Exploring the experience of older people in care homes with the administration of oral medication, a hermeneutic phenomenological study

Abstract

This thesis reports a hermeneutic phenomenological exploration into the experience of care home residents with the administration of their medication. Residents of care homes for older people experience multi-factorial problems when being given oral medication. A systematic integrated mixed-methods review of the literature revealed that practices of modifying tablets, crushing and mixing with food, in attempts to administer medication, remain widespread internationally. There is a high prevalence of swallowing problems. Care home routines are time pressured, and there are incidences of disempowering practices and language associated with processes of medication administration. The literature presented very little from the residents’ experience, largely representing them as passive recipients in the activity. The aim of this study was to explore the experience of residents of care homes for older people who need help from care staff to take their medication. Its purpose was to answer a single research question, ‘What is the experience of residents of care homes when oral medication is administered?’ Observation of an episode of medication administration and semi-structured interviewing were conducted with eight residents between the ages of 84 and 95 from care homes in Scotland. Data was analysed in accordance with a Gadamerian philosophy of hermeneutics, with a commitment to understanding and representing the participants’ experience. Four themes emerged from the data, ‘Being in control/relinquishing control’, ‘Being comfortable in routine’, ‘Trusting’, and ‘Swallowing’. Interpretive exploration of these themes revealed the importance of facilitating individual routines when taking medication, and that a trusting relationship with staff and with the medication can be an indicator of vulnerability. The risks to autonomy in relation to taking medication, and an imbalance of power for care home residents who are given medication to take emerged as an overarching concept. Recommendations for practice focus on the potential for empowering practices in relation to taking medication.