Challenges in Honoring Self-Determination of Nursing Home Residents with Dementia
Author Information
Author(s): Bern-Klug Mercedes, Levine Meredith
Primary Institution: University of Iowa, Iowa City, Iowa, United States
Hypothesis
What happens when instructions in an advance directive are in opposition to the current expressed requests of a person with advanced dementia?
Conclusion
Nursing home staff face significant logistical and moral challenges when trying to honor advance directives of residents with dementia who express a desire to eat.
Supporting Evidence
- Staff were unanimous in declaring the need to honor the resident’s self-determination.
- Many staff indicated they would go ahead and feed the person despite the advance directive.
- Staff expressed challenges in operationalizing 'self-feed' and dealing with fluctuating functional capacity in dementia.
Takeaway
Nursing home workers sometimes have to choose between following a resident's written wishes and feeding them when they want to eat.
Methodology
Qualitative descriptive methodology with individual interviews of nursing home staff.
Potential Biases
Potential bias in staff responses based on personal beliefs and moral dilemmas.
Limitations
The study is a pilot and may not represent all nursing home contexts.
Participant Demographics
Nursing home staff members in various roles.
Digital Object Identifier (DOI)
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