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Residents' views: Findings of a survey
Territory and Privacy Residents'Views: Findings ofa Survey vided, and what activities required identification when in a crowd privacy.. • reserve-a ·psychological barThe selected nursing home is well rier created between oneself and regarded for its high quality care others(2). Today, by "privacy" we seem to and innovations in geriatric residential living. Located in a neigh- imply withdrawal from social interborhood of one- and two-family action or limiting the disclosure of WANDA M. ROOSA homes in New York City, the home personal information. Legislative accommodates 386 residents: 149 concerns, as expressed in the 1977 who need skilled nursing and 237 Report of the Privacy Protection he desire for privacy seems to who need to have only health- Study Commission, focus on controlling the spread of personal inbe universal, yet exactly what related care. we mean by privacy is difficult to . Before the survey, I informally formation in the computer age(3). Residents I interviewed unaninterviewed ·nursing home personsay. For many of us privacy means nel and residents at two other imously selected solitude or alonebeing alone; for others it is keeping homes to identify areas of concern ness as their definition of privacy. secrets or doing something·without related to privacy. Then, after de- For some it meant having a single others knowing about it; for some veloping a semistructured interview room; for others, simply "being by it's the opportunity to get lost in a schedule and administering the myself' part of the time. One can Mental Status Questionnaire, I speculate that sharing living quarcrowd. By law ·and tradition, a person's conducted extensive interviews ters in nursing homes probably home is private. Because nursing with 60 consenting residents at the makes aloneness the residents' homes are homes. residents' priva- selected home. All respondents' prime concern. Some respondents provided addiMSQ scores indicated that they cy deserves special consideration. tional definitions. A form of perIn 1979 I conducted the survey were mentally alert( 1). sonal control, such as "doing my reported here to discover what resi- What Is Privacy? own thing" or "freedom to choose" dents in one nursing home defined Westin identified four states of was mentioned by ·15 respondents. as privacy, what benefits it proprivacy: Privacy as maintaining secrecy or Wanda M. Roosa, RN, EdD. is an assistant professor, State University of New York at • solitude-physical seclusion limiting sCIf-disciosure was the secBinghamton, where she teaches gerontologfrom others ond definition of 8 persons. ical nursing to graduate students. Her artiFrom time to time all of us need intimacy-dose familiarity • cle is based on research for her doctorate, between people to withdraw from the scrutiny of earned while she was studying at Teachers College, Columbia University, New York. • anonymity-freedom from others to review our lives, plan for
Is social withdrawal sometimes the only way that residents can find privacy?
T
Geriatric Nursing July/August 1982241
Space to call his own, a voice in selecting draperies or the color of the walls. and some furnishings brought from home ease an elder's adjustment to the new home.
the future, or simply to vent feel- read, write, conduct personal busi- used so frequently that ownership ings that we suppress in public. To ness, watch TV, and listen to mu- by the user is clearly evident to the be alone when we wish promotes sic. other residents. the feeling that we are in charge of Other space, such as a favorite our lives and reinforces our ability PriY8CY in the Nursing Home chair in the lounge, cannot be solely to help ourselves. The belief that "a man's home is owned, even though the resident Almost one-half (28) of the re- his' castle" is supported by social may feel that her privacy has been spondents identified emotional re- custom and Constitutional guaran- invaded when she finds someone lease as a benefit of privacy. Priva- , tees that restrict entry into one's sitting in'''her chair." But she is far cy "calmed" them, made them home. more distressed if she finds a disori"more comfortable and secure," orToday's nursing home is a social ented resident rummaging through "provided a breather." In short, institution that has acquired the , her dresser drawers. privacy gave them respite from position of "home" by housing perOne way to claim ownership of a stress, for example, "watching a sons who are no longer able to care territory is to fill it with one's own roommate die." for themselves or to arrange for possessions. Personal photographs care in their own homes. This care- or articles placed on a dresser top PriY8CY'S Benefits taker role carries with it a degree of or room divider tell others that this After solitude, self-evaluation control over residents' lives that did place is occupied. Some nursing was the benefit, mentioned most not exist when they were private homes allow residents to use their frequently. Eleven respondents said citizens residing in their own own furniture to personalize their having privacy let them reflect homes. space. Unfortunately but necessariabout the past, concentrate, or "reAll residents need some territory ly, fire and other safety regulations main the person I am." Having pri- or space to call their own, a place to do restrict the amount and kind of vacy strengthened feelings of per- be physically separated from oth- personal possessions. sonal autonomy for 9 residents, ers. Semiprivate rooms predominate making them feel that they were in The nursing home, to a large de- in most nursing homes. This arcontrol and could do as they gree, controls the places and spaces rangement may be wanted, unpleased. within it, and the types and num- wanted, or. gradually accepted. Privacy also allows one to pursue bers of private areas vary with each Typically, the resident has no prior activities beyond the day's routine nursing ~ome. Some places, such as acquaintance with the new roomevents. Residents wanted privacy to one's bed and surrounding area,are mate and must adjust to this per-
son, who may playa radio loudly, watch TV all day, or keep the light on late at night. In this survey, almost every respondent (56) indicated that his or her room was the best place to have privacy; 37 of those who had semiprivate rooms said they would like a private room. Residents' physical and mental capabilities may affect their access to privacy. The man who wants to escape from an annoying roommate but cannot walk unassisted must depend on the staff to help him when they have time. The inability. to find a place for solitude and relief may leave the man with no choice except to withdraw psychologically. Decreased self-help ability requires more staff assistance to complete daily activities. The woman who previously bathed herself must now adjust to having a nurse do it. The toilet, a place where one invariably had privacy, may now have to be used in the presence of another.
Promoting Prhacy The nurse in a nursing home has the dual responsibility of safeguarding residents by monitoring their health and providing nursing care while at the same time she helps define and defend residents' rights. She is, in fact, the key person to balance the individual's right of privacy with the institution's responsibility for safe care. As advocates, nurses can find many ways to enhance residents' control over their space. Allowing them to choose the paint and select the draperies and bedspreads for .their room promotes a sense of belonging in that space. Regulations on wall decorations, personal items, and personal furniture should be as flexible as possible. In selecting furniture for bedrooms and activity spaces, consider a diversity of uses. Too many hardto-move chairs in lounges, for instance, prevent group formation and exclude wheelchair residents. Communal areas that are open, and light, stackable chairs promote the use of these areas for either so-
cial interaction or solitude. tains before carrying out treatSemiprivate rooms restrict priva- ments are demonstrating that they cy and, as this survey showed, respect the resident's privacy. many residents prefer a private Future Studies room. In designing future nursing homes, construction costs, often The survey respondents gave used to justify semiprivate rooms, similar definitions of privacy, but it need to be weighed against the cu- may have more tflan one meaning. mulative costs in time spent by per- Nurses need to identify the privacy sonnel in solving roommate prob- definitions of older people who are lems as well as the psychic costs living in a variety of housing ararising from residents' loss of pri- rangements. Possibly, privacy and solitude vate space. Movable screens can separate may not have the unanimous assothe beds in semiprivate rooms. ciation that they did in this study if Screens made of cork or pegboard elderly persons are living in relative would provide space to hang pic- social isolation in the community. tures, greeting cards, or a dried The meaning of privacy and privaflower arrangement. cy-seeking behavior may vary with Residents need a variety of different cultural backgrounds places where they can enjoy sorne . even though these were not found to be significant in this survey. Other issues -o_eed to be explored. Do people who cannot get away from others lose their positive selfIn a nursing home the image or their sense of individunurse is the key person ality? Do people who cannot shut out environmental stimuli ever to balance the right have a real opportunity for selfof the. indh'idual evaluation? Is the lack of privacy that typifies to prh'acy with the congregate living a factor-that hashome's responsibility tens the change from elderly resident who reminisces to regressed to provide safe care. patient who no longer tries to care for himself? Nurses daily observe and interpret human behavior. Are some reform of aloneness. Several small sident behaviors that we interpret lounges, designated specifically for as social withdrawal actually a reading, TV, or games, might be form of privacy seeking? Do instimore desirable than the large mul- tutional norms that encourage totipurpose lounge. getherness sometimes lead us to laNot all residents want private bel the active privacy seeker as unrooms but a compatible roommate cooperative or deviant? A reasoned appreciation of hucontributes to their satisfaction. By placing gregarious roommates to- man behavior indicates that each of gether and quieter roommates to- us needs to create his or her unique gether, nurses can promote harmo- balance of privacy and social interaction. ny. Locks for room doors and mailboxes increase residents' control of References I. Kahn. R. L., and others. Brief objective mea· their' space. Encourage locks within sure for the determination of mental status in the limits of safety. the aae
Geriatric Nursing July/August 1982243
Is social withdrawal sometimes the only way that residents can find privacy?
T
Geriatric Nursing July/August 1982241
Space to call his own, a voice in selecting draperies or the color of the walls. and some furnishings brought from home ease an elder's adjustment to the new home.
the future, or simply to vent feel- read, write, conduct personal busi- used so frequently that ownership ings that we suppress in public. To ness, watch TV, and listen to mu- by the user is clearly evident to the be alone when we wish promotes sic. other residents. the feeling that we are in charge of Other space, such as a favorite our lives and reinforces our ability PriY8CY in the Nursing Home chair in the lounge, cannot be solely to help ourselves. The belief that "a man's home is owned, even though the resident Almost one-half (28) of the re- his' castle" is supported by social may feel that her privacy has been spondents identified emotional re- custom and Constitutional guaran- invaded when she finds someone lease as a benefit of privacy. Priva- , tees that restrict entry into one's sitting in'''her chair." But she is far cy "calmed" them, made them home. more distressed if she finds a disori"more comfortable and secure," orToday's nursing home is a social ented resident rummaging through "provided a breather." In short, institution that has acquired the , her dresser drawers. privacy gave them respite from position of "home" by housing perOne way to claim ownership of a stress, for example, "watching a sons who are no longer able to care territory is to fill it with one's own roommate die." for themselves or to arrange for possessions. Personal photographs care in their own homes. This care- or articles placed on a dresser top PriY8CY'S Benefits taker role carries with it a degree of or room divider tell others that this After solitude, self-evaluation control over residents' lives that did place is occupied. Some nursing was the benefit, mentioned most not exist when they were private homes allow residents to use their frequently. Eleven respondents said citizens residing in their own own furniture to personalize their having privacy let them reflect homes. space. Unfortunately but necessariabout the past, concentrate, or "reAll residents need some territory ly, fire and other safety regulations main the person I am." Having pri- or space to call their own, a place to do restrict the amount and kind of vacy strengthened feelings of per- be physically separated from oth- personal possessions. sonal autonomy for 9 residents, ers. Semiprivate rooms predominate making them feel that they were in The nursing home, to a large de- in most nursing homes. This arcontrol and could do as they gree, controls the places and spaces rangement may be wanted, unpleased. within it, and the types and num- wanted, or. gradually accepted. Privacy also allows one to pursue bers of private areas vary with each Typically, the resident has no prior activities beyond the day's routine nursing ~ome. Some places, such as acquaintance with the new roomevents. Residents wanted privacy to one's bed and surrounding area,are mate and must adjust to this per-
son, who may playa radio loudly, watch TV all day, or keep the light on late at night. In this survey, almost every respondent (56) indicated that his or her room was the best place to have privacy; 37 of those who had semiprivate rooms said they would like a private room. Residents' physical and mental capabilities may affect their access to privacy. The man who wants to escape from an annoying roommate but cannot walk unassisted must depend on the staff to help him when they have time. The inability. to find a place for solitude and relief may leave the man with no choice except to withdraw psychologically. Decreased self-help ability requires more staff assistance to complete daily activities. The woman who previously bathed herself must now adjust to having a nurse do it. The toilet, a place where one invariably had privacy, may now have to be used in the presence of another.
Promoting Prhacy The nurse in a nursing home has the dual responsibility of safeguarding residents by monitoring their health and providing nursing care while at the same time she helps define and defend residents' rights. She is, in fact, the key person to balance the individual's right of privacy with the institution's responsibility for safe care. As advocates, nurses can find many ways to enhance residents' control over their space. Allowing them to choose the paint and select the draperies and bedspreads for .their room promotes a sense of belonging in that space. Regulations on wall decorations, personal items, and personal furniture should be as flexible as possible. In selecting furniture for bedrooms and activity spaces, consider a diversity of uses. Too many hardto-move chairs in lounges, for instance, prevent group formation and exclude wheelchair residents. Communal areas that are open, and light, stackable chairs promote the use of these areas for either so-
cial interaction or solitude. tains before carrying out treatSemiprivate rooms restrict priva- ments are demonstrating that they cy and, as this survey showed, respect the resident's privacy. many residents prefer a private Future Studies room. In designing future nursing homes, construction costs, often The survey respondents gave used to justify semiprivate rooms, similar definitions of privacy, but it need to be weighed against the cu- may have more tflan one meaning. mulative costs in time spent by per- Nurses need to identify the privacy sonnel in solving roommate prob- definitions of older people who are lems as well as the psychic costs living in a variety of housing ararising from residents' loss of pri- rangements. Possibly, privacy and solitude vate space. Movable screens can separate may not have the unanimous assothe beds in semiprivate rooms. ciation that they did in this study if Screens made of cork or pegboard elderly persons are living in relative would provide space to hang pic- social isolation in the community. tures, greeting cards, or a dried The meaning of privacy and privaflower arrangement. cy-seeking behavior may vary with Residents need a variety of different cultural backgrounds places where they can enjoy sorne . even though these were not found to be significant in this survey. Other issues -o_eed to be explored. Do people who cannot get away from others lose their positive selfIn a nursing home the image or their sense of individunurse is the key person ality? Do people who cannot shut out environmental stimuli ever to balance the right have a real opportunity for selfof the. indh'idual evaluation? Is the lack of privacy that typifies to prh'acy with the congregate living a factor-that hashome's responsibility tens the change from elderly resident who reminisces to regressed to provide safe care. patient who no longer tries to care for himself? Nurses daily observe and interpret human behavior. Are some reform of aloneness. Several small sident behaviors that we interpret lounges, designated specifically for as social withdrawal actually a reading, TV, or games, might be form of privacy seeking? Do instimore desirable than the large mul- tutional norms that encourage totipurpose lounge. getherness sometimes lead us to laNot all residents want private bel the active privacy seeker as unrooms but a compatible roommate cooperative or deviant? A reasoned appreciation of hucontributes to their satisfaction. By placing gregarious roommates to- man behavior indicates that each of gether and quieter roommates to- us needs to create his or her unique gether, nurses can promote harmo- balance of privacy and social interaction. ny. Locks for room doors and mailboxes increase residents' control of References I. Kahn. R. L., and others. Brief objective mea· their' space. Encourage locks within sure for the determination of mental status in the limits of safety. the aae
Geriatric Nursing July/August 1982243