Dignity in Elderly Care - Thesis Proposal Example

Dignity in elderly care Introduction 1 Background study The term ‘dignity’ derived from the Latin word dignitas or dignus that means worthy, can be defined as “quality of being worthy of honour” or “a sense of self-importance” (Collins Language. com, 2011). Thus, one can view dignity as an individual’s personal characteristic, recognised by self and others. From a broader perspective, dignity is “an umbrella concept...which makes it at once inclusive and comprehensive, and yet raises issues of scope and precision... [While creating an] awareness of the gulf separating humans from all other species can sensitize us to our potential for dignity” (Holmes, 2008, 130). Thus, dignity  is a comprehensive subject, which is predisposed to vary within the context of different ethical and cultural background. Modern, contemporary cultures seek to assimilate and subsequently transmit values, which directly aim at sustaining human dignity; additionally life by itself carries a fundamental value pertaining to dignity that merits respect. The term dignity encompasses various human intrinsic values such as freedom, love, justice, and integrity, thus making it liable to change from one country to country. Here the notions of dignity must be comprehended and connoted within the realms of the culture concerned. This is essential to bring in sustainable and positive changes while avoiding the drawbacks emanating from "moral imperialism." Owing to the presence of a large number of highly varying cultural concepts worldwide, no single country can be accorded the right to create an universal standard for human dignity with which all other countries must comply. Nevertheless, there must also be an exclusive set of international code of standard for upholding and safeguarding human dignity, commonly enforceable in all the societies, worldwide. From a global perspective, in the realms of practicality, human dignity is likely to be threatened by various factors. Human dignity may be undermined under conditions of physical ill health or diseases, certain undesirable juvenile conditions, the immediate and foreseen impacts of human ageing process, and adverse economic and cultural circumstances. Other undesirable external forces include defeats experienced throughout the past years, as well as failure of will, which once engrained within the mentality and daily attitudes of the elderly, tends to persist till their very death. The media both local and foreign has depicted on diverse occasions, the scrupulous levels of neglect and abuse that the elderly may experience at times within the health care systems (Mark et al., 1998); while often there are also reports of direct killings of the elderly patients perpetuated by their caregivers (Wainwright, 2008). in this context, The World Health Organisation defines the term “Elder Abuse” act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (WHO, 2011). This abuse can take place in three different ways: psychological/ emotional abuse, physical abuse, financial abuse, and sexual abuse. The basic notions of human dignity were first conceived within the Universal Declaration of Human Rights (UNDHR) that states in its preamble “Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world” (UNDHR, 1948). Based on this guiding principle, the Charter of Fundamental Rights of the European Union states in its first article, “human dignity is inviolable. It must be respected and protected,” thus, proclaiming that dignity in an integral part of all human existence, and human dignity must always be upheld. Article 3 of the Charter focuses on physical and mental integrity, whilst article 4 focuses on the protection against inhuman or degrading treatment or punishment. Article 25 focuses on “the right of the elderly to lead a life of dignity and independence and to participate in social and cultural life” (further expounded in details within the literature review chapter). Keeping the charter’s observations as the guiding principles, the European older people’s platform seeks to voice and promote the interests of the elderly within the EU, and ventures further to raise awareness on the issue that concerns this particularly vulnerable group. The organisation ‘Age’ is involved in advocating and promoting for the enactment of a range of policies for the elderly people within the EU agenda, while it is also working towards creating a support network amongst elderly groups. Among the guiding principles embraced by this organisation is that it is necessary to have a change of attitude to achieve equal treatment for all residing within the realms of a society, while also seeking a sense of solidarity between generations within a culture that recognises older peoples contribution to society. ‘Age’ is committed in combating all forms of age discrimination within all areas of life, and aims to monitor and improve the implementation of the various EU initiatives in this area. Negative attitudes, incorrect beliefs, and subsequent practices within a society can lead to ill treatment of the elderly population. ‘Age’ aims to help in the process of designing policies and practices that would help to stop the negatively influence towards the well-being of the older people. By addressing and achieving change in the experience and situation of older people, this tactical approach can directly assist in creating an age friendly society for all age groups. Ageing is a biological process and an individual experience, and it is wrong to generalize about a person’s ability or skill solely based on age.  The views expressed by the European commission, as regards the abuse faced by the elderly population is also applicable within the context of the Maltese health sector. The EC had commented, “The growing percentage of older people, the increasing strains on their relatives, who more and more often need to reconcile work and private obligations, and the risk of a lack of affordable professional care, could make the situation worse” (International Inner Wheel, 2008, 3). This observation represents an opportunity to constructively discuss with the various stakeholders from across the European Union how to uphold and safeguard the dignity of older people, and how to prevent all future elder abuse and neglect. The European Commission in this context further advocates, “The frail elderly are a highly vulnerable group of people and it is crucial to address the question of safeguarding their fundamental rights. Responsibility for protecting the elderly people remains with the Member States” (ibid, 2). There are various evidences which prove that within the scope of healthcare, if a patient is treated with dignity and care, it can work towards improving his/her health while also allowing the patient to cope better with illness (Anderberg, Lepp, Berglund, & Segesten, 2007). Thus, promoting dignity in health care can lead to a better quality life for the patient and this is especially so in the context of elderly patients who are particularly vulnerable to abuse, owing to their advanced age, and often frail physical conditions. The issue of dignity in care for the elderly has gained importance in the recent context owing to the worldwide rise in the population of the elderly. In 1988, the Organization for Economic Cooperation and Development (OECD), in its report Ageing Populations: The Social Policy Implications, predicted that between the years 1980 and 2040, the percentage of the elderly population (over 65 years of age) would show a sharp rise from 12.2% to 21.9%. Meanwhile the the average proportion of the population segment below 15 years of age will decline from 23.4% in 1980 to 18.3% of the entire population by 2050, thus predicting a sharp rise in the global elderly population (OECD, 1988). Since the elderly people are more likely to suffer from various physical ailments and illnesses, it has become imperative for the various governments to provide and safeguard dignity in care for it rising elderly population; while the abuse of the dignity of older people must be granted the same priority as other critical issues like domestic violence.  The Human Rights Act represents a cultural shift in the optimal direction, as regards both the abuse and neglect of the elderly particularly whenever their respective dignity is at stake. The cases of mistreatment of elderly, to the very detriment of their own dignity, are multiple. Foremost one can mention elderly being mistreated in a hospital ward or alternatively facing neglect within a care home. Other more severe cases include the denial of adequate health care, or worse still old people repeatedly bullied by a health care employee within the domestic environment of the former.  In these cases, there is a direct ongoing challenge not only to the dignity of the elderly, but also more significantly to their own humanity. Such a threat is essentially a fundamental breach of human rights. The latter is unacceptable on the moral level. At a critical point, the shelved problem will simply erupt to unthinkable proportions. In human dignity and bioethics book, it is highlighted that “it is hard to see how ethical standards for the treatment of human beings can be maintained without relying on some conception of what human beings are and what they therefore deserve” (Schulman, 2008, 15). To address this problem, many EU countries have established a Health Care Commission with clearly defined functions and frameworks in which to operate. These institutions have proved to be of central importance, in acting as a powerful and instrumental advocate, not only as regards the respective interests of elderly in particular, but also in instilling the notion of dignity, as regards the elderly population, amongst the general populace. Within the Maltese context a succession of initiatives have been undertaken in this regards, however, it must be noted that a holistic approach towards upholding elderly dignity, is still lacking. The Maltese government must address this issue so that constructive outcomes can be effectively attained in the near future, while the policies and legislation on this issue must be drawn on the same lines as its EU counterparts. The preservation and enhancement of human dignity is a cardinal universal value.  The concept of dignity is often associated with notions of autonomy and having a control over one’s fate. In the context of elderly healthcare, various evidences suggest that • There are chances that within a healthcare setting an elderly patient’s autonomy and dignity may be extenuated. • There are often many individuals within a healthcare setting who may have certain preconceived misconceptions, and subsequently may express a negative attitude towards the elderly people. • When such negative attitudes are tackled effectively through the right exposure and appropriate education it can work towards preserving an elderly patient’s dignity and sense of autonomy. • providing adequate and correct information to the elderly people and their caregivers adequate information for them to make informed choices about care further increases autonomy (Lothian, & Philp, 2001). Thus, within the context of a country’s health care sector one must seek to train and educate those associated with the health and care of the elderly patients. The state’s policies and the respective measures must revolve around the objective of safeguarding and enhancing the personal dignity of older people in a comprehensive manner that should encompass all the provisions made within the various international conventions and charters related to human rights. In this respect, Malta is actively working in unison within the wider framework of the EU, so as to ensure the proper care and security of the elderly, and can enjoy a decent life based on healthy values.  1.2 Problem statement In past twenty years, I have been a part of the Maltese medical sector, working in different medical facilities as a podiatrist within the country. This includes working at the Institute for the Elderly at St. Vincent de Paul (Luqa), which is a long-term care geriatric institute; in the various primary health care centres around the Maltese islands; and also as a part of the rehabilitation team at the Rehabilitation Hospital Karen Grech, an institute for short-term geriatric care. Through these various exposures, I have felt that one of the fundamental challenges that face our contemporary society is the need to instil a sense of commitment and responsibility amongst the caregivers, in order to secure an effective and sustaining care-treatment program for the rising elderly population. Another area of concern relates to the unequal distribution of healthcare resources for the elderly population. My paper will address the concerns primarily arising from these two problems or issues related to the elderly care management within the Maltese health sector. 1.3 Nature of study In this study, I will focus on three main questions that will help me to understand the various problems that are faced within the Maltese heath sector as regards upholding the dignity of the elderly patients. What is the significance of dignity from the perspective of the older elderly, within the health care system?  Can dignity be measured, and if so by what specific instruments?  Is dignity of old people within the Maltese health care system sufficiently respected?  These three questions probe within the highly practical dimensions of the realities faced by the elderly, with the aim of helping the elderly to enjoy a life based on dignity and sustain their meaningful daily experiences, in the near future. 1.4 Significance of the study While advances in healthcare can indeed prolong and improve life, the real life experiences of patients in this system continue to evolve. Keeping this mind, the current research seeks to examine the real life experiences of the elderly patients, to determine how conceptualizations and understanding of dignity are formed within the health sector and care giving facilities for the geriatric patients. In this respect, underlying objective in this research will contribute directly towards paving the way forward in this sector. In view of the greying of the Maltese society, this research is highly opportune so as to qualify the health related approaches in this regard.  This would help to seek solutions for treating the elderly patients with dignity and care within the Maltese heath sector that would act as a guideline for all future research work in this area 1.5 Aims and objectives In the context of the Maltese health care sector and its attitude towards maintaining dignity for its elderly patients, it can be said from personal experience that the country has developed a high quality care delivery system. The underlying core objective of the Maltese health sector has always been to protect and enhance the respective human dignity of all citizens, which has led to the development of the present day high quality medical care. This research aims to evaluate the notions of dignity within the Maltese health arena as regards the elderly patient, so as to identify the necessary benchmarks for preserving and safeguarding dignity. The chief focus and objective of this research paper would be to find out whether the current medical services are adequately contributing towards the safeguarding and enhancement of the elderly patient’s dignity. The notions of dignity in thesis paper will be evaluated directly from the perspective of the various elderly patients, personal experiences, and a review of all current literature on the issue, thus giving it a holistic view.  This research paper will follow the order that will have six sections: Section (chapter) 1- Presentation of the Problem (Introduction); Section (chapter) 2- Literature review; Section(chapter) 3- Presentation of Method and Methodology; Section (chapter) 4- Data Collection and Analysis; Section (chapter) 5-Conclusion; and Section (chapter) 6- Recommendations. 2 Methodology All forms of undertaken research work consist of a fixed procedure, which is made up of a series of varying enquiries on the selected issue/ problem that are systemic in nature. These systemic enquires enable the research scholar, to imbibe new knowledge on that particular theme. This thesis paper will comprise of both primary and secondary work, though the primary nature of the research work carried out in this paper is secondary research, defined as “analyzing [the] already collected data within another study” (Sarantakos, 2005, 297). Secondary researches generally involve a detailed study of all the available data, which is perceived as necessary, owing to the fact that often ‘a wealth of data’ that has been collected for various other non-research objectives, can also be used quite effectively to answer one’s questions in a research paper. Secondary research work generally creates a broader perspective for the concerned researcher to study and collect a large number of required data from various resources. The research process methodology as followed for this paper is based on the outline given by Graziano & Raulin, in their paper. Personal experience other’s research Initial idea procedures design study analysis Communication Interpretation Stimulating Others Research Fig: 3- Research process methodology by Graziano & Raulin, 2009, 40. The research paper is qualitative in nature and, this type of research work “is best suitable when little is known about a product, category, or respondent group or when the researcher wishes to expand the current state of knowledge…” (Mariampolski, 2001, 23-24). It is also important to use an inductive and qualitative analytical method, which would make it easier for the researcher to come to a “conclusion from one of more particular facts or pieces of evidence [where] the conclusion explains the facts, and the facts explain the conclusion” (Blumberg, Cooper, Schindler, 2005, 23). Summarily, this research process will consist of first locating all the relevant data and then studying and analyzing all the available data on this topic; then critical assumptions will be made from the gathered data; while, further supporting material will be collected to provide supporting evidence for all the opinions expressed and conclusions derived. Primary research (data collection and collection instrument): In Fig 1, under ‘procedure designs’ there are two forms researches shown: the primary and secondary researches. The primary research will consist of interviews and questionnaires, which will involve the elderly patients with the Maltese health care sector. Their answers will be studied closely to interpret and show as to how the elderly patients in Malta feel towards the present system of care, and whether their dignity was safeguarded within the present medical care facilities. The primary research will give a voice to the common elderly patients and will help us to get a clear picture of the actual ground scenario within the health care sector as regards geriatric care, in Malta. Secondary research: This will involve study and analysis of pre-existing information from various books, journals, and websites on the treatment elderly patients within the Maltese health care sector. This form of study would account for the main pool of information for my thesis paper, and would help in comprehending the [problems within the present system while enabling me to analyse the entire situation correctly, so as to be able to arrive at a somewhat balanced conclusion. Bibliography Anderberg, P., Lepp, M., Berglund, A., Segesten, K., 2007. Preserving dignity in caring for older adults: a concept analysis. J Adv Nurs., 59:635-43. Blumberg, B., Cooper, R., & Schindler, P. 2005. Business research methods. Berkshire: McGraw Hill. Collins Language. com. 2011. Dignity. Retrieved from, http://www.collinslanguage.com/shop/schools/times-spelling-bee.aspx Graziano, A., & Raulin, M. 2009. Research methods: A process of inquiry (7th ed.). Boston, MS: Allyn & Bacon. Holmes, R., 2008. “Human uniqueness and human dignity.” In, Presidents Council on Bioethics (U.S.) (ed.), Human Dignity and Bioethics: Essays Commissioned by the Presidents Council on Bioethics. Washington: Government Printing Office, 130. International Inner Wheel, 2008. News on the web. Issue 3. Retrieved from, http://www.innerwheel.com/newsletters/News%20on%20the%20Web%203.pdf. Lothian, K., & Philp, I., 2001. Maintaining the dignity and autonomy of older people in the healthcare setting. British Medical Journal 322: 668-670. Mark, S., et al., 1998. The Mortality of Elder Mistreatment. 280 JAMA 428-432. Mariampolski, H. 2001. Qualitative Market Research: A Comprehensive Guide. London: Sage. OECD. 1988. Ageing Populations: the Social Policy Implications. OECD, Paris. Sarantakos, S. 2005. Social Research. Basingstoke: Palgrave. Schulman, A., 2008. “Bioethics and the question of human dignity.” In, Presidents Council on Bioethics (U.S.) (ed.), Human Dignity and Bioethics: Essays Commissioned by the Presidents Council on Bioethics. Washington: Government Printing Office, 15. Universal Declaration of Human Rights (UNDHR), 1948. Preamble. Retrieved from, http://www.un.org/en/documents/udhr/index.shtml Wainwright, M., 2008. Nurse who killed four elderly patients jailed for life. The Guardian. Retrieved from, http://www.guardian.co.uk/society/2008/mar/05/nhs.ukcrime WHO, 2011. Aging and life course- elder abuse. Retrieved from http://www.who.int/ageing/projects/elder_abuse/en/index.html Read More