The Implementation of a Model of Person-Centred Practice In Older ...

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The implementation of a model of person-centred practice in older person settings Category 3 = Hope and Hopelessness Category 3 = Hope and Hopelessness • Hope • Loss – Health Independence Identity Self Life Freedom • Hopelessness – Worry Ignored not included Loss Depression low spirits Sad No enjoyment Sense of hopelessness • Acceptance - Making the best Loss of independence • Voiceless - Fear of future Fear of Dying Staying quick Fitting in Ignored not included The category of ‘hope and hopelessness’ reflected the contradiction that was evident in the data, i.e. a greater sense of hope being instilled into residential care settings, seeing them as a place of growth and development, whilst at the same time a prevailing sense of hopelessness existing. The theme of ‘hope’ was reflected in the variety of activities that had been developed to enable older people in residential care settings to have a more meaningful life, irrespective of disability (physical and/or cognitive). However, overall there continued to be a prevailing sense of hopelessness, predominantly reflected in the themes of loss, hopelessness, acceptance and voicelessness. The theme of ‘loss’ is not unsurprising as it is recognised that loss is a common experience for older people. The areas of loss identified in the data are also not surprising – loss of health, independence, identity, self, life, freedom I like reading and doing crosswords. I tend to spend a lot of time in my room but I get involved in activities when they are available. I enjoy listening to classical music … in the afternoon I go for a nap just before tea time I don’t sleep very much so I tend to read quite late into the night. My sleep is always broken waking during night to go to toilet. This is very tiring and I feel ‘sick of it all’. I feel obsessed. I feel I am troublesome because of going to the toilet. The incontinence has become a phobia. I am absolutely shagged and my bones are like biscuits and I feel very apprehensive about the future … I feel inept in my life, I have been a perfectionist. Little things make me intolerant. I constantly compare how I would do it myself. I feel I need to relax more … I miss my old home and I am still unable to let go ...” (Resident’s story) 155
The implementation of a model of person-centred practice in older person settings Participants in the programme recognised the difficulties inherent in addressing these issues as they are often at the core of older persons’ life experiences. However, activities that enabled greater participation in the daily life of wards/units, activities to enable social connection and activities that enabled connection with past lives (see Findings Chapter 1 for examples of these) were implemented and were successful in addressing issues of loss for many residents. The implementation of these activities has an added benefit of dealing with issues of hopelessness. The first and 2 nd round of observations of practice identified how ‘hopeless’ some residential care settings are, often reflected by a lack of meaningful activity, a lack of meaningful social engagement and a lack of attention to maximising the older person’s ability to do things for themselves (no matter how small). A has been illustrated in category 1 and 2, much effort went into addressing these issues by programme participants. However, hopelessness continued to be seen in resident’s narratives through their worries, sadness and depression and a feeling of being ignored. Older people seemed to accept their lot and make the most of their loss of independence and were content with where they were at. The voicelessness was underpinned by fear – fear of the future, fear of dying, fear of function and fears of not being included or fitting in: “Time is long, boredom sometimes. I’d love to get home but there would be no one there. Just to get out would be great – great to get away from it. I will go out in the weather when the weather is good. I go down in the lift but my husband used to come down four times a week before he died. He is a terrible loss. The girls are working and live off away from here. I’d like to get out while I’m able …No, I don’t feel I have a say in how things are done here – No say, no, just get on with it …” (Resident story) “There is no pressure on you to do anything. I like that because I find it hard to decide and they are very kind, the nurses, and I am not just saying that, they are very caring and very kind. The only big choices I have to make is if I will get up or if I will stay in bed. Most of the time I get up but some of the time I prefer to stay in bed. Sometimes I choose my clothes, well they ask me what will I put on and would I like this or that on, and sure I don’t care … I don’t talk to the others much , don’t know why that is, sometimes it is not easy because you are inclined to close up at least I am anyway and it isn’t easy to talk to people” (Resident’s story). 156
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