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Chapter 6 Phase Two
one were now more evident in the residents sets of documentation (Table 6.4).
Negotiated care had the most significant increase with a 61% improvement while
evidence that residents could delegate their care needs improved by 74%. These
attributes were now documented in the “Daily life – promotion of choice”
domain and the “Personal care” domain. Residents past, present and future
interests, life histories and social activities were now being documented in the
“Social participation” domain. Promotion of resident capacity was encouraged by
commencing each care plan domain with a positive statement of the residents’
abilities. Non-paternalistic language was now evident, residents first names were
used in the care plans and the goals were all agreed goals, care was planned as
“doing with” rather than “doing to”.
Table 6.4: Documentary evidence of resident autonomy: Before and after
phase 2 action research
Element of Resident
Autonomy
1. Self-governing, self-ruling,
self-determining.
2. Care plans negotiated.
Family involved.
3. Residents delegate care
needs. Staff promote resident
capacity.
4. Values and beliefs of staff
are non-paternalistic. Ethos
of maintaining dignity.
5. An atmosphere of
openness, motivation and
flexibility.
6. Open and respectful
communication. Sharing
information.
7. Recognition of past and
present life which may shape
residents wishes. Life
histories.
Before After
40% evident 55% evident
13% 74%
24% 98%
22% 87%
22% 66%
9% 58%
64% 69%
In addition one of the empirical referents from the concept analysis of autonomy
for older people in residential care is: “Observation of residents expressing their
wants, needs, wishes and desires. Evidence that staff strive to meets these needs.
Evidence of family involvement. Recognition of the residents past and present
life, which may shape their wishes. Care plans to reflect this” and hence it