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Principles and practice of geriatric assent
- Authors:
- MOLINARI V., et al
- Journal article citation:
- Aging and Mental Health, 10(1), January 2006, pp.48-54.
- Publisher:
- Taylor and Francis
Geriatric assent involves health care professionals’ active collaboration with cognitively impaired patients that takes account of their longstanding values in any major health care decisions. The main purpose of this paper is to assist geriatric health practitioners to understand how to apply geriatric assent in a variety of clinical situations to maximize incapacitated older adults’ input into decision-making. A case example and algorithm are presented to illustrate the basic principles of implementing geriatric assent. Practice informed by the principles of geriatric assent will preserve respect for the current and future autonomy of patients across diverse cultural backgrounds.
Evaluation systems in local eldercare governance
- Authors:
- HANBERGER Anders, LINDGREN Lena
- Journal article citation:
- Journal of Social Work, 19(2), 2019, pp.233-252.
- Publisher:
- Sage
Summary: This article explores how three evaluation systems in eldercare governance, two national and one local, operate and interact at the municipal, administrative, and service levels in a Swedish municipality. The case study focuses on the three systems’ contributions to accountability and to improving eldercare quality. It is based on multiple sources, including 28 interviews with local key actors involved in local eldercare governance, and the results derive from a directed content analysis guided by four research questions. Findings: The study demonstrates that the three evaluation systems support accountability and quality improvement in different ways and have different consequences for local actors. The systems create multiple accountability problems and have multiple constitutive effects, for example, creating different notions of what quality in eldercare means. The systems’ contributions to improving eldercare quality differed: the net effect of the two national systems was negative, whereas the local system has helped improve eldercare quality without any identified negative effects so far. Applications: The article broadens our theoretical understanding and knowledge of regulatory mechanisms in eldercare governance. It has significance for eldercare policy by finding that policymakers and service providers must be aware of and manage multiple evaluation systems and accountability problems. Its implication for eldercare practice is that local actors must build evaluation capacity to manage existing evaluation systems in order to improve their own practices. (Edited publisher abstract)
First do no harm
- Author:
- THOMPSON Neil
- Journal article citation:
- Social and Public Policy Review, 3(1), 2009, Online only
- Publisher:
- University of Plymouth
- Place of publication:
- Plymouth
Social work has for some considerable time professed a commitment to empowerment as a fundamental value. However, professing a value and making it a reality as a genuine underpinning of practice can be two different things. This paper presents an account of a case in which the actions or inactions of social work staff left individuals feeling distressed, disempowered and traumatised. The dissatisfaction in the case arose due to a lack of liaison and lack of a thorough assessment and the failure of authorities to respond adequately to complaints made. By describing and analysing the actions taken, the paper shows how a lack of genuine commitment to empowerment can have extremely detrimental effects. In doing so, it exposes the dangers of forms of practice that are not person-centred or based on partnership. Lessons are highlighted in the areas of case records, assessment, managing conflict, personal/professional boundaries, recognising grief, and providing information.
Communication in interdisciplinary team meetings: what are we talking about?
- Author:
- BOKHOUR Barbara G.
- Journal article citation:
- Journal of Interprofessional Care, 20(4), August 2006, pp.349-363.
- Publisher:
- Taylor and Francis
Interdisciplinary teams are central to the care of the older patient in long-term care settings. Critical to the success of caring for these patients is the communication between providers about patient care. This study examines professional communication practices in interdisciplinary team meetings, a common forum for discussing patient care. Two teams at a long-term care facility in the United States specializing in patients with Alzheimer's participated in this qualitative exploratory study. All team members participated in semi-structured interviews. In addition, seven team meetings in which 31 patients were discussed were audio and video taped. Team members discussed the importance of team meetings to help coordinate care provided to patients, while also expressing concern about the effectiveness of the meetings to reach this goal. Through detailed discourse analyses of transcripts of the meetings, we identified three different communication practices in team meetings: giving report, writing report, and collaborative discussion. Only the latter practice met the goals indicated by the team members to coordinate and make joint decisions about patient care and allowed for team members to collaboratively solve problems. The article discusses one case study to exemplify how the use of these communication practices results in the omission of information central to making decisions regarding patient care.
Female caregivers' reflections on ethical decision-making: the intersection of domestic violence and elder care
- Authors:
- KOENIG Terry L., RINFRETTE Elaine S., LUTZ Wendy A.
- Journal article citation:
- Clinical Social Work Journal, 34(3), September 2006, pp.361-372.
- Publisher:
- Springer
- Place of publication:
- New York
As our population ages, increasing numbers of social workers and other therapists will provide counselling to women who are caregivers of frail elders. These female caregivers often face complex ethical dilemmas in caring for a frail elder. Furthermore, these dilemmas are compounded by domestic violence in the caregiver/frail elder relationship initiated before the onset of caregiving. Illustrated with case examples, this article presents an ethical decision-making model based on an empowerment framework for helping practitioners work with caregivers who face difficult dilemmas impacted by domestic violence. Implications for strengthening clinical practice with these caregivers are discussed.
Decision-making capacity: the core of self-neglect
- Authors:
- DONG XinQi, GORBIEN Martin
- Journal article citation:
- Journal of Elder Abuse and Neglect, 17(3), 2005, pp.19-36.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Self-neglect in the elderly is a pervasive public health issue that affects 1.2 million elderly each year. In working with self-neglect cases, ethical issues are often raised that challenge all professionals. Professional and family's wishes to remove obstacles to the wellbeing of an elderly may be directly in opposition to the individual's wishes. The core of many ethical dilemmas resides in the question of the individual decision-making capacity. Issues surrounding decision-making capacity are complex with many confounding factors. This article uses case-discussion, to explore fundamental ethical issues of decision-making capacity relating to self-neglect and strategies are offered to resolve these dilemmas. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Decision-making capacity of elderly patients assessed through the vignette method: imagination or reality?
- Authors:
- VELLINGA A., et al
- Journal article citation:
- Aging and Mental Health, 9(1), January 2005, pp.40-48.
- Publisher:
- Taylor and Francis
This article evaluates whether providing hypothetical or realistic information influences the assessment of decision-making capacity in elderly patients with (and without) cognitive impairment. Decision-making capacity was assessed by means of a clinical vignette that presented a choice about whether to undergo an endoscopic procedure. The following standards of decision-making capacity were evaluated quantitatively and qualitatively: ability to evidence a choice, to understand, to reason, and to appreciate a situation. The vignette was presented to patients in either a hypothetical or real situation. In the hypothetical situation cognitively impaired patients performed significantly poorer than cognitively non-impaired patients on all abilities associated with decision-making capacity (with the exception of evidencing a choice). The realistic situation showed the same pattern among cognitively impaired and non-impaired patients in their ability to understand and in the total vignette score. Both types of patients reasoned about and appreciated the realistic situation equally well. Qualitative analysis revealed that patients gave comparable answers in both hypothetical and realistic situations. The answers were not related to standards of decision-making capacity. Moreover, personal circumstances were taken as a reference point for making a decision, regardless of the situation. We did not find any major differences between the hypothetical and realistic situation. Our findings do raise questions about the validity of hypothetical vignettes, however, especially when used with cognitively impaired persons.
Analysis of key decision-making incidents in the life of a nursing home resident
- Authors:
- SHAWLER Celeste, ROWLES Graham D., HIGH Dallas M.
- Journal article citation:
- Gerontologist, 41(5), October 2001, pp.612-622.
- Publisher:
- Oxford University Press
This American study examined change in the decision-making autonomy of a single nursing facility resident. This case analysis was part of a larger 3-year ethnographic investigation of decision-making events in four nursing facilities. In this case analysis, the resident, her daughter, and three staff members closely associated with the resident's care were each interviewed five times over a 15-month period. Analysis of interview transcripts revealed four themes in decision making. Temporal change was evident in a complex scenario regarding room changes. Spatial context reflected the need for predictability and adaptability in decisions using space. Interdependence of decisions and decision makers was most evident with medical treatment and health care decisions. Awareness, being informed, and knowing what was going on was the final theme. Despite having the best interests of the resident in mind, the process of decision making in nursing facilities may contribute to a pattern of gradual withdrawal of decisional autonomy form residents regardless of their ability to make decisions.
Ethics and aging: confronting abuse and self-neglect
- Authors:
- SIMMONS Paul D., O'BRIEN James G.
- Journal article citation:
- Journal of Elder Abuse and Neglect, 11(2), 1999, pp.33-54.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This article explores the issue of refusal of treatment and the determination of decisional capacity. Advocacy for the victim in the least intrusive manner is recommended.
Using multidisciplinary teams to address ethical dilemmas with older adults who hoard
- Authors:
- KOENIG Terry L., CHAPIN Rosemary, SPANO Richard
- Journal article citation:
- Journal of Gerontological Social Work, 53(2), February 2010, pp.137-147.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Resolving conflicts between older people’s freedom to hoard versus their or the public’s safety, often falls to multi-disciplinary teams of professionals to address the ethical dilemmas posed. This article considers the current use of hoarding task force or team interventions, proposes an ethical decision making framework for use by these teams and others, and discusses the practice implications whilst implementing this framework. The authors present a case vignette of Mrs M, developed as a composite of hoarding cases analysed in the literature reviewed, and analyse it using the ethical decision making framework they advocate in this paper. Important factors to be considered are who is the client - Mrs M or Mrs M and her neighbours, what are the facts, whose account is to be believed, what motivates differing accounts, who should intervene, what will be the consequences, and what are the alternatives to intervention? Three key implications for practice are discussed. Effective ethical decision making must balance the rights and responsibilities of the multiple actors involved, say the authors. In addition, competent practice relies on a realisation that interpersonal relationships between professionals and clients and amongst professionals are the vehicles which create probable solutions to such ethical dilemmas. Finally, the use of a consistent framework by teams changes practice from individual interventions to the development of policies and system change based on good practice.