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Chapter 7 Discussion
It was also important to analyse the demographic profile of the resident group in
order to judge whether or not the findings of this study could be compared with
other studies. Analysis revealed that the dependency figures for the resident
participants were comparable to national statistics for resident dependency in
long-stay residential care and that 50% of the residents were in the “maximum”
dependency category (“typical”). The literature suggests that an older person’s
level of independence or dependence can affect their ability to manage their
routine self-care (Blackwell’s Dictionary of Nursing, 2010; Boyle, 2008).
Decreasing independence is often a factor that leads to admission to residential
care, wherein barriers to residents’ autonomy and participation in self-care are
created (Scott-Peterson and Borell, 2004), therefore suggesting that resident
dependence is a prohibiting factor for resident autonomy. McCormack (2001)
and Nolan et al. (2004) suggest that autonomy which only recognises one’s level
of independence, such as functional independence, is “untenable”. However, this
research observed that residents with low Barthel scores (low levels of
independence) were also observed to exercise the least amount of autonomy.
Similarly, from the interview data, residents stated that “if you can walk you are
ok” and the analysis of the residents’ sets of documentation revealed that nurses
placed little or no emphasis on maximising residents’ independence or on
planning care based on the residents’ delegation of care if they were functionally
dependent.
Hanford et al. (1999) acknowledged that the promotion of independence and
autonomy for older people is a major policy driver but this research found that
the most dependent residents were least likely to experience autonomy over their
everyday lives. Hence this research found that there was a link between
residents’ functional independence and autonomy. The staff participants in this
study acknowledged that resident independence and autonomy are important, but
also talked about their difficulties with enabling autonomy when residents’
dependency increased. The interviews and observations supported this and found
that the resident person’s independence was considered to be a factor in whether
or not they experienced autonomy. It was suggested that the residents’ capacity
for independence is enhanced when it is encouraged and maintained by staff