Oosterveld-Vlug Mariska G, Onwuteaka-Philipsen Bregje D, Pasman H Roeline W, van Gennip Isis E, de Vet Henrica C W
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
Int J Nurs Stud. 2015 Feb;52(2):555-67. doi: 10.1016/j.ijnurstu.2014.06.007. Epub 2014 Jun 19.
Preserving dignity is an important goal of the care given in nursing homes. Although nursing home residents themselves are the preferred source of information about the factors that influence their dignity, they may not always be able to provide this. In these cases, information must be obtained from proxy informants such as family members or caregiver staff. Knowledge on comparability of proxies' and residents' answers is then important to interpret this information appropriately.
To explore the extent to which responses of different types of proxies correspond with nursing home residents' responses when they both assess the resident's personal dignity.
A cross-sectional survey.
The general medical wards of six nursing homes in the Netherlands.
Ninety-five nursing home residents, their family members, nurses and elderly care physicians.
Agreement percentages were calculated between residents' and proxies' answers on the Measurement Instrument for Dignity AMsterdam-for Long Term Care facilities, an instrument consisting of 31 symptoms or experiences for which presence as well as influence on dignity were asked, and a single item score for overall personal dignity.
Proxies generally rated the residents' dignity more negatively on the single item score than residents did themselves. Agreement percentages between residents and the different proxies ranged between 53% and 63% for the single item score, between 68% and 72% for the presence of items and between 68% and 76% for items' influence on dignity. Agreement on items' presence and influence on dignity was highest for physicians and lowest for family. Family members tended to overestimate the presence of items in the resident's life as well as their influence on dignity. They could however best recognize when a resident's dignity was considerably violated, whereas physicians and nurses overlooked this more often. Physicians and nurses were not always aware that certain items were present--especially of care items in which they themselves were involved.
Reports from proxy-informants cannot simply be substituted for nursing home residents' reports of personal dignity. However, if residents are not able to provide information themselves, there can still be value in proxy response on dignity if results are interpreted in light of the patterns of deviation observed in this study.
维护尊严是养老院护理工作的一个重要目标。虽然养老院居民自身是了解影响其尊严因素的首选信息来源，但他们可能并非总能提供此类信息。在这些情况下，必须从诸如家庭成员或护理人员等代理 informant 处获取信息。了解代理 informant 和居民答案的可比性对于正确解读这些信息很重要。
探讨当不同类型的代理 informant 和养老院居民都对居民的个人尊严进行评估时，二者的回答在多大程度上一致。
横断面调查。
荷兰六家养老院的普通内科病房。
95 名养老院居民、他们的家庭成员、护士和老年护理医生。
计算居民和代理 informant 在《阿姆斯特丹长期护理设施尊严测量工具》上的答案之间的一致百分比，该工具包含 31 种症状或经历，询问了这些症状或经历的存在情况以及对尊严的影响，并给出了个人总体尊严的单项评分。
在单项评分上，代理 informant 对居民尊严的评价总体上比居民自己更负面。居民与不同代理 informant 在单项评分上的一致百分比在 53%至 63%之间，在项目存在情况方面为 68%至 72%，在项目对尊严的影响方面为 68%至 76%。医生与居民在项目存在情况和对尊严的影响方面的一致性最高，家庭成员最低。家庭成员往往高估居民生活中项目的存在情况及其对尊严的影响。然而，他们最能识别居民的尊严何时受到严重侵犯，而医生和护士则更常忽视这一点。医生和护士并不总是意识到某些项目的存在——尤其是他们自己参与其中的护理项目。
代理 informant 的报告不能简单地替代养老院居民关于个人尊严的报告。然而，如果居民自己无法提供信息，那么如果根据本研究中观察到的偏差模式来解读结果，代理 informant 关于尊严的回答仍可能有价值。
