Rehnsfeldt Arne, Lindwall Lillemor, Lohne Vibeke, Lillestø Britt, Slettebø Åshild, Heggestad Anne Kari T, Aasgaard Trygve, Råholm Maj-Britt, Caspari Synnøve, Høy Bente, Sæteren Berit, Nåden Dagfinn
Stord/Haugesund University College, Norway
Karlstad University, Sweden.
Nurs Ethics. 2014 Aug;21(5):507-17. doi: 10.1177/0969733013511358. Epub 2014 Jan 13.
As part of an ongoing Scandinavian project on the dignity of care for older people, this study is based on 'clinical caring science' as a scientific discipline. Clinical caring science examines how ground concepts, axioms and theories are expressed in different clinical contexts. Central notions are caring culture, dignity, at-home-ness, the little extra, non-caring cultures versus caring cultures and ethical context - and climate.
This study investigates the individual variations of caring cultures in relation to dignity and how it is expressed in caring acts and ethical contexts. Three assumptions are formulated: (1) the caring culture of nursing homes influences whether dignified care is provided, (2) an ethos that is reflected on and appropriated by the caregiver mirrors itself in ethical caring acts and as artful caring in an ethical context and (3) caring culture is assumed to be a more ontological or universal concept than, for example, an ethical context or ethical person-to-person acts.
The methodological approach is hermeneutic. The data consist of 28 interviews with relatives of older persons from Norway, Denmark and Sweden.
The principles of voluntariness, confidentiality and anonymity were respected during the whole research process.
Three patterns were revealed: dignity as at-home-ness, dignity as the little extra and non-dignifying ethical context.
Caring communion, invitation, at-home-ness and 'the little extra' are expressions of ethical contexts and caring acts in a caring culture. A non-caring culture may not consider the dignity of its residents and may be represented by routinized care that values organizational efficiency and instrumentalism rather than an individual's dignity and self-worth.
An ethos must be integrated in both the organization and in the individual caregiver in order to be expressed in caring acts and in an ethical context that supports these caring acts.
作为斯堪的纳维亚一项正在进行的关于老年人护理尊严项目的一部分，本研究以“临床关怀科学”这一学科为基础。临床关怀科学研究基础概念、公理和理论如何在不同临床环境中得以体现。核心概念包括关怀文化、尊严、居家感、额外关怀、非关怀文化与关怀文化以及伦理背景和氛围。
本研究调查关怀文化在尊严方面的个体差异以及其在关怀行为和伦理背景中的表现方式。提出了三个假设：（1）养老院的关怀文化影响是否提供有尊严的护理；（2）护理人员所反思并内化的一种精神气质会在伦理关怀行为以及伦理背景下的巧妙关怀中得以体现；（3）与例如伦理背景或伦理人际行为相比，关怀文化被认为是一个更具本体论意义或普遍意义的概念。
采用诠释学方法。数据包括对来自挪威、丹麦和瑞典的老年人亲属进行的28次访谈。
在整个研究过程中，尊重自愿、保密和匿名原则。
揭示了三种模式：作为居家感的尊严、作为额外关怀的尊严以及非尊严性伦理背景。
关怀交流、邀请、居家感和“额外关怀”是关怀文化中伦理背景和关怀行为的表现形式。非关怀文化可能不考虑其居民的尊严，可能表现为重视组织效率和工具主义而非个人尊严和自我价值的常规护理。
一种精神气质必须融入组织和个体护理人员之中，以便在关怀行为以及支持这些关怀行为的伦理背景中得以体现。
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