Dementia, dignity and quality of life: nursing practice and its dilemmas

manthorpe j., iliffe s., samsi k., cole l., goodman c., drennan v. & warner j. (2010) Dementia, dignity and quality of life: nursing practice and its dilemmas. International Journal of Older People Nursing 5 , 235–244
doi: 10.1111/j.1748-3743.2010.00231.x Aims. The need for healthcare practitioners to respect the dignity of older people is widely recognised in England, where it has been given attention by politicians, professionals and health service regulators. This article aims to provide examples of how such ambitions may be used in practice development. Methods. This article reports the use of five vignettes discussed by dementia care practitioners that explored the areas of dementia diagnosis, lying, incontinence, behavioural and psychological distress, and end of life care. Findings. Each vignette promoted discussion of differences of perspectives about the ways to enhance the dignity of people with dementia in hospital, care home and community settings. The discussion confirmed that while dignity may be one quality indicator of good care potentially enhancing quality of life, it is not always straightforward. It may be more easily conceptualised when talking of physical care and treatment than other areas. Conclusion. The opportunity to debate the subject and to discuss practice examples revealed differences of opinion and moral perspectives between practitioners about the use and relevance of the term dignity. These need to be acknowledged in any debates about objective and subjective definitions of quality of life.     

Dignity, dining and dialogue: reviewing the literature on quality of life for people with dementia

venturato l. (2010) Dignity, dining and dialogue: reviewing the literature on quality of life for people with dementia. International Journal of Older People Nursing 5 , 228–234
doi: 10.1111/j.1748-3743.2010.00236.x Aim. To review contemporary literature on quality of life for people with dementia. Background. One of the consequences of population ageing is the predicted increase in the incidence of dementia. While we can as yet do little to affect the course of the disease, health care professionals are well-placed to intervene to affect quality of life and quality of care for people with dementia. Results. Research into quality of life for people with dementia has grown markedly over the last decade, in line with evolving conceptual and theoretical understandings of this complex concept. While much of the literature continues to focus on assessment and measurement of quality of life, emerging areas of interest are noted, including dialogue associated with personhood; dignity; and dining and mealtime experiences. Conclusion. Literature on quality of life for people with dementia is as diverse as the concept itself. Established and emerging areas of research suggest that this diversity will continue into the future as we strive to better understand quality of life for people with dementia in all its complexity.     

Autonomy and integrity: upholding older adult patients' dignity

AIM: The aim of this study was to deepen understanding of the relationship between autonomy and integrity in interactions between patients and individual health care workers in real-life care situations. METHOD: The data reported here are from a 6- and 12-month follow-up of the teaching of ethics to health care professionals working with older people. The data collection method used was participant observation. Health professionals' caring behaviour in everyday situations was observed from the point of view of patients' autonomy and integrity. Theoretical frameworks relating to autonomy and integrity were used to analyse the data. FINDINGS: The structural framework was useful for identifying the two concepts and their relationship in everyday situations. The data suggest that the two concepts are ethically complex. Autonomy is grounded in respect for patients' ability to choose, decide and take responsibility for their own lives. Autonomy varies within and between individuals and is dependent on context and on those involved. It stresses the intrinsic value of patients, which marks their worth independently of others. Integrity, however, is bound to patients' very existence, no matter what their physical and mental conditions, and must be respected regardless of their ability to act autonomously. CONCLUSION: The concepts of autonomy and integrity appear to presuppose one another and to be indivisible if older adult patients' dignity is to be maintained. This implies that when patients' autonomy is supported their integrity is protected and, consequently, their dignity upheld.     

运动-心理-睡眠护理干预结合尊严护理对癌症晚期患者尊严水平、睡眠质量及心理状态的影响

目的 探讨运动-心理-睡眠护理干预结合尊严护理对癌症晚期患者尊严水平、睡眠质量及心理状态的影响.方法 将我院接收的82例癌症晚期患者按护理方案分为对照组和观察组,各41例.对照组实施常规护理,观察组在对照组基础上实施运动-心理-睡眠护理干预结合尊严护理.比较两组的尊严水平、睡眠质量及心理状态.结果 干预后,观察组的依赖...     

Path model of factors influencing health‐related quality of life among older people with knee osteoarthritis

Chronic illness has a significant effect on quality of life, and a critical measure of health outcomes. Correlations between pain, depressive symptoms, fatigue, and physical function and their direct and indirect effects on quality of life were determined among 200 Thai older population with knee osteoarthritis using the Numeric Rating Scale, the Multidimensional Assessment of Fatigue, and the Thai Geriatric Depression Scale‐15. Physical function was investigated by using the Timed Up and Go test. Path analysis revealed significant negative direct paths from pain, depressive symptoms, fatigue, and Timed Up and Go test results to quality of life. Pain, fatigue, and the Timed Up and Go test results had indirect effects on quality of life, while depressive symptoms had no indirect effect on quality of life. Increases in pain, depressive symptoms, fatigue, and Timed Up and Go test results were associated with reductions in quality of life. An understanding of the complex relationship among these variables is beneficial for designing an appropriate intervention for improving quality of life among older people with knee osteoarthritis.     

护理干预对老年人生活质量影响的研究进展

介绍了影响老年人生活质量的因素,从行为干预、心理干预、认知干预方面综述了对老年人的干预措施,并对护理干预的应用前景提出展望。     

Sleep disruption and quality of life in persons with dementia: A state-of-the-art review

Sleep disruption in persons with dementia is pervasive and contributes to negative health outcomes and decreased quality of life. Using Lawton's framework for quality of life in persons with dementia, the aim of this state-of-the-art review was to synthesize current knowledge on the association between sleep disruption and quality of life in persons with dementia in four domains: physical, social/behavioral, emotional well-being, and cognitive. Based on the final sample of six studies, sleep disruption was negatively associated with all four quality of life domains in persons with dementia. Given the variations in research design, measurement and sample size, conclusions could not be generated on the magnitude of the effects by domain. We do, however, provide recommendations for future research and clinical practice.     

痴呆患者照顾者的自我效能感在患者相关损害和照顾者健康相关生活质量间的中介效应

目的:探讨痴呆患者家属照顾者的自我效能感在患者相关损害和照顾者健康相关生活质量间的中介效应。方法:本研究为横断面研究。采用便利抽样法,选取2015年12月—2019年9月在上海市2所三级甲等医院陪同患者就诊的痴呆患者家属照顾者作为研究对象。采用中国家属照顾者自我效能问卷、简明健康调查量表（SF-36）、阿尔茨海默病相关...