Self-determination in nursing homes: the path to quality of life and dignity

This article is written from a Swedish perspective. Hopefully, it can inspire interested parties from other countries.

Self-determination is a fundamental prerequisite in the Social Services Act and the Health and Medical Services Act. Aging in itself means poorer conditions for asserting one's self-determination. Healthcare staff have a responsibility to be responsive to the resident's wishes. It requires an ongoing discussion about how employees can strengthen the individual's self-determination in the elderly home. Restricted self-determination often has negative consequences for health.

Self-determination - a human right

Self-determination is a fundamental human right that extends throughout life, regardless of age or health status. In nursing homes, the preservation of this right becomes even more crucial. Providing the residents with the opportunity to continue making decisions and having control over their lives not only promotes their well-being but also contributes to an increased quality of life and a sense of dignity.

Reduced self-determination affects well-being

Restrictions on this right can have serious consequences for people's physical and mental well-being. Therefore, it is important to promote and respect people's self-determination as far as possible and reasonable in care and service contexts.

When a person is no longer allowed to participate in making decisions that affect their lives, it can lead to a feeling that their opinions and wishes are not respected. This can make one feel violated and that self-esteem decreases.

Restricted self-determination can give rise to feelings of frustration, anger, and resistance. People may feel trapped in a situation they did not choose and cannot influence. The reaction can be frustration and anger.

When people no longer feel that their actions and decisions matter, they can develop a sense of passivity and apathy. They may give up and stop trying to influence their situation.

When a person's opportunities to make choices decrease, their quality of life can deteriorate. They may feel that their life is no longer meaningful or rewarding.

Restricted self-determination can lead to increased dependence on other people or institutions that make decisions for them.

When people are not allowed to decide on their own goals and plans, their motivation to strive for these goals may decrease.

The feeling of not having control over one's life can lead to increased stress and anxiety. People may feel insecure about the future and worried about what awaits.

When people are no longer encouraged to express their opinions and wishes, they may stop communicating effectively. This can affect their relationships with others and lead to isolation.

In some cases, restricted self-determination can lead to depression, especially if the individual feels powerless and hopeless.

The importance of self-determination in nursing homes

In nursing homes, staff and caregivers meet a varied group of elderly individuals with different backgrounds, experiences, and health conditions. Despite any physical or cognitive limitations, it is important to see each individual as a unique person with their own desires and starting points. Supporting their self-determination becomes a crucial factor in creating an environment where they feel respected and heard.
Many elderly people can maintain good contact with relatives by continuing to visit or meet in other contexts, which should be encouraged. When the residents are well and have a sensible occupation that is planned based on their interests, the staff feel pride and satisfaction, while relatives feel secure with the care given. The elderly stay healthier. Collaboration between the contact person and relatives is important for the elderly to have it as good as possible. Therefore, the contact person's role constantly needs to be improved, strengthened, and developed.  

It should be pleasant for relatives to come and visit. The staff's personal approach colors the atmosphere on the ward. Life is not over because you have moved into a residence "you should live until you die". The residents do not have to sit idle. It often does not take much to add some life to the residence. It is about getting the staff interested, getting them to understand that a lot is about their commitment. Often, it saves time in the long run to take the time for consideration for the elderly. Care will not be good if those who care do not give of themselves. The care burden can decrease through the right interventions.

The contact person's role

The contact person's role is central for those who move to a residence, that there is continuity and that the elderly as much as possible get to keep their contact. At the same time, the contact must feel good for the elderly and if it does not work, it is better to change the contact person. Continuity is important for the elderly and their opportunity to maintain their identity and interests. The relative should know who is the contact person and be able to reach them. A good relationship between the contact person and the elderly is the prerequisite for relatives to feel safe and the resident to receive good supervision and care. The contact person's work should be located so that it is possible to create continuity and should, as far as possible, take care of intimate hygiene and other tasks concerning the individual.

The contact person should have an arrival conversation with relatives when moving into the care home and get to know the care recipient and their life and health history. The contact person should find out how the elderly want it, habits and non-habits, what the care recipient likes and does not like. The contact person obtains information about what the elderly likes to do and has the overall responsibility for ensuring that the elderly can participate in various activities. This can also involve doing short trips together with the elderly on their own. The contact person should ensure that other staff get information about the new care recipient. The responsibility for the elderly having what they need of hygiene articles, clothes, and other things is done in agreement with relatives.

Over the past decade, a long series of measures have been taken to strengthen the individual's influence. We have received a new patient law as a result of the patient power investigation. There is talk of person-centered care, the individual or elderly needs in the center, and other measures to strengthen the resident's right to decide. A knowledgeable and committed contact person is worth gold to realize this.

Self-determination can be promoted through:

1. Individual planning: Create health and implementation plans that include the residents' wishes and needs, and which respect their independence.
2. Clear communication: For open and honest conversations with the residents about their wishes and decisions regarding their care and everyday life.
3. Employee training: Train staff to promote and respect self-determination, even when there are cognitive challenges. Education, supervision, and support for the contact men.
4. Include relatives: Involve the residents' relatives in the decision-making process when possible and desirable.
5. Continuous follow-up: Update and adapt planning and activities in accordance with the residents' changed wishes and needs.

Reflection questions - self-determination:
Care staff:
- Do the contact routes between you as a contact person and the relatives work?
- Do you have substitute contact persons when the regular contact person is off for a period?  

Manager, nurse, occupational therapist, and physiotherapist:
- Do you evaluate how the contact person's role works for the residents?
- Does it work with replacements when regular contact persons are absent for a period?
- Does the resident truly influence your planning?

Resident and relatives:
- Is there a reliable staff member who has primary responsibility for your relative?
- Are there forums where you as relatives get to meet the manager and licensed personnel?
- Are you invited to the doctor's conversations?
- What is the company's view on visits?

Erland Olsson
Specialist Nurse
Better care every day

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