Autonomy in Assisted Living: Employees’ Perspectives

Nursing support for older people's autonomy in residential care: An integrative review

“…Based on our findings, nurses recognised that dignity created a basis for older people's autonomy (Bentwich et al, 2018a; Boisaubin et al, 2007) and they referred to the right of individuals to make their own decisions (Chan & Pang, 2007; Zhai & Qiu, 2007). In addition, autonomy was connected to residents being able to enjoy their freedom (Chan & Pang, 2007) and independence (Oakes & Sheehan, 2012). Enabling autonomy meant that older people were treated with respect in residential care (Bentwich et al, 2018a; Bentwich et al, 2018b; Boisaubin et al, 2007; Chan & Pang, 2007; Zhai & Qiu, 2007).…”

“…However, some nurses said that older people's autonomy could also increase their workload. For example, if a person with incontinence did not have to wear continence aids, the professionals had to deal with the consequences, including soiled clothes and furniture and the unpleasant smell (Oakes & Sheehan, 2012).…”

“…Nurses recognised that older people had the right to make their own decisions (Barmon et al, 2017; Boisaubin et al, 2007; Chan & Pang, 2007; Oakes & Sheehan, 2012; Zhai & Qiu, 2007), as long as they were cognitively and mentally competent to do so (Boisaubin et al, 2007; Chan & Pang, 2007; Whitler, 1996). This was because older people had the rights and responsibilities to make their own decisions (Barmon et al, 2017; Chan & Pang, 2007; Zhai & Qiu, 2007), and they also had the right to have a good quality of life.…”

“…Nurses also reported that advance directives had failed to acknowledge family members' wishes or the duty of professionals to take care of older people when that care contradicted their wishes (Chan & Pang, 2007). Respecting older people's needs and wishes was a balancing act between the residents' health and their safety (Evans et al, 2018; Klaassens & Meijering, 2015) and independence (Evans et al, 2018; Oakes & Sheehan, 2012). Meeting the needs of one person was time‐consuming, and it could stop them from meeting the needs of other residents.…”

“…In addition, nurses acknowledged that they had to disregard some of the older people's wishes in order to meet their families' expectations (Barmon et al, 2017; Chan & Pang, 2007; Dreyer et al, 2010). This could lead to nurses pressuring older people to follow the wishes of their families (Barmon et al, 2017; Oakes & Sheehan, 2012; Solum et al, 2008)…”