The thesis consists of four original articles and a synthesis chapter. The first study explored how long-term care residents and nurses understand functional ability. The second examined nurses’ experiences of functional assessment as part of their work. The third study explored how nurses and residents understand rehabilitation. The fourth study examined family members’ role in long-term care and especially in maintaining the functional ability of their older relatives.
The results indicated that there is some unclarity and ambiguity about functional ability and associated activities in long-term care. In nurses’ talk, the functional ability of long-term care residents appeared as an abstract and multidimensional phenomenon. Furthermore, functional ability was described in terms of daily activities such as ambulating and taking care of personal hygiene. In residents’ talk, functional ability was understood in broader terms. In addition to daily activities, residents talked about seeing, hearing, drawing and television viewing. They also associated functional ability with their life course. For nurses, functional assessment was contradictory to what they perceived as good care. Assessments were considered useful in principle, but it was felt that they should have been put to better use in daily practices of care. Nurses portrayed functional assessment as an exercise of meeting formal requirements set by the authorities rather than residents’ needs.
Rehabilitation was perceived as an important part of long-term care. However, defining rehabilitation was difficult. Nurses described rehabilitative nursing as a form of rehabilitation, and said they engaged in rehabilitative nursing as part of their everyday work. Residents, by contrast, did not understand the work done by nurses as rehabilitation. They regarded rehabilitation as something that was done by other professionals, such as physiotherapists. For family members, maintaining functional ability was related to providing and maintaining social contacts. They highlighted activities that took into consideration their relative’s personal wishes and habits and which thus supported the resident’s personhood. As far as family members were concerned, these were important to maintaining functioning.
The results highlighted the complexity of functional ability in the context of both care policies and daily life in long-term care. Interviewees talked about functional ability in the same way that it is discussed and represented in care policies and public debate. In these cases, functional ability and rehabilitation were associated with an activity paradigm and with measurements of care and its quality. However, functional ability was portrayed differently when it was considered as part of daily life in long- term care: here the interviewees emphasized the importance of meaningful life, social interaction, and lack of resources.
It is difficult to implement concrete measures and to understand the goals and purpose of policy papers if the concepts used are unclear or if they are not aligned with common understandings and values in practical work.
In the design of long-term care it is important to take account not only of policy objectives and measures but also of the realities and prerequisites of everyday care. Personal experience, social interaction and continuity of care must be given a more central place in the vocabulary of functional ability so that it is not reduced to a matter of numbers. While long-term care is aimed at maintaining and improving functional ability, it is also important to make sure that these goals do not override long-term care residents’ right to care and a dignified life.
The doctoral dissertation of Master of Health Sciences Vilhelmiina Lehto-Niskala in the field of gerontology titled Toimintakyky hoivapolitiikan ja hoidon arjen risteyksessä: Ikääntyneiden ympärivuorokautisen hoidon asukkaiden, heidän perheenjäsentensä sekä hoitajien käsityksiä toimintakyvystä ja kuntoutuksesta will be publicly examined at the Faculty of Social Sciences of Tampere University at 12 o'clock on Friday 27 August, 2021. The venue is Arvo building auditorium F114, address: Arvo Ylpön katu 34. Professor Heli Valokivi from University of Jyväskylä will be the opponent while Professor Marja Jylhä will act as the custos.
The event can be followed via Panopto remote connection.
The dissertation is available online at
http://urn.fi/URN:ISBN:978-952-03-2054-6
Photo: Paavo Niskala