used as a theoretical framework for designing improvement strategies that aim to promote dignity and well-being. First-line managers and registered nurses in residential care facilities have different knowledge and skills. They therefore need to work together as a team when developing improvement strategies that aim to promote the dignity and well-being of residents. In addition, residents should be included on the team given their knowledge regarding what is important for promoting dignity and well-being.