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The staff struggled to attend to all these diverse needs, trying to calm residents. At this point, the musical performers were about to start. A couple of minutes later, the musical performance began, Sara started to listen to the music, and the conversation ended. This exemplar could be interpreted as showing a deeper quality of everyday life activities, the elicitation of multiple life worlds.

It becomes clear that Sara's story at the NH is part of a bigger story. Sara's engagement in conversation with the primary researcher opened momentarily the possibility to talk about her multiple life worlds Gubrium, , such as her background as a secretary and even her contemplation of death, life worlds that would pass unseen without engagement. It also seems difficult for Sara to situate this new form of life at the NH, which does not have precedents. Everyday life activities, arranged mostly by others, seem difficult to be situated; she has no ownership on them and could be seen as challenging influence enactment.

In this sense, Sara's exemplar could also be seen as making visible a certain disruption of her identity due to the institutional culture. Everyday life activities, which are planned without consulting her interests and leaving unaddressed relevant aspects of her identity, do not necessarily contribute with a sense of continuity for Sara.

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This context offers predominantly passive roles such as to be taken care of, entertained, or invited into tasks. Other aspects of Sara's repertoires, closer to her interests and abilities, are less acknowledged. This way of introducing herself, foregrounding her diagnosis, attracted my interest in her and situations she could be facing. After this, the primary researcher met her several times during the fieldwork period. The following event took place right after lunch in the dining area at the NH. I was sitting beside Catherine, talking about what she was interested in doing.

She told the primary researcher that she liked reading books, but had difficulties in seeing now and therefore did not read any longer.

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It even varies from one day to another or even during the same day. Yesterday I went for a trip by car to the other side of the city. I had a dentist appointment at X hospital. I have been in many hospitals, but I hadn't been there before. It was fun to see the city, to see how things change! The hospital was very modern and clean, and the staff was really nice.

They explained to me everything they were going to do! It also shows how ephemeral and situational these moments could be in everyday practices. The event of traveling outside the institution through the changing city, to be physically in other places, and to be met differently than the usual way could be understood as a valued event per se. Furthermore, the set of events as they unraveled during her dentist visit could be understood as a preparatory preamble for her to dare to propose the fika afterward.

Catherine's attempt to enact influence could also be understood as a desire to shift from the institutionally assigned fixed role of a patient toward the role of a person, foregrounding instead space for spontaneity, flexibility, and real influence in favor of a more pleasing day. As expressed by Catherine, the mood to engage in something desirable is experienced as unreliable for her, because of the uncertainty of the occurrence of such events and because of her labile energy.

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The aim of this study was to reveal how influence is situated contextually, emerges through activities, and is negotiated in everyday activities by frail older adults living in a NH. The findings point toward the urgent need to redefine frailty beyond the medical paradigm and rather as a demand for responsive and ethical engagement. The findings of this study contribute to new understanding of the meaning of everyday activities in an institutional setting, experienced by residents of a NH.

These findings suggest that everyday activities in NHs could have an amplified relevance, beyond something being provided or solely understood as tasks. This amplified relevance is illustrated in the exemplar An almost perfect trip , exemplar where the opportunities for the resident to enact influence could be seen as emerging and unfolding during her visit to the dentist. It could also be seen at the exemplar Seeking for a place for other life worlds , where everyday life activities elicit the surfacing of other life worlds.

In the first case, the positive experience during the dentist visit could be seen as changing her own embodied perception of the situation and giving her the courage to propose the fika. From the institutional perspective, the whole situation in An almost perfect trip might be unproblematic, since the requirement of the dentist appointment was fulfilled. One explanation for this logic could be that the staff is immersed in the traditional understanding of care, in which procedures have a given order, sequence, and structure.

It is then not easy to make space to the resident and her emerged logic. In the second exemplar Seeking for a place for other life worlds , the fragmentation of everyday activities as a whole is striking. While understanding that routines are necessary to provide care services in a secure way, other types of situations and practices as sources of meaning are less addressed.

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Furthermore, the exemplar Seeking for a place for other life worlds could be understood as threatening the resident's identity, due to limited influence and ownership over her everyday life. The findings of our study show that this deeper meaning of everyday activities could remain invisible to the staff representing the institutional routines. It can be argued that Catherine's experience of attempting to suggest a fika might set a precedent for future similar situations. By assuming that, she cannot make spontaneous attempts and she might be embodying the institutional order and giving up on her hope to influence everyday practices.

In this sense, there is a risk that she could progressively give up a sense of ownership and sovereignty Frank, of her everyday life activities. In the second case, the risk is the invisibility of other life worlds. Frailty and dependency are central conditions to be acknowledged in this context of a NH. In this sense, frailty adopts a new character, as a demand for responsive and ethical engagement.

This engagement is seen as responsive in the meaning that is aligned with the limitations and resources of older adults. It is ethical in the sense that acknowledges the relevance of activities in this phase of life and context. By saying this, she recognizes the institutional routines and that her request is out of the ordinary, and might cause trouble. This highly embodied awareness of the place, the NH culture, and its dynamic does not inhibit her from asking for an exception to the rule. She relies on the nurse assistant's responsive action that will help her to relieve her pain.

As exemplified above, frailty becomes a demand for engagement and this will require a certain degree of readiness among the staff to read, assess, and act on a given situation. These will need an appreciation of the potential of emergent situations, a logic of engagement by acting beyond the routines. This lack of cues could be seen as a call for further help.

What can I do here? Would you explain this to me? Could you guide me through it? This could be seen then as another dimension of frailty, of reaching out for dialogue and connection enacted by the residents. Existential issues at risk of passing by unseen could gain a time and a place, through engagement. Embracing these openings provided by frailty in everyday activities could eventually help to deflect traditional power positions enacted in NHs.

Such approach toward the residents would require profound philosophical and practical changes in the institutional culture of care of frail older adults. These dilemmas can be seen as being understood and accepted to different degrees by all parties involved as follows: management staff, significant others, and even the residents. Furthermore, these dilemmas could be seen as showing what is missing in the culture of care, the need for attention toward everyday life as whole for older adults.

The presentation of the findings in complementing exemplars may be untraditional; however, this choice was made based on the assumption that human experiences are often complex and intertwined Frank, However, even if the presented exemplars are local, it does not mean their significance is local. Our findings suggest that everyday life activities in the context of a NH have an amplified meaning and pivotal role and could be considered a chance for responsive and ethical engagement. Influencing everyday activities in a nursing home setting: A call for ethical and responsive engagement.

Nurs Inq. The copyright line for this article was changed on 30 July after original online publication. National Center for Biotechnology Information , U.

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Nursing Inquiry. Published online Aug 1. Author information Article notes Copyright and License information Disclaimer. Margarita Mondaca, Email: es. Corresponding author. Email: es. Accepted Jun Abstract This study focuses on influence that older adults, living in nursing homes, have over everyday activities.

Revisiting the concept of frailty Frailty is an important condition to relate to in everyday practices in NHs. The main research questions are as follows: How do frail older adults exert influence in everyday activities in a nursing home setting? Study design Epistemologically, this study is situated in a hermeneutic tradition Kinsella, Research context This study was conducted in an urban area of Sweden. Data analysis Data were analyzed guided by a narrative method grounded in Polkinghorne Ethical considerations Ethical approval was obtained from the local ethical committee in Stockholm prior to data collection.

Findings The findings of this study are presented as a set of exemplars. Limitations of the study The presentation of the findings in complementing exemplars may be untraditional; however, this choice was made based on the assumption that human experiences are often complex and intertwined Frank, Notes 1 Craquelures: comes from the world of art and has as such particular aspects, cracked texture. Social and democratic participation in residential settings for older people: Realities and aspirations. Health Expectations , 18 6 , — Journal of Aging Studies , 23 1 , 37— Pioneering partnerships: Resident involvement from multiple perspectives.

Journal of Aging Studies , 27 4 , — Nursing Inquiry , 23 2 , — Thriving in nursing homes in Norway: Contributing aspects described by residents. International Journal of Nursing Studies , 43 6 , — The significance of peer relationships to thriving in nursing homes. Journal of Clinical Nursing , 17 10 , — Frailty: An emerging research and clinical paradigm—Issues and controversies.

Nursing Inquiry , 22 1 , 64— Journal of Aging Studies , 31 , 45— On autonomy and participation in rehabilitation. Disability and Rehabilitation , 24 18 , — Theorizing accommodation in supportive home care for older people. Journal of Aging Studies , 27 1 , 30— Perspectives on care at home for older people.

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Scandinavian Journal of Occupational Therapy , 14 2 , 96— Narrative methodology: A tool to access unfolding and situated meaning in occupation In Nayar S. New York and London: Routledge. A multidisciplinary systematic literature review on frailty. The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context. Jr, Inui T. Qualitative Research , 3 1 , 35— Hermeneutics and critical hermeneutics: Exploring possibilities within the art of interpretation. Dementia reconsidered: The person comes first.

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