Elements of assisted bodily care: Ethical aspects

Abstract

Background: Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim they have to adapt to assistant nurses' routines. The provider–receiver incongruence revealed here warrants investigation. Aim: To describe the elements of assisted bodily care, as performed in a nursing home. Research design: Data were collected through thirty-nine observations of assisted bodily care, analyzed with qualitative content analysis. Participants and research context: Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home. Ethical considerations: The research was conducted in line with the Declaration of Helsinki, further approved by the regional ethics committee. Findings: Findings show that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Assistant nurses still attempt to adapt this work to the older persons’ wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care. Discussion: Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. They nevertheless seem to know the older persons well enough to adapt the assisted bodily care according to their preferences and to support self-determination. This indicates that openness to older persons’ lifeworlds may be more important than the amount of time available. Conclusion: Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could agree on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all.

Body care of older people in different institutionalized settings: A systematic mapping review of international nursing research from a Scandinavian perspective

“…These papers mainly had a qualitative or concept analytical design. In six of them, there are references to the notion of person‐centered care, fundamentals of care, or concepts such as dignity and autonomy (Borglin et al, 2020 ; D'hondt et al, 2012 ; Hälleberg Nyman et al, 2017 ; Holmberg et al, 2020 ; Ostaszkiewicz et al, 2018 ) (Supporting Information: Table 12 ).…”

“…The papers cover a wide range of participants (Supporting Information: Table 15 ). Two papers have included both care workers and older people (Holmberg et al, 2020 ; Holroyd & Holroyd, 2015 ). Out of the eight papers exploring the experiences of care workers, three focus solely on nurses (Borglin et al, 2020 ; Coker et al, 2017a , b ; Råholm, 2012 ).…”

“…There are traces of ethical discourses of respecting autonomy and dignity and protecting the vulnerable old person in the body care situations. Scandinavian philosophy (Nordenfelt) and nursing philosophy theories (Eriksson, Nåden) are cited in these papers (Holmberg et al, 2020 ; Råholm, 2012 ). Other discourses within this underlying assumption are the notions of person‐centered care approaches, with a focus on respecting self‐determination, control, autonomy, dignity, and identity, where the relationship between the older people and the care workers is the prerequisite for the provision of body care.…”

“…Another underlying assumption in most of the papers is an implicit consensus of what a body is. There are traces of the notion of a Cartesian dualism that sees the body‐object as a physical entity (Draper, 2014 ; Marchetti et al, 2016 ) present in the body care practices as a passive biomedical object divided into bodily parts (skin, mouth, feet, perineal area), which can be handled and be the subject of clinical studies (e.g., Bliss et al, 2011 , 2017 ; Jablonski et al, 2017 ; Kon et al, 2017 ; Matsumoto et al, 2019 ), as well as a body‐subject experiencing either receiving body care (Råholm, 2012 ) or providing body care (D'hondt et al, 2012 ; Holmberg et al, 2020 ). In these papers, the corporeality of the body is not mentioned, whereas the experiencing subject is dominant.…”

Sharing decision‐making between the older person and the nurse: A scoping review

“…The terms person and patient‐centred care both appear the most within the records included. Six records use person‐centredness or person‐centred care (Cranley et al, 2020; Holmberg et al, 2020; McKinnon, 2014; Nicholson, 2017). Five records use patient‐centred care (de Angst et al, 2019; Doekhie et al, 2020; Eloranta et al, 2014; Hallock, 2014; Siouta et al, 2015).…”