Participation in vulnerable old age? Barriers and opportunities in nursing homes in Germany

Abstract Background Nursing homes in Germany are still often associated with the idea of a daily routine determined by the institution, linked to losses of self-determination and participation. Residents, as well as carers and caregivers, perceive chances for co-determination and co-creation as limited. Methods The research project PaStA (Participation in Inpatient Care for Older People) examined and analyzed opportunities and limits of improved participation in nursing homes in Germany with the help of a participatory action research design. Experiences and findings with participatory research processes in two nursing homes are presented. Results Access to people both living and working in nursing homes is demanding and time-consuming. Building a trusting cooperation requires commitment and resources. However, if a research team - including residents - is successfully installed, the participatory process enables all those involved to explore, try out and shape participation possibilities. The reflection that takes place in the process leads to learning processes that (can) result in empowerment. Discussion However, there is a danger that participatory research may primarily reach people better provided with resources for participation based on life-long circumstances (participation dilemma), highlighting the need for responsibly designed access. Likewise, the question of impact must be critically discussed. Sustainability must be considered from the beginning. Conclusions Participatory action research is a worthwhile endeavor, even in settings that are rather unfamiliar with participation, such as residential care for older people. However, researchers should not underestimate the time and commitment required, because preconditions and resistance of people and structures can compromise progress.


Background:
Nursing homes in Germany are still often associated with the idea of a daily routine determined by the institution, linked to losses of self-determination and participation. Residents, as well as carers and caregivers, perceive chances for codetermination and co-creation as limited.

Methods:
The research project PaStA (Participation in Inpatient Care for Older People) examined and analyzed opportunities and limits of improved participation in nursing homes in Germany with the help of a participatory action research design. Experiences and findings with participatory research processes in two nursing homes are presented.

Results:
Access to people both living and working in nursing homes is demanding and time-consuming. Building a trusting cooperation requires commitment and resources. However, if a research team -including residents -is successfully installed, the participatory process enables all those involved to explore, try out and shape participation possibilities. The reflection that takes place in the process leads to learning processes that (can) result in empowerment.

Discussion:
However, there is a danger that participatory research may primarily reach people better provided with resources for participation based on life-long circumstances (participation dilemma), highlighting the need for responsibly designed access. Likewise, the question of impact must be critically discussed. Sustainability must be considered from the beginning.

Conclusions:
Participatory action research is a worthwhile endeavor, even in settings that are rather unfamiliar with participation, such as residential care for older people. However, researchers should not underestimate the time and commitment required, because preconditions and resistance of people and structures can compromise progress.

Background:
Many chronically ill persons are challenged by integrating the illness in everyday life and making 'competent' decisions on their life and care. In multiprofessional primary care, promoting clients' self-management and strengthening their abilities to participate in everyday life is increasingly recognized as a nursing task. This study investigates facilitating and inhibiting conditions that nurses experience when exercising this task.

Methods:
Drawing upon a phenomenological approach, we conducted guided interviews with 34 practicing nurses and 23 key informants with advanced knowledge of primary health care nursing practice in Brazil, Germany, and Spain. The interviews were analysed using structuring content analysis.

Results:
The interviewees see competencies of nurses to establish trusting relationships with chronically ill clients as key to greater client participation. Nurses, however, state that bonding with clients can be time-consuming and exhausting. They consider it fundamental that physicians and other professionals value nurses' efforts towards stronger client participation as a way forward to reach for person-oriented primary care. They criticize that especially physicians value biomedical tasks more than enabling participation. Referring to primary health care organisation, nurses experience that pressure of time through a growing number of routine and administrative tasks inhibits their efforts to strengthen clients' participation.

Conclusions:
To promote the participation of clients with chronic illnesses in their everyday life and in care, relationship building with clients and self-management support needs to be acknowledged as an important scope of practice approached by nurses. To be able to unfold the potentials nurses need to be equipped with sufficient time and skills.
iii294 European Journal of Public Health, Volume 32 Supplement 3, 2022