Balancing the safety and dignity equation: Developing a conceptual framework for resident, staff and data perspectives on adverse impacts in residential aged care

There is a growing awareness of the need to create residential care systems for older people that encompass strong safe environments and effective clinical care processes alongside attention to dignity and quality of life. Drawing on three studies: i) a scoping review of 46 published articles; ii) examination of 67,000 residential aged care incident reports, and iii) interviews with residents and staff, a mixed method approach was used to develop a conceptual framework for addressing adverse impacts in residential aged care. This paper considers the implications of the conceptual framework through examples such as falls and restrictive practices, in order to highlight the potential tension between safety and dignity of risk considerations. The literature review and incident report data demonstrated that residential aged care research and reporting systems primarily have a quantitative focus on physical injuries such as falls and the impact of behavioural driven outcomes. In contrast, the qualitative interviews highlighted the lived experiences of residents and revealed a desire for meaningful and dignified interactions. Staff insights covered the challenges faced working in a system set up for risk mitigation while striving to provide quality care and compassion. These aspects were brought together to create a conceptual framework which embraces the diversity of both the quantitative and qualitative perspectives. This conceptual framework demonstrates that future development of residential care systems will need to consider multi-faceted and often contradictory views to achieve care systems that better balance the equation of duty of care and dignity of risk.