Exploring Oral Medication Administration From the Perspective of Older People in Scottish Care Homes: A Hermeneutic Phenomenological Study

Abstract

Introduction Older people in care homes experience multi-factorial problems when being given oral medication. Practices of modifying tablets, crushing and mixing with food, in attempts to administer medication, remain widespread globally. Care home routines are time-pressured, and there are incidences of disempowering practices and language associated with processes of medication administration. Evidence in this field reveals very little from the residents’ experience, representing this group as passive recipients of medication. Objective The aim of this research was to explore, for the first time, the experience of residents of care homes for older people at the point of receiving support from care staff to take medication. Methods Observation of medication administration and semi-structured interviews were conducted in Scotland with eight residents between the ages of 84 and 95 living in three care homes, therefore including a perspective and a participant group often neglected in research. Data was analyzed in accordance with a philosophy of hermeneutic phenomenology, with a commitment to understanding the participants’ experience. Results Three major themes emerged from the data: “being in control/relinquishing control,” “being comfortable in routine,” and “trusting.” Interpretive exploration of these themes revealed the importance of facilitating individual routines when taking medication, and that a trusting relationship with staff can be an indicator of vulnerability. Conclusion 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.