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Human capabilities in advanced dementia: Nussbaum's approach
Luleå University of Technology, Department of Health Sciences, Nursing Care.ORCID iD: 0000-0003-0313-6002
Luleå University of Technology, Department of Health Sciences, Nursing Care.ORCID iD: 0000-0001-7830-8791
Luleå University of Technology, Department of Health Sciences, Nursing Care.
Luleå University of Technology, Department of Health Sciences, Nursing Care.
2018 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, no 2, article id 12178Article in journal (Refereed) Published
Abstract [en]

Aims and objectives

To explore how Martha Nussbaum's approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes.

Background

Challenges experienced when supporting people with advanced dementia who express problematic behaviours include understanding their needs and ensuring a dignified life for them.

Design and methods

Data were gathered using an ethnographic approach based on participatory observation. Nussbaum's capability approach was then used as a framework for the analysis. Four women diagnosed with advanced dementia who also expressed problematic behaviours were recruited from a nursing home in Northern Sweden. The data collection was performed during 2015.

Findings

Individuals with advanced dementia had difficulties in participating in the planning of their lives and achieving the human capability of practical reasoning. They were also at risk of being placed outside the social group, thus hindering them from attaining the human capability of affiliation. A dignified life for individuals with advanced dementia requires nursing staff to be present and to provide adapted support to ensure that the individual can actually pursue human capabilities.

Conclusion

Creating opportunities for the human capabilities of practical reasoning and affiliation is essential as they permeate all other human capabilities. For these individuals, it was crucial not only to create opportunities for human capabilities but also to attend to their expressions and needs and to guide and steer them towards a dignified life.

Implications for Practice

The normative structure of the capability approach described by Nussbaum can ensure that nursing staffs move beyond fulfilling patients’ basic needs to consider other capabilities vital for a dignified life.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018. Vol. 13, no 2, article id 12178
National Category
Nursing
Research subject
Nursing
Identifiers
URN: urn:nbn:se:ltu:diva-66049DOI: 10.1111/opn.12178ISI: 000434118100002PubMedID: 28990351Scopus ID: 2-s2.0-85047906757OAI: oai:DiVA.org:ltu-66049DiVA, id: diva2:1148429
Note

Validerad;2018;Nivå 2;2018-06-04 (svasva)

Available from: 2017-10-11 Created: 2017-10-11 Last updated: 2018-09-12Bibliographically approved
In thesis
1. Piecing together a fragmented world: Structures to promote the understanding of people with advanced dementia
Open this publication in new window or tab >>Piecing together a fragmented world: Structures to promote the understanding of people with advanced dementia
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Föra samman fragment till en helhet : Strukturer för att öka förståelsen för personer med avancerad demens
Abstract [en]

Understanding people with dementia whose verbal ability has been impaired is a complex and challenging task, even for professional nursing staff. The aim of this PhD thesis was to explore structures that may promote the understanding of people with advanced dementia living in nursing homes. It focusses specifically on (I) the clinical reasoning employed by assistant nurses when utilizing the NPI-NH (Neuropsychiatric Inventory Nursing Home version) as a tool to assess frequency and severity of BPSD (behavioural and psychological symptoms in dementia, i.e. problematic behaviours) in people with advanced dementia, (II) whether a sensor measuring electrodermal activity (EDA) can improve the identification of agitation in individuals with dementia, (III) how an EDA sensor impacts assistant nurses’ structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions, and (IV) how Martha Nussbaum’s approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes. Study I used a method of discourse analysis that focussed on clinical reasoning utilized by assistant nurses when assessing problematic behaviours. In study II, a nonexperimental and correlational observation of the relationship between a sensor measuring EDA and assistant nurses’ structured observations of agitation in people with advanced dementia was applied. Study III used both quantitative and qualitative approaches; data were collected during structured assessments of problematic behaviours conducted by assistant nurses, as well as by focus group interviews with assistant nurses. Study IV took an ethnographic approach with participatory observations that were analyzed with a recursive analysis using a theoretical framework for the conditions necessary for a dignified human life. The structure of the NPI-NH provided a supportive framework that encouraged assistant nurses to discuss and broaden their understanding of the person with dementia (I). The EDA sensor provided continuous information regardless of staff presence and the potential to identify EDA prior to observing these behaviours (II, III), which supported the understanding of the person and when to introduce timely interventions to prevent the onset of problematic behaviours (III). The structure of Nussbaum’s approach to human capabilities illuminated that people with advanced dementia were at risk of living a life in which their opportunities for human capabilities were limited, and hence, the possibility to live a dignified life (IV). An overview of the findings in this thesis indicates that the studied structures were used to piece together fragments of information to create a comprehensive understanding of the needs of the person with dementia. For the structures to support the understanding of the person with dementia, it was crucial that nursing staff were present, attentive and engaged in each person’s situation in order for them to figure out how to piece together and integrate the structures into the overall understanding of the person and, based on that, formulate caring actions in daily life that are meaningful from the perspective of the person with advanced dementia.

Place, publisher, year, edition, pages
Luleå: Luleå University of Technology, 2018
Series
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
Keywords
dementia, nursing home, electrodermal activity, capability approach, clinical reasoning, assessment, behaviour
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-70847 (URN)978-91-7790-199-0 (ISBN)978-91-7790-200-3 (ISBN)
Public defence
2018-10-26, Deltasalen, D770, Luleå, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2018-09-13 Created: 2018-09-12 Last updated: 2018-09-27Bibliographically approved

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Melander, CatharinaSävenstedt, StefanVälivaara, Britt-MarieOlsson, Malin

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