Nudging in the nursing home: A qualitative interpretive study

IF 3.1 Q1 NURSING

International Journal of Nursing Studies Advances Pub Date : 2024-12-29 DOI:10.1016/j.ijnsa.2024.100287

Anne Helene Mortensen, Dagfinn Nåden, Dag Karterud, Vibeke Lohne

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Abstract

Background

Nudging involves deliberately changing the environment or context to induce better choices. Several studies consider such methods unethical manipulation that threatens the principles of informed consent and autonomy, which are particularly vital in healthcare. Others argue that nudging respects personal freedom because it is not in conflict with the person's explicit values or choices, beneficial, and easy to resist. Additionally, studies argue that such strategies are legitimate as they can prevent more intrusive forms of paternalism. Given the increasing prevalence of soft paternalism through nudging, there is a need to examine its use in healthcare.

Objective

This study explored the phenomenon of nudging in a nursing home context.

Design

A qualitative interpretive design informed by Gadamer's hermeneutics was employed.

Setting

Three distinct nursing home units in Norway, including long-term, dementia, and rehabilitation units. The study was conducted between December 7^th. 2019 and July 2^nd. 2020.

Participants

Individuals involved in the units during the observation period.

Methods

Seven to eight weeks of observations, followed by interviews with caregivers (nurses and auxiliary nurses), two occupational therapists, and two physiotherapists.

Results

The results suggest that nudging in this context can be understood across three themes: modification of physical surroundings, information and interaction, and ambiguous interventions.

Conclusions

Nudging is being used in nursing homes to guide residents’ choices and behaviors to foster their well-being and uphold social norms. However, caregivers are also navigating the use of diverse forms of influence, including subtle nudging and assertive persuasion, and must consider complex factors.