Applying dignity of risk principles to improve quality of life for vulnerable persons

Abstract

Objectives: Freedom of choice impacts quality of life. Expressed through dignity of risk (DoR), nursing home (NH) residents should be afforded the dignity to take risks to enhance well-being. How DoR is understood and implemented in the context of aged care remains largely unknown. This study explored the meaning and the barriers and facilitators to applying DoR to NH residents. Methods:Qualitative study, comprising semistructured interviews. Senior policy makers and advocate guardians working in the aged care or disability sector were invited to participate. Recruitment continued until data saturation was reached.Two researchers coded interviews, applying inductive and thematic analysis. Results: Fourteen participants took part during 2016-2017. Analysis demonstrated uniformity in participants' description of DoR, comprising four elements: (a) individuals are at the centre of decision making; (b) life involves risk; (c) individuals must have choice; and (d) DoR is a continuum of experiences. Three main barriers for implementing DoR into practice were identified: (a) balancing autonomy with risks; (b) situational nature of DoR; and (c) taking responsibility for risk. Conclusion:The novel findings provide an explicit understanding of DoR and the facilitators and barriers to applying the principle in the NH setting. These findings inform those who engage in making and implementing choices in the presence of risk for vulnerable clients. To translate the multifaceted elements of DoR into practice requires the development of unambiguous policies/guidelines about who will be responsibility for potential risks that may arise from residents' choices. Further, education programmes supporting care staff/management to enact resident choices in the presence of real or perceived risk are required. KEYWORDS autonomy, decision making, nursing home, quality of life, residential aged care

Chart based data as a resource for tracking and improving a person‐centred palliative approach in long‐term care

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Decisions and Dilemmas: The Context of Prioritization Dilemmas and Influences on Staff Members’ Prioritization Decisions in Residential Aged Care

“…Conflicts in decision-making were particularly evident in responses about independence and safety, with staff members talking about the need to balance these two priorities. The balance between risk and autonomy has been previously identified as a barrier to allowing aged care residents dignity in risk-taking, known in the literature as “dignity of risk” (Woolford et al, 2020). Other studies have documented similar tensions between risk and autonomy, particularly for older persons with dementia (Evans et al, 2018; Lawrence & Murray, 2010).…”

Vulnerable, recalcitrant and resilient: a Foucauldian discourse analysis of risk and older people within the context of COVID-19 news media

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