Search

Objectives: To better understand how nurses experience and react to intimate and sexual expressions of nursing home residents. Background: Although many nursing home residents continue to desire intimacy and sexual expression, they commonly perceive negative attitudes of nursing staff towards them as a major barrier to their sexual well‐being. To eliminate this barrier, it is crucial to gain a more in‐depth understanding of nurses' personal experiences and reactions towards intimacy and sexuality in aged care. Design: Our study used a qualitative design, rooted in grounded theory. Methods: Semi‐structured interviews with 15 nurses between 34 and 59 years of age were conducted. Participating nurses were recruited from seven different nursing homes in Flanders, Belgium. We used the Qualitative Analysis Guide of Leuven (QUAGOL) for data analysis. We followed the COREQ guidelines to ensure rigour in our study. Results: Nurses experienced and dealt with intimate and sexual expressions of residents in an individual way, which was focused on setting and respecting their own sexual boundaries and those of residents and family members. Depending on their comfort level with residents' expressions, nurses responded in three ways: active facilitation, tolerance and termination. Nurses' responses depended on contextual factors, including their personal experiences with sexuality, the nature of their relationship with the residents involved, the presence of dementia and the organisational culture of the facility. Conclusions: Nurses face a wide range of experiences and emotions when confronted with residents' expressions of sexuality and intimacy. A supportive approach is needed to guide nurses in dealing with these highly sensitive situations. This approach can be promoted at the institutional level through continuous educational programmes. Relevance to clinical practice: This study advocates a contextual and interpretative ethical approach to sexuality in older adults, taking as starting point nurses' own vulnerability and that of residents and relatives. [ABSTRACT FROM AUTHOR]

In the era of deinstitutionalisation of psychiatric patients, steady or even increasing rates of compulsory commitment to care (CCC) are an intriguing phenomenon to analyse. From a clinical, legal and ethical perspective, CCC continues to be a controversial practice in psychiatry, and perhaps even more so when applied to patients with severe substance use disorder (SUD). Several reasons make it controversial. The lack of consensus about the benefits of CCC and professional disagreement about what mental illness and autonomy mean in the case of SUD make it difficult to apply ethically sound clinical decision‐making in CCC. Also, the medico‐legal framework underlying CCC use sometimes appears to foster the use of reductionist clinical evaluation. Layered on top of these issues is how stakeholders view coercion. There is a discrepancy between clinicians’ and patients’ perception of coercion, which leads to clinician–patient differences on whether CCC is necessary. Moreover, the way in which the evaluation is typically carried out influences patients’ perception of coercion and subsequently their motivation for participating fully in treatment. In this article, we explore the value of care ethics, often applied to care practices such as nursing, when applied to more procedural medical practices, such as decision‐making regarding CCC. The care‐ethical approach views decision‐making as part of a dynamic care process, within which the lived experience, interpretative dialogue and promotion of dignity are core features. Embracing this new framework means a paradigm shift in when the therapeutic relationship begins, namely, investing in it occurs while conducting an evaluation for a possible CCC procedure. Unlike in current typical evaluations, early cultivation of the therapeutic relationship enables the patient to participate in the definition of his needs, reduces perceived coercion and negative emotions and enhances treatment motivation. Finally, implications of this novel approach for clinical practice are formulated and discussed. [ABSTRACT FROM AUTHOR]

Objectives:The aim of this review was to gain a better understanding of how older adults experience, perceive, think, and feel about the use of socially assistive robots (SARs) in aged care settings. Method:We conducted a literature search for studies that used a qualitative or a mixed-method approach having a significant qualitative element. Pubmed, Cinahl, Embase, Scopus, and Web of Science electronic databases were queried. Candidate articles published in journals and conference proceedings were considered for review. Two independent reviewers assessed the included studies for methodological quality using the Critical Appraisal Skills Program, after which data on subjects’ self-reported opinions and perceptions were extracted and synthesized using thematic analyses. Results:Seventeen studies producing 23 publications were included. Based on the opinions of older adults, four themes emerged in relation to the use of SARS: (1) roles of a SAR; (2) interaction between the older adult and the SAR, which could be further subdivided into (a) the technical aspect of the interaction and (b) the human aspect of the interaction; (3) appearance of the SAR; and (4) normative/ethical issues regarding the use of SARs in aged care. Conclusions:Older adults have clear positive and negative opinions about different aspects of SARs in aged care. Nonetheless, some opinions can be ambiguous and need more attention if SARs are to be considered for use in aged care. Understanding older adults’ lived experiences with SARs creates the possibility of using an approach that embeds technological innovation into the care practice itself. [ABSTRACT FROM PUBLISHER]

Background. Vulnerability is a key concept in traditional - as well as contemporary - bioethics and medical ethics (Ten Have 2015, 2016). Within this literature, the concept of vulnerability is mostly defined in relation to autonomy: vulnerability refers to conditions of impaired and/or diminished autonomy (Belmont Report 1979; CIOMS 1991, 1993, 2002; WMA 2000, 2008; Bracken-Roche et al. 2017). Historically, vulnerability has been associated with several categories of agents, amongst which the elderly are paramount. However, no clear and unique conceptualization of vulnerability, when referred to the ageing population, is currently present - especially in domains other than research ethics: some refer to physiological degradation as a defining tenet, some others appeal to autonomy impairment, some others point to loneliness and isolation (Kahana et al. 1995; Slaets 2006; Dodds 2007; Andrew et al. 2008: Sternberg et al. 2011; Clegg et al. 2013). To fill this gap, we examined the meaning, foundations, and uses of vulnerability as ethical concept in the literature of aged care. Method. Using PRISMA procedure, we conducted a systematic review of argument-based ethics publications in 4 major databases (Pubmed, Embase, Web of Science, and Philosopher's Index) of biomedical, philosophy, bioethical, and anthropological literature that focused on vulnerability in aged care.5,735 results were obtained. Titles and abstracts were all screened. We are now in the process of full articles screening. All includes articles will then be critically analyzed. The results of this analysis process as well as a critical reflection on the results will be presented at the EACME conference. [ABSTRACT FROM AUTHOR]

Objectives The aim of this systematic literature review is to investigate older residents’ thoughts on, experiences of and engagement in sexual behavior and aged sexuality within institutionalized elderly care. Design Systematic literature review. Data sources We conducted an extensive search of the electronic databases Cinahl, Medline, Pubmed, Embase, Web of Science and Invert for papers published between January 1980 and October 2014 when the searches were closed. Additional papers were identified through forward and backward citation chasing. Review methods Data from relevant studies were extracted by means of a data extraction form. Relevant data were isolated, summarized, compared, related and categorized according to theme. Quality assessment of the included studies focused on their adequacy of reporting the study's research aim, sampling, collection, and analysis procedures, ethical considerations and results. Results Twenty-five appropriate studies were identified. These studies varied in research design (using surveys, vignettes, focus groups, interviews, or observation), objectives, quality of reporting, and sample characteristics (i.e. male and/or female long-term care residents with and/or without dementia). Yet, they all point to the relevance of sex and sexuality in old age and emphasize the highly individual character of both sexual interest and expression. Older residents who wish to sexually express themselves, might do this in a wide variety of ways, including, but not limited to, daydreaming, dressing-up, looking for emotional and intellectual intimacy, stroking, caressing, kissing, and engaging in sexual intercourse. Overall, residents appear to have a rather positive attitude toward aged sexuality as such. When it comes to specific sexual behaviors or homosexuality, however, attitudes tend to be more negative. The perceived appropriateness of the displayed behavior is a predominant factor in determining older people's reactions to the sexual behavior of co-residents, rather than the potential emotional discomfort brought on by witnessing this behavior. Conclusions Relatively little work has been published on older residents’ perspectives regarding aged sexuality in institutionalized elderly care. If, however, we wish to devote ourselves to individualized or person-centered nursing care, we will have to gain more insight into the patient's perspective and take notice of the needs, expectations, attitudes, experiences and behaviors of residents with regard to (aged) sexuality. Hence more research is needed that depicts the issue of aged sexuality in institutionalized elderly care from a patient's and thus resident oriented perspective. [ABSTRACT FROM AUTHOR]

The article discusses the study that determined perceived efficacy of nursing ethics education by students in Flanders, Belgium, for the development of Students' Perceived Effectiveness of Ethics Education Scale (SPEEES). Findings discussed include reflecting critically on their own values as the only ethical competence promoted by ethics courses, failure of ethics courses to meet some basic ethics education objectives, and need for further SPEEES improvement and larger scale research.