Bewarende zorg : een visie voor verzorgenden en verpleegkundigen

Abstract

Older persons in nursing homes often describe their situation as difficult and hopeless. They face an all-encompassing dependence on care, a lack of control in daily routines of clothing, washing, eating and socializing, and loneliness. Reports show cases in which residents were actually harmed by a lack of care given by nurses. This inadequate care is morally reprehensible. The aim of this research is to develop a philosophy for nurses as a counterstory that relates the problems of nursing home residents and suggests solutions in terms of good care. The quality of this counterstory is measured by its coherence, its credibility and its validity. This dissertation concentrates on accomplishing the first criterion: coherence. The research question is: What is good daily nursing care for vulnerable nursing home residents? In a spiraling research model, empirical data and theoretical insight are continually connected, compared, tested against each other and then merged step-by-step into a coherent whole. Empirical data were collected through participative observation and structured interviews in various care practices. The theoretical insights derive from the literature on needs led care and the ethics of care. In this philosophy of care for nurses, nursing home residents are viewed as vulnerable persons. Often they are not recognised or acknowledged for either who they used to be or who they have become now: a particular person in a situation of dependence. This demands, as it were, a special kind of protection. Nurses, as no other, are in a position to offer this protection by continually attuning their care to this unique person in this unique situation. In so doing, they are sustaining or holding the personhood of the unique person in the context of nursing home care. This expression of protection is thus a special kind of preservative care, a moral practice. The moral test of preservative care is ‘recognising the uniqueness of the other in this particular community’. Preservative care strongly emphasizes the life the person led both before and after landing in their current vulnerable context, which ideally should sustain the person’s personhood. Awareness of the moral context of care-giving to nursing home residents may help nurses determine what may or may not be good actions to undertake in the circumstances and the manner in which they should carry out these actions. It is up to the reader to judge the coherence of the counterstory presented, and to the nursing profession and nursing home residents to judge its credibility, but the ultimate test is how well preservative care is received and valued by the nursing home residents themselves. The dissertation concludes with a proposal outlining a program of further research to test the validity of preservative care. Given the crucial role that nursing attitudes and skills play in the accomplishment of preservative care, and also taking into account its relative complexity, this dissertation closes by suggesting that future nurses should be given a thorough grounding in the philosophy of preservative care during their training.