Context:Although the number of people with physical disabilities who need nursing support is increasing, there is a lack of empirical knowledge about how they experience necessary care support. This knowledge is a prerequisite for enabling self-determination in the provision of care and for providing care based on needs and requirements. People with physical disabilities live in residential institutions and their own homes with the support of care services, and they are dependent on permanent nursing assistance.Objective: This qualitative grounded theory study describes the importance that people with physical disabilities ascribe to the provision of care and how they organise their cooperation with caregivers.Methods: Twenty-seven problem-centred interviews with people who had a permanent physical disability and a need for care were analysed using the grounded theory approach.Findings: People with physical disabilities and a need for care want to enhance their quality of life with assistance. Quality of life is influenced by their wishes regarding assistance, acceptance of the physical disability, (previous) experience with assistance and the possibility of actively influencing the implementation of necessary assistance. The development and maintenance of a friendly relationship with professional carers represent a strategy for achieving quality of life.Limitations: This study focuses on people with physical disabilities who receive care from a professional service. Questions about the influence on family carers remain unanswered.Implications: For successful social participation, people with physical disabilities should be supported by nursing professionals to identify and express their priorities and needs.
People with physical disabilities (PWD) are a large population group in Germany. Due to functional limitations of the body, they may be dependent on nursing assistance. PWDs’ wishes for assistance can be expressed verbally to nurses. However, these wishes do not always match what nurses want to happen. As a result, nursing care and the autonomy of PWDs can be critically opposed to each other. Thirteen problem-centered interviews were conducted with nurses on the care of PWDs. According to Strauss and Corbin (2010), analysis was conducted using grounded theory. When caring for PWDs, nurses may be confronted with wishes and needs they cannot or do not want to fulfill. As a result, they experience a conflict between care and respect for autonomy. Nurses critically assess these situations, including professional, ethical, and legal-organizational aspects. They interact with PWDs as well as colleagues to manage the conflict. Positive outcomes result in the conflict being resolved; negative outcomes result in nurses stopping care. Ambivalence also exists, which is characterized by tensions in further care. Nurses want to support PWDs, enable participation, and promote independence. They want to feel comfortable with their decisions. Therefore, they weigh carefully whether wishes for nursing assistance are realized or denied. Decision coaching can be a new task for academic nurses to enable PWDs to make health-promoting decisions for themselves.
ZusammenfassungDie Pflege von Menschen mit Körperbehinderungen wird in pflegewissenschaftlichen Diskursen bislang nur randständig betrachtet. Erkenntnisse zur Pflege dieser Zielgruppe sind notwendig, da die körperlichen Besonderheiten zu einer Inanspruchnahme pflegerischer Hilfestellungen führen können. Im Rahmen unserer qualitativen Grounded-Theory-Studie konnte gezeigt werden, dass Lebensqualität im Mittelpunkt der Pflege von Menschen mit Körperbehinderungen steht. Demnach werden pflegerische Handlungen maßgeblich durch das Wohn- und Hilfsumfeld, z. B. stationäres oder ambulantes Wohnen, sowie intervenierende Bedingungen, z. B. das Ausmaß der Akzeptanz einer vorhandenen Körperbehinderung, beeinflusst. Pflegerische Maßnahmen können dann die Veränderung der Wohnform oder die positive Beeinflussung von Verarbeitungsprozessen sein, jedoch immer mit dem Ziel, dass Menschen mit Körperbehinderung selbst über die eigene Lebensqualität entscheiden.
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