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Sturge J, Janus S, Zuidema S, Frederiks B, Schweda M, Landeweer E. The Moral and Gender Implications of Measures Used to Modulate the Mobility of People With Dementia Living in Residential Care Environments: A Scoping Review. Gerontologist 2024; 64:gnad071. [PMID: 37330640 PMCID: PMC10943503 DOI: 10.1093/geront/gnad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Policies and measures often restrict the mobility of people with dementia living in residential care environments to protect them from harm. However, such measures can violate human rights and affect the quality of life. This review aims to summarize the literature on what is known about measures used to modulate the life-space mobility of residents with dementia living in a residential care environment. Furthermore, moral and sex and gender considerations were explored. RESEARCH DESIGN AND METHODS A scoping review framework was referenced to summarize the literature. A total of 5 databases were searched: PubMed, Embase, CINAHL, SCOPUS, and Web of Science. The studies for eligibility using the Rayyan screening tool. RESULTS A total of 30 articles met the inclusion criteria. A narrative description of the findings of the articles is presented across 3 themes: (1) measures and strategies used to modulate the life-space mobility; (2) moral aspects; and (3) sex and gender considerations. DISCUSSION AND IMPLICATIONS Various measures are used to modulate the life-space mobility of people with dementia living in residential care facilities. Research exploring the sex and gender differences of people with dementia is lacking. With a focus on human rights and quality of life, measures used to restrict or support mobility must support the diverse needs, capacity, and dignity of people with dementia. Noting the capacity and diversity of people with dementia will require society and public space to adopt strategies that promote safety and mobility to support the quality of life of people with dementia.
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Affiliation(s)
- Jodi Sturge
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Brenda Frederiks
- Department of Ethics, Law and Humanities, University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Mark Schweda
- Division of Ethics in Medicine, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Elleke Landeweer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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De Witte J, Noten S, Vinckers F, Stoop A, Hovenga N, Landeweer E, Van Regenmortel T. "You Needed to Accept the Situation": Resilience of Nursing Home Residents in Times of COVID-19. Can J Aging 2024; 43:75-83. [PMID: 37665004 DOI: 10.1017/s0714980823000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
The restrictive measures taken by nursing homes during the COVID-19 outbreak in 2020 (e.g., quarantine) may have been important stressors for which residents needed resilience to safeguard their well-being. Based on 30 semi-structured interviews with nursing home residents and close relatives, this study explored the lived experiences with respect to the restrictive measures. The data were collected in psychogeriatric, somatic, and mixed wards in The Netherlands and Flanders, Belgium. The restrictive measures were important stressors for residents, indicated by feelings of loneliness, sadness, and powerlessness. To deal with these measures, residents used various resources, which were determined by factors in the individual (e.g., health), interactional (e.g., possibilities for social interactions) and contextual (e.g. nursing home policy) domains. Because the lived experiences with respect to the restrictive measures seemed to relate to the resilience of nursing home residents, it is crucial to reinforce resources in the individual, interactional, and contextual domains.
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Affiliation(s)
| | - Suzie Noten
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Floor Vinckers
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Annerieke Stoop
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Nina Hovenga
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Elleke Landeweer
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tine Van Regenmortel
- HIVA KU Leuven, Leuven, Belgium
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Hovenga N, Landeweer E, Vinckers F, Leget C, Zuidema S. Family involvement in dementia special care units in nursing homes: A qualitative care ethical study into family experiences. J Adv Nurs 2024; 80:200-213. [PMID: 37458271 DOI: 10.1111/jan.15794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 12/18/2023]
Abstract
AIM To explore the moral dimension of family experiences with being involved in the care of their loved one with dementia in the nursing home, using the care ethical framework of Tronto. DESIGN This qualitative study used a care ethical approach in which empirical data and care ethical theory were dialectically related and mutually informing. METHODS Fifteen close family members of nursing home residents with dementia were interviewed between February 2020 and October 2020. Forty-two interviews were conducted, based on a semi-structured open-ended design. A thematic narrative approach combined with the five phases of care as defined by Tronto was used to analyse the empirical data. Subsequently, Tronto's identified ethical qualities were used to identify the moral dimension of these empirical findings. RESULTS We found that in the care process (1) family can find it difficult to recognize their loved one's care needs; (2) both family and staff are reluctant to discuss the allocation of responsibilities with each other; (3) family sometimes feels insecure when it comes to connecting with their loved one; (4) family is often reluctant to provide feedback to staff when they are critical about the care that has been given; and (5) family is generally mild in judging staff, due to staff shortages. The care ethical interpretation of these findings showed that the moral qualities of attentiveness, responsibility, competence, responsiveness, and solidarity are under pressure to a certain extent. CONCLUSION Family experiences moral distress during the care process, which hinders family involvement in nursing homes for people with dementia. IMPACT Nursing home staff can look for and pilot strategies focused on supporting families to act more in accordance with the moral qualities that are under pressure. This can improve family involvement in practice. PATIENT OR PUBLIC CONTRIBUTION No Patient/Public Contribution. IMPLICATIONS FOR PRACTICE/POLICY Nursing home staff paying more attention to families' emotional struggles related to the decline of their loved one, could help families to be more attentive to noticing true care needs of the resident. Both family and nursing home staff should take more often initiatives to evaluate the division of care responsibilities with each other. Nursing home staff should help family connect with their loved one during their visits if they experience difficulties in doing so. Nursing home staff taking more often initiatives to contact family and ask them how they perceive the care for their loved one, can positively affect the responsiveness of both family and staff. It would be helpful if nursing home management could ensure the presence of sufficient and qualified staff so that the first four phases of the care process are not hindered by the lack of staff.
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Affiliation(s)
- Nina Hovenga
- Department of Primary- and Long-term Care, University Medical Center Groningen, Groningen, Netherlands
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Elleke Landeweer
- Department of Primary- and Long-term Care, University Medical Center Groningen, Groningen, Netherlands
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Floor Vinckers
- Department of Primary- and Long-term Care, University Medical Center Groningen, Groningen, Netherlands
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Utrecht, Netherlands
| | - Sytse Zuidema
- Department of Primary- and Long-term Care, University Medical Center Groningen, Groningen, Netherlands
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
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Landeweer E, Hovenga N, Noten S, Vinckers F, Witte JD, Stoop A, Zuidema S. Moral lessons from residents, close relatives and volunteers about the COVID-19 restrictions in Dutch and Flemish nursing homes. Philos Ethics Humanit Med 2023; 18:12. [PMID: 37670362 PMCID: PMC10481572 DOI: 10.1186/s13010-023-00140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND During the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As 'safety' prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding the restrictions in retrospect, and what moral lessons they considered important. METHODS We conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design. RESULTS Critical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions. DISCUSSION Comparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives.
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Affiliation(s)
- Elleke Landeweer
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands.
| | - Nina Hovenga
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands
| | - Suzie Noten
- TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Floor Vinckers
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands
| | - Jasper de Witte
- HIVA- Research Institute for Work and Society, KU Leuven, P.O. Box 5300, 3000, Leuven, Belgium
| | - Annerieke Stoop
- TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Sytse Zuidema
- Department of Primary and Long-term care, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands
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Abstract
Background Family involvement in nursing homes is generally recognized as highly
valuable for residents, staff and family members. However, family
involvement continues to be challenging in practice. Aim To contribute to the dialogue about family involvement and develop strategies
to improve family involvement in the nursing home. Methods This interpretative synthesis consists of a thematic analysis and care
ethical interpretation of issues regarding family involvement from the
perspective of families in nursing homes reported in literature. Findings This study reveals the complexities of family involvement in the nursing home
by drawing attention to the moral dimension of the issues experienced by
families, as seen through the theoretical lens of Baier’s care ethical
concept of trust as a theoretical lens. The synthesis of literature resulted
in a thematic categorization of issues reported by families, namely,
family–staff relationship, psychosocial factors and organizational
circumstances. The care ethical interpretation of the synthesis of
literature showed that the concept of trust resonates with all reported
issues. Trust evolves over time. Early issues are mostly related to getting
to know each other. Secondly, families want to experience that staff are
competent and of good will. Difficult feelings families may have, such as
guilt or loneliness, and dealing with the deterioration of the loved one
puts families in a vulnerable position. This power imbalance between family
and staff impedes a trusting relationship. Issues related to organizational
circumstances, such as understaffing, also undermine families' trust in
staff and the nursing home. Discussion and conclusion Baier’s theoretical concept of trust provides a deeper insight into the moral
dimension of family involvement from the perspective of families in the
nursing home. To improve family involvement in practice, we propose to aim
future interventions at reinforcing trust in the relationship between family
and staff as well as in the organizational context in which these care
relationships occur.
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Affiliation(s)
- Nina Hovenga
- 10173University Medical Center Groningen, Netherlands
| | | | - Sytse Zuidema
- 10173University Medical Center Groningen, Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Netherlands
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Noten S, Stoop A, De Witte J, Landeweer E, Vinckers F, Hovenga N, van Boekel LC, Luijkx KG. "Precious Time Together Was Taken Away": Impact of COVID-19 Restrictive Measures on Social Needs and Loneliness from the Perspective of Residents of Nursing Homes, Close Relatives, and Volunteers. Int J Environ Res Public Health 2022; 19:ijerph19063468. [PMID: 35329154 PMCID: PMC8950639 DOI: 10.3390/ijerph19063468] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022]
Abstract
During the COVID-19 outbreak in March 2020, restrictive measures (e.g., prohibiting physical visits and group activities) were introduced in nursing homes to protect older residents. Although the importance of social contacts and social activities to fulfill social needs and avoid loneliness is known, these were challenged during the pandemic. This qualitative study specifically focused on how residents, close relatives, and volunteers in nursing homes experienced the restrictive measures in retrospect and gained insights into the impact of the restrictive measures on social needs and loneliness, and the lessons that could be learned. Thirty semi-structured, face-to-face interviews with residents and close relatives, and one online focus group with ten volunteers, were conducted. Recruitment took place at psychogeriatric and somatic units in the Northern, Eastern and Southern regions of the Netherlands and Flanders, Belgium. The interviews and focus group were transcribed verbatim, and an open, inductive approach was used for analysis. Alternative ways of social contact could not fully compensate for physical visits. Generally, participants reported that it was a difficult time, indicated by feelings of loneliness, fear, sadness, and powerlessness. A great diversity in loneliness was reported. The most important reasons for feeling lonely were missing close social contacts and social activities. The diversity in the impact of restrictive measures depended on, e.g., social needs, coping strategies, and character. Restrictive COVID-19 measures in nursing homes resulted in negative emotions and unmet social needs of residents, close relatives, and volunteers. During future outbreaks of the COVID-19 virus or another virus or bacterium, for which restrictive measures may be needed, nursing homes should actively involve residents, close relatives, and volunteers to balance safety, self-determination, and well-being.
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Affiliation(s)
- Suzie Noten
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; (S.N.); (K.G.L.)
| | - Annerieke Stoop
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; (S.N.); (K.G.L.)
- Correspondence:
| | - Jasper De Witte
- HIVA—Research Institute for Work and Society KU Leuven, P.O. Box 5300, 3000 Leuven, Belgium;
| | - Elleke Landeweer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.L.); (F.V.); (N.H.)
| | - Floor Vinckers
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.L.); (F.V.); (N.H.)
| | - Nina Hovenga
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.L.); (F.V.); (N.H.)
| | - Leonieke C. van Boekel
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, 4819 EV Breda, The Netherlands;
| | - Katrien G. Luijkx
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; (S.N.); (K.G.L.)
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de Boer B, Caljouw M, Landeweer E, Perry M, Stoop A, Groen W, Schols J, Verbeek H. The Need to Consider Relocations WITHIN Long-Term Care. J Am Med Dir Assoc 2021; 23:318-320. [PMID: 34932987 DOI: 10.1016/j.jamda.2021.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Bram de Boer
- The Living Lab in Aging and Long-Term Care, Maastricht University, Maastricht, the Netherlands
| | - Monique Caljouw
- The University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Elleke Landeweer
- The University Network of Elderly Care-UMCG, University of Groningen, Groningen, the Netherlands
| | - Marieke Perry
- The University Knowledge Network for Older People-Nijmegen, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Annerieke Stoop
- The Academic Collaborative Centre Older Adults-Tranzo, Tilburg University, Tilburg, the Netherlands
| | - Wim Groen
- The University Network for Organizations of Elderly Care-Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jos Schols
- The Living Lab in Aging and Long-Term Care, Maastricht University, Maastricht, the Netherlands
| | - Hilde Verbeek
- The Living Lab in Aging and Long-Term Care, Maastricht University, Maastricht, the Netherlands
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Landeweer E, van Willigenburg-de Wolff H. [Alcohol in nursing homes.]. Tijdschr Gerontol Geriatr 2021; 52. [PMID: 36408622 DOI: 10.36613/tgg.1875-6832/2021.04.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A part of the residents of nursing homes drink alcohol. This regularly leads to moral questions and discussions. An explorative qualitative study has been done to gather insight into the experiences and views of residents and staff regarding alcohol consumption in nursing homes. Aim of this publication was to support care professionals in nursing homes to deal with moral challenges related to alcohol consumption. With interviews and a focus group with residents and staff, experiences, values and moral dilemmas were collected. While residents viewed alcohol consumption as a private matter, opinions of staff were not uniform. Staff is confronted with various moral questions based on different values, such as Respect for Autonomy, Quality of Life, Authenticity and (collective) Safety. This study advises staff to use the value scheme in case of concrete moral questions as a tool to careful analyse which values and norms are at stake and balance what could be an appropriate response.
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Affiliation(s)
- Elleke Landeweer
- Universitair Netwerk Ouderenzorg UMCG (UNO-UMCG), Afdeling Huisartsgeneeskunde en Ouderengeneeskunde, Universitair Medisch Centrum Groningen, Rijksuniversiteit Groningen, Groningen, Nederland
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Ives J, Dunn M, Molewijk B, Schildmann J, Bærøe K, Frith L, Huxtable R, Landeweer E, Mertz M, Provoost V, Rid A, Salloch S, Sheehan M, Strech D, de Vries M, Widdershoven G. Standards of practice in empirical bioethics research: towards a consensus. BMC Med Ethics 2018; 19:68. [PMID: 29986689 PMCID: PMC6038185 DOI: 10.1186/s12910-018-0304-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 05/29/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This paper reports the process and outcome of a consensus finding project, which began with a meeting at the Brocher Foundation in May 2015. The project sought to generate and reach consensus on standards of practice for Empirical Bioethics research. The project involved 16 academics from 5 different European Countries, with a range of disciplinary backgrounds. METHODS The consensus process used a modified Delphi approach. RESULTS Consensus was reached on 15 standards of practice, organised into 6 domains of research practice (Aims, Questions, Integration, Conduct of Empirical Work, Conduct of Normative Work; Training & Expertise). CONCLUSIONS Through articulating these standards we outline a position that encourages responses, and through those responses we will be able to identify points of agreement and contestation that will drive the conversation forward. In that vein, we would encourage researchers, funders and journals to engage with what we have proposed, and respond to us, so that our community of practice of empirical bioethics research can develop and evolve further.
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Affiliation(s)
| | | | | | - Jan Schildmann
- Martin Luther University Halle-Wittenberg, Halle, Germany
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Landeweer E, Molewijk B, Hem MH, Pedersen R. Worlds apart? A scoping review addressing different stakeholder perspectives on barriers to family involvement in the care for persons with severe mental illness. BMC Health Serv Res 2017; 17:349. [PMID: 28506296 PMCID: PMC5433083 DOI: 10.1186/s12913-017-2213-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/31/2017] [Indexed: 11/24/2022] Open
Abstract
Background Empirical evidence shows that family involvement (FI) can play a pivotal role in the coping and recovery of persons with severe mental illness (SMI). Nevertheless, various studies demonstrate that FI in mental healthcare services is often not (sufficiently) realized. In order to develop more insights, this scoping review gives an overview of how various stakeholders conceptualize, perceive and experience barriers to FI. Central questions are: 1) What are the main barriers to FI reported by the different key stakeholders (i.e. the persons with SMI, their families and the professionals, and 2) What are the differences and similarities between the various stakeholders’ perspectives on these barriers. Methods A systematic search into primary studies regarding FI was conducted in four databases: Medline/Pubmed, Cinahl, PsychInfo and Web of Knowledge with the use of a PICO scheme. Thematic analysis focused on stakeholder perspectives (i.e. which stakeholder group reports the barrier) and types of barriers (i.e. which types of barriers are addressed). Results Thirty three studies were included. The main barriers reported by the stakeholder groups reveal important similarities and differences between the stakeholder groups and were related to: 1) the person with SMI, 2) the family, 3) the professionals, 4) the organization of care and 5) the culture-paradigm. Discussion Our stakeholder approach elicits the different stakeholders’ concepts, presuppositions and experiences of barriers to FI, and gives fundamental insights on how to deal with barriers to FI. The stakeholders differing interpretations and perceptions of the barriers related to FI is closely related to the inherent complexity involved in FI in itself. In order to deal better with these barriers, openly discussing and reflecting upon each other’s normative understandings of barriers is needed. Conclusions Differences in perceptions of barriers to FI can itself be a barrier. To deal with barriers to FI, a dialogical approach on how the different stakeholders perceive and value FI and its barriers is required. Methods such as moral case deliberation or systematic ethics reflections can be useful. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2213-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elleke Landeweer
- Center for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, Oslo, NO, 0318, Norway.
| | - Bert Molewijk
- Center for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, Oslo, NO, 0318, Norway.,Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
| | - Marit Helene Hem
- Center for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, Oslo, NO, 0318, Norway
| | - Reidar Pedersen
- Center for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, Oslo, NO, 0318, Norway
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Abstract
BACKGROUND: Living with a renal disease often reduces quality of life because of the stress it entails. No attention has been paid to the moral challenges of living with renal disease. OBJECTIVES: To explore the moral challenges of living with a renal disease. RESEARCH DESIGN: A case study based on qualitative research. We used Walker's ethical framework combined with narrative ethics to analyse how negotiating care responsibilities lead to a new perspective on moral issues. PARTICIPANTS AND RESEARCH CONTEXT: One case was chosen from 20 qualitative interviews with renal patients in the Netherlands. ETHICAL CONSIDERATIONS: Several actions have been taken to ensure the informed consent, privacy, anonymity and confidentiality of the patient in this article. More details are offered in this article. The study has been conducted in line with the recommendations of the Medical Ethical Committee of the VU Medical Center. FINDINGS: A renal disease can force people to change their identity, relationships, values and responsibilities. The case study illustrates the moral challenges confronting renal patients. DISCUSSION AND CONCLUSION:: Moral issues can be raised by the changes to identities, relationships, values and responsibilities caused by renal disease. Support services for renal patients and their relatives should pay more attention to these issues in order to promote self-management.
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Affiliation(s)
| | | | - Tineke A Abma
- VU University Medical Centre (VUmc), The Netherlands
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Abstract
In this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of 'theory' and show how it is interwoven with 'practice' as we go along. First, we look at theory in its foundational role: in our case 'narrative ethics' and 'philosophical hermeneutics' provide a theoretical base for clinical ethics by focusing on human identities entangled in stories and on moral understanding as a dialogical process. Second, we consider the role of theoretical notions in helping practitioners to understand their situation in clinical ethics practice, by using notions like 'story', 'responsibility', or 'vulnerability' to make explicit and explain their practical experience. Such theoretical notions help us to interpret clinical situations from an ethical perspective and to foster moral awareness of practitioners. And, thirdly, we examine how new theoretical concepts are developed by interpreting practice, using practice to form and improve our ethical theory. In this paper, we discuss this threefold use of theory in clinical ethics support services by reflecting on our own theoretical assumptions, methodological steps and practical experiences as ethicists, and by providing examples from our daily work. In doing so, we illustrate that theory and practice are interwoven, as theoretical understanding is dependent upon practical experience, and vice-versa.
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Affiliation(s)
- Rouven Porz
- Ethics Unit of the Bern University Hospital in Switzerland.
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Landeweer E, Abma TA, Dauwerse L, Widdershoven GAM. Triad collaboration in psychiatry: Privacy and confidentiality revisited. IJFAB: International Journal of Feminist Approaches to Bioethics 2011. [DOI: 10.3138/ijfab.4.1.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within psychiatry, patients, family, and professionals are involved and interrelated. Yet it is not easy for healthcare professionals to involve family actively in patient care. Taking a feminist perspective, we investigate why health-care professionals experience ambivalence in involving family in attempts to reduce seclusion, suggesting how they can improve family involvement by adopting a relational view on autonomy. Professionals should view patients not only in terms of individual autonomy and rights, but also in terms of relations and dependencies that need to be considered in fostering patient care.
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Landeweer E, Abma T, Santegoeds J, Widdershoven G. Psychiatry in the age of neuroscience: the impact on clinical practice and lives of patients. ACTA ACUST UNITED AC 2008; 6:43-55. [PMID: 27340391 PMCID: PMC4875058 DOI: 10.1007/s10202-008-0057-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Due to the progress being made in the neurosciences, higher expectations for the use of medication, even against the patient’s will, are arising in mental hospitals. In this article, we will discuss whether the neurosciences and new psychopharmacological solutions really support patients who suffer from mental illnesses. To answer this question, we will focus on the perspective of patients and their experiences with psychiatric (coercive) treatments. The analysis of one person’s story shows that other issues besides appropriate medication are important for recovery from a mental illness. In daily life, issues such as coping, rehabilitation and social support are of major importance for a patient suffering from psychiatric disease. Thus, although progress in the neurosciences is a positive development for clinical practice, it does not mean that (coercive) medication alone will carry a patient into recovery. A patient’s recovery is dependent, not only upon the process of finding the appropriate medication and trust between the psychiatrist and the patient, but also upon relational aspects, such as being recognised as a person, belonging, accepting responsibilities, developing friendships and trusting others. These findings lead to the conclusion that dealing with psychiatric diseases is more complex than what the biomedical model of neuroscience suggests and that one should include the social context of the patient in the recovery process.
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Affiliation(s)
- Elleke Landeweer
- Department of Health, Ethics and Society/Metamedica, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (Caphri), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Tineke Abma
- Department of Health, Ethics and Society/Metamedica, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (Caphri), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | | | - Guy Widdershoven
- Department of Health, Ethics and Society/Metamedica, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (Caphri), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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