In the United States, the number of people in the over 65 year category will rise to 80 million, or 20% of the total population by 2040 (Palmore, 2009). This older group traditionally requires more services ranging from healthcare to housing than younger generations. Skilled nursing facilities provide long-term care for older adults who need around the clock nursing support, and are likewise increasing in number to accommodate this change.
One of the challenges facing retirement communities is respecting residents’ rights of autonomy and control while still following the many required laws and regulations placed on skilled nursing establishments (Frank, 2002). Administrators often desire to create a home-like environment, but the setting may still interfere with residents’ ability to make personal choices, which is an essential component associated with empowerment in the home (Frank, 2002). Given the value of stories in revealing hopes, dreams and perceptions, some researchers suggest that narrative inquiry is a valuable technique for gathering data in studies of the elderly. There is an advantage of older adults presenting their views on life: researchers can gain a better grasp of the needs of any individual by accessing his or her personal accounts of the aging experience (Harrigan & Raiser, 1998).
This study explored the built environment’s role in perceived empowerment by skilled nursing residents. Literature suggests that a sense of control, choice, and autonomy are factors that can determine if an older resident is satisfied with their living conditions that, in turn, may facilitate empowerment and overall well-being. This concept is the foundation for the study’s primary research question: What role do empowering elements in the built environment play in supporting quality of life for skilled nursing residents? The Person-Environment (P-E) Fit Theory by Kahana, Lovegreen, Kahana, & Kahana shaped the study’s approach (2003), which evaluates the interaction of personal preferences and environmental characteristics along the following four physical and two social domains: Physical Amenities/Aesthetics, Resource Amenities, Safety, Stimulation/Peacefulness, Homogeneity/Heterogeneity, and Interaction/Solitude. As the name suggests, the goal is to have a positive “fit” of the preferences and characteristics that leads to resident satisfaction and psychological well-being (Kahana et al., 2003).
The research study was comprised of two phases. The first phase involved interviewing skilled nursing residents which allowed them to share stories with the researcher of their lived experience in their long-term care facilities. They were asked about their perceptions of the spaces in the facilities that the residents determined to be empowering. The second phase took the form of observation mapping in which the researcher tracked the movement and activities of the general population of residents in the common areas of the study’s two site facilities.
Through the residents’ stories and site observations, this study reviewed a range of residents’ lived experiences from roommate relations to favorite pastimes to quiet moments. The P-E Fit theory domains proved a helpful model to understand certain physical aspects of empowerment in skilled nursing facilities. However, those domains were not able to fully explain some of the psychosocial concepts that residents expressed, which they perceived to be beneficial. The researcher discovered emerging themes for empowerment that combined both the physical findings as supported by the P-E Fit domains and these additional psychosocial findings that included personal relationships, sense of belonging, sense of identity, and knowledge of community culture. The emerging themes lead to the development of ten guidelines for skilled nursing facilities that identify and recommend empowering elements in the built environment. These included resident room equals home; centralized place to access resources, freedom to access community spaces, centralized social gathering spaces, places for retreat, connection to nature, off-campus adventures, places to explore personal interests, sense of belonging, and safety. The intent is that these guidelines will benefit skilled nursing facility administrators, staff, and other design professionals who seek to empower and improve quality of life for older adults.
|Commitee:||Huber, Amy M., Waxman, Lisa K.|
|School:||The Florida State University|
|School Location:||United States -- Florida|
|Source:||MAI 55/01M(E), Masters Abstracts International|
|Subjects:||Gerontology, Design, Social psychology, Aging|
|Keywords:||Aging, Built environment, Empowerment, Older adults, Quality of life, Skilled nursing homes|
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