Nudging in the nursing home: A qualitative interpretive study.

Background: Nudging involves deliberately changing the environment or context to induce better choices. Several studies consider such methods unethical manipulation that threatens the principles of informed consent and autonomy, which are particularly vital in healthcare. Others argue that nudging respects personal freedom because it is not in conflict with the person's explicit values or choices, beneficial, and easy to resist. Additionally, studies argue that such strategies are legitimate as they can prevent more intrusive forms of paternalism. Given the increasing prevalence of soft paternalism through nudging, there is a need to examine its use in healthcare.

Objective: This study explored the phenomenon of nudging in a nursing home context.

Design: A qualitative interpretive design informed by Gadamer's hermeneutics was employed.

Setting: Three distinct nursing home units in Norway, including long-term, dementia, and rehabilitation units. The study was conducted between December 7. 2019 and July 2. 2020.

Participants: Individuals involved in the units during the observation period.

Methods: Seven to eight weeks of observations, followed by interviews with caregivers (nurses and auxiliary nurses), two occupational therapists, and two physiotherapists.

Results: The results suggest that nudging in this context can be understood across three themes: modification of physical surroundings, information and interaction, and ambiguous interventions.

Conclusions: Nudging is being used in nursing homes to guide residents' choices and behaviors to foster their well-being and uphold social norms. However, caregivers are also navigating the use of diverse forms of influence, including subtle nudging and assertive persuasion, and must consider complex factors.

Registration Number: REK - Regional ethics committee case number 175774Sikt - Norwegian Agency for Shared Services in Education and Research case number 248550.

Social Media Abstract: Experienced caregivers in nursing homes effectively use nudging to guide care routines, resulting in efficient care and better interactions.