Achieving quality dementia care in nursing homes : understanding nurses’ perceptions of dignity and person-centred care

Abstract

Aims: This study sought to narrow the gap in the knowledge surrounding Person-Centred Care (PCC) and dignity in Maltese state-administered nursing homes by seeking to establish the following: (a) The extent to which nurses rated their work environment to be ‘personcentred’ and how this potentially informs us of their perceptions of dignity, specifically, the provision of dignified care within these environments, and (b) The challenges and obstacles to PCC within these environments, and how they also potentially inform us of nurses’ perceptions surrounding the delivery of dignified care. Background: The National Strategy for Dementia in the Maltese Islands (2015-2023) has called for a ‘needs analysis’ to identify gaps in knowledge and experience of healthcare workers working with older persons living with dementia (Parliamentary Secretariat for the Rights of Persons with Disability and Active Ageing: PSRPDAA, 2014). Furthermore, publication of the National Minimum Standards for Nursing Homes for Older Persons mandated that all local nursing homes adopt a person-centred approach. (Social Care Standards Authority: SCSA, 2015). PCC has become synonymous with both high quality dementia and geriatric care (Brooker & Latham, 2015), whilst dignified care is recognised as an outcome of effective PCC (McCormack & McCance, 2016). Despite this, several recent published and unpublished studies have indicated that PCC is not being practiced effectively in local nursing homes (Borg, 2019; Scolaro, 2016; Teebi, 2017; Zammit & Florini, 2015). Design and Methodology: This study utilised a qualitative research design from a post-positive world view perspective. The identified research sites were five state-administered nursing homes. These included: (a) Dar il-Madonna tal-Melleiha Home, (b) Floriana Home, (c) Mosta Home, (d) Msida Home, and (e) Mtarfa Home. From within these homes, 78 nurses were eligible to participate in this study. This also included nurses from the relieving pool whom were invited to participate in this study. To gather data, this study utilised a combination of both the Person-Centred Care Assessment tool (P-CAT) developed by Edvardsson, Fetherstonhaugh, Nay and Gibson (2010) and a demographic questionnaire. Statistical analysis was used to determine the association or otherwise between the mean results of the P-CAT and factors within the demographic questionnaire. This data, in combination with calculated percentages of responses to the P-CAT and relevant surrounding literature was used to address and discuss the aims of this study. Results: The results showed that the majority of nurses agreed that their workplace was personcentred, which suggests there is scope for dignity-preserving dementia care to take place within these environments. Barriers and obstacles to PCC were identified as a ‘chaotic environment’ and nurses having to get the work done before they can worry about a homelike environment. Furthermore, statistical analysis demonstrated that there were significant statistical differences between nurses’ place of work and their mean P-CAT scores related to organisational support, and nurses’ country of origin and mean P-CAT scores relating to environmental accessibility. However, these results ran contrary to the vast majority of local and international research, whilst also containing contradicting majority responses to questions within the P-CAT. This resulted in the study being unable to effectively discuss nurses’ perceptions of dignity in relation to the identified challenges and obstacles to PCC. Conclusion: The results from this study demonstrated that further research in this area is needed with potentially differing research designs in order to effectively validate the reality of nurses’ perceptions of PCC and dignity in residential care settings.