Narratives for Empowerment: Skilled Nursing Residents Convey Stories of Their Lived Experiences in the Built Environment of Retirement Communities

Presented by: Mary Katherine Crouch, Jill Pable

Introduction One of the challenges facing retirement communities is respecting residents’ rights of autonomy, choice, and control while still following the many required laws and regulations (Frank, 2002). Administrators in skilled nursing facilities often strive to create environments which support these essential components associated with empowerment. However, the physical attributes of skilled nursing facilities may prevent residents from fully experiencing empowerment (Frank, 2002). This presentation will discuss the results of a study that explored the built environment’s influence on perceived empowerment by skilled nursing residents. The resulting data may be used to inform the future design of skilled nursing facilities so they may better support empowerment in older adults. Review of Literature Literature suggests that a sense of control, choice, and autonomy are factors that can determine if an elderly resident is satisfied with their living conditions in a skilled nursing facility. Such satisfaction may facilitate empowerment and overall well-being (Barnes, 2006; Kane et al., 2003) (Figure 1). 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. 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). Methodology The study’s primary research question was: What role does empowering elements in the built environment play in supporting quality of life for skilled nursing residents? The methodology consisted of interviews with thirteen residents and twenty hours of site observations across two skilled nursing facilities. The Person-Environment (P-E) Fit Theory by Kahana et al. shaped the study’s approach (2003). This theory evaluates the interaction of personal preferences and environmental characteristics along four physical domains (Physical Amenities/Aesthetics, Resource Amenities, Safety, and Stimulation/Peacefulness,) and two social domains (Homogeneity/Heterogeneity, and Interaction/Solitude) (Figure 2). As the name suggests, the goal is to have a positive “fit” between the preferences of the residents and the environmental characteristics of the skilled nursing facility to support resident satisfaction and psychological well-being (Kahana et al., 2003). Results The researcher discovered emerging themes for empowerment that combined both the physical findings as supported by the P-E Fit domains and additional psychosocial findings that included personal relationships, sense of belonging, sense of identity, and knowledge of community culture (Figure 3). The emerging themes lead to the development of the following ten guidelines that may inform future designs of skilled nursing facilities: 1. Resident room equals home 2. Centralized place to access resources 3. Freedom to access community spaces 4. Centralized social gathering spaces 5. Places for retreat 6. Connection to nature 7. Off-campus adventures 8. Places to explore personal interests (Figure 4) 9. Sense of belonging 10. Safety Conclusion By using narrative inquiry and observations to better understand the preferences of elderly residents for the built environment of skilled nursing facilities, the researcher was able to develop guidelines that will benefit facility administrators, staff, and other design professionals who seek to empower and improve quality of life for older adults.


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