Enhancing autonomy for older people in residential care: what factors affect it?

Abstract

As the population ages, the expectations of consumers rise and future care provision for older people will demand that autonomy is operationalised in residential care facilities. This paper looks at international publications related to identifying the factors which facilitate or hinder residents autonomy and directs the reader to reflect on their own custom and practice. There are many factors which both facilitate and hinder the level of autonomy which older people experience in residential care. This paper will discuss the three most pertinent factors that are discussed repeatedly in the literature, and they are as follows: the organisations approach to care, person-centred care and life planning.

Person‐directed care planning in nursing homes: A scoping review

“…Rodgers, Welford, Murphy, and Frauenlob (2012) emphasised the need for meaningful options in daily living. Simmons et al (2011, p. 867) contend that nursing home residents’ autonomy supports well‐being: “[N]ursing homes that elicit and honour resident choices help to foster residents’ sense of autonomy and… their sense of well‐being.…”

“…Specific things that service providers are encouraged to know include the individual's health status and prognosis (Gestuvo, 2012), his/her goals, preferences, needs, values, and priorities, particularly as these pertain to daily life (Haitsma, et al, 2014; Rodgers et al, 2012). Their personal histories, significant life stories, social networks (Boyd, McNabney, & Brandt, 2012), and what he or she believes will help promote recovery or optimise well‐being should also be considered (Frazee, 2011).…”

“…To ensure that care plans remain aligned with the needs and preferences of individuals with disabilities, Sanderson (2013) suggests that practitioners must regularly ask individuals what is working and what is not working. With a focus on older people in residential care, Rodgers et al (2012) emphasise that individuals change across the life cycle, which reinforces the importance of regularly checking with them to inform care plan updates. The iterative nature of PDCP mirrors that of adaptive leadership; according to Bailey et al (2012, p. 7): “Adaptive leadership is fundamentally a non‐linear, iterative, reciprocal interaction between the health care practitioner and the patient.”…”

Norwegian Nurse Managers’ Perceptions of Ethical Conflicts in Community Healthcare When Caring for Older Persons Who Wish to Die

“…The word "autonomy" comes from the Greek words "autos" meaning "self" and "nomos" meaning "rule", which can be translated into the term "self-rule" [47]. The concept can thus be seen as exercising individual choice, freedom, free will and assuming responsibility for one's own behaviour and/or self [46]. Autonomy can refer to what makes a life one's own based on personal preferences and choices [48].…”

“…Ethical conflict can also occur when nurse managers have used force or pressure in response to a situation. Autonomy is central to the notion of independence [46]. The word "autonomy" comes from the Greek words "autos" meaning "self" and "nomos" meaning "rule", which can be translated into the term "self-rule" [47].…”