Nursing home contrasts: A critical discussion on harnessing reflection for dignified change

The capacity of healthcare personnel to promote well-being and dignity among nursing home residents remains a topic of ongoing discourse. This critical discussion extends from a previously published research project on healthcare leadership. The results revealed that healthcare middle managers' perceived lack of resources, trust, and collaboration hindered their capability for quality improvement. Our concern was reinforced when relatives expressed a willingness to accept undignified care due to resource constraints. In this discussion paper, we add to existing knowledge by critically discussing how nursing home relatives and managers share experiences and face the consequences of negotiating human dignity as both a fundamental right and moral obligation. Galvin and Todres's existential theoretical framework is applied to understand dignified care and to reveal contrasts and overlaps within academic and public discourse. We argue that resource-limited healthcare, which generates undignified care, creates cross-pressure of suffering for relatives and managers. If both groups are incapacitated by this cross-pressure, knowledge mobilization and practice improvement stagnate. However, integrating measures into organizational quality systems to promote critical reflection among both groups as a tool for quality improvement may offer potential dignified change.