Horizon Health Network, Ridgewood Veterans Hospital, Saint John, NB, Canada.
Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada.
JBI Evid Synth. 2021 Jul 1;19(7):1583-1621. doi: 10.11124/JBIES-20-00291.
This scoping review aimed to map the existing literature about nursing provisions for self-determination in residents with cognitive impairments living in residential aged care facilities.
Freedom to decide for oneself and express preferences about daily care is important for all older adults. When older adults transition to residential aged care facilities, they may experience barriers to self-determination due to routine care practices and staff attitudes about autonomy. This is particularly true for residents living with cognitive impairments. Residents with cognitive impairments are often prevented from making choices that nursing staff perceive to be unwise or harmful, as nurses uphold their professional duties to protect and care. This can result in the denial of preferences and the right to self-determination. Mapping the ways nurses balance their duty to protect with residents' rights to self-determine provides insight into nurses' roles and residents' experiences of care.
Research and narrative articles about nursing provisions for self-determination in residents with cognitive impairments living in residential aged care facilities were included in this review. The main concepts explored were nurses' provisions and residents' self-determination. Self-determination included residents' preferences and expressions of choice, while nurses' intentional reactions to residents' preferences were considered nurses' provisions.
The review included qualitative and quantitative studies as well as text and opinion papers. Only studies and papers published in English from 1992 onwards were included. The databases searched were CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), and ERIC (EBSCO). The search for unpublished papers included ProQuest Nursing and Allied Health Database, ProQuest Dissertations and Theses, and Google (with advanced search strategies). The reference lists of included articles were searched for additional studies not captured by the search strategy. Data were extracted using a standardized tool created by the authors and included details on study design, strategies to promote, and conditions that deny residents' self-determination. Charting tables were developed to record and analyze data related to the review questions.
The final set of 17 articles were published from 1995 to 2018. The literature was analyzed in relation to the review's four questions to map the boundaries of the nurse's role in providing for residents' self-determination. Nurses' roles as investigators, advocates, protectors, and assessors emerged as critical to providing for self-determination.
Literature about this topic has tended to describe nursing provisions for self-determination in people with cognitive impairments in terms of an ethical dilemma between the resident's right to act autonomously and their right to protection as a vulnerable population. In mapping the literature, this scoping review demonstrates a more complex process at work in providing for self-determination in the context of cognitive impairment and highlights a need for deeper reflexivity around nurses' understandings of personhood and autonomy. Further research should focus on determining if nurses' perceptions of residents' experience with self-determination are accurate. The complexity of self-determination in the context of cognitive impairment and nurses' advocacy role highlights the need for ongoing support and education for staff working in residential aged care facilities.
本范围综述旨在绘制现有的关于居住在养老院中认知障碍居民的自主护理规定的文献。
自由决定和表达对日常生活护理的偏好对所有老年人都很重要。当老年人过渡到养老院时，由于常规护理实践和工作人员对自主权的态度，他们可能会遇到自主决策的障碍。对于患有认知障碍的居民来说，这种情况尤其如此。认知障碍的居民往往被阻止做出护理人员认为不明智或有害的选择，因为护士要履行保护和照顾的专业职责。这可能导致对偏好和自主决策权的否定。描绘护士在保护居民和居民的自主决策权利之间平衡的方式，可以深入了解护士的角色和居民的护理体验。
纳入了关于居住在养老院中认知障碍居民的自主护理规定的研究和叙述性文章。本次综述主要探讨了护士的护理规定和居民的自主决策两个概念。自主决策包括居民的偏好和表达选择，而护士对居民偏好的有意反应被认为是护士的护理规定。
综述包括定性和定量研究以及文本和观点论文。仅纳入了 1992 年以后发表的英文研究和论文。检索的数据库包括 CINAHL（EBSCO）、MEDLINE（Ovid）、Embase（Elsevier）和 ERIC（EBSCO）。对未发表论文的检索包括 ProQuest Nursing and Allied Health Database、ProQuest Dissertations and Theses 和 Google（使用高级搜索策略）。还对纳入文章的参考文献进行了检索，以查找未被检索策略捕获的其他研究。使用作者创建的标准化工具提取数据，包括研究设计、促进策略和否定居民自主决策的条件等详细信息。为记录和分析与综述问题相关的数据，开发了图表表格。
最终纳入的 17 篇文章于 1995 年至 2018 年发表。文献分析与综述的四个问题有关，旨在绘制护士在为居民自主决策提供支持方面的角色边界。护士作为调查员、倡导者、保护者和评估者的角色，对于提供自主决策至关重要。
关于这个主题的文献往往将认知障碍患者的自主护理规定描述为居民作为弱势群体的自主行动权和保护权之间的伦理困境。在绘制文献图谱时，本次范围综述表明，在认知障碍背景下提供自主决策的过程更加复杂，并强调了需要对护士对人格和自主的理解进行更深入的反思。进一步的研究应侧重于确定护士对居民自主决策体验的看法是否准确。认知障碍背景下自主决策的复杂性和护士的倡导角色凸显了为居住在养老院中的工作人员提供持续支持和教育的必要性。
