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Chapter 7 Discussion
persons. McCormack (2001) supports this in his discussion of staff members
trying to get the balance between “doing for, doing to and enabling self-doing”.
This research also revealed that there was a difference between espoused care
and actual care in relation to the resident person’s ability to make decisions. The
interview participants recognised the rights of the resident to self-determine, self-
govern and self-rule but analysis of the residents’ sets of documents revealed that
only 40% of notes had documented evidence of residents being self-governing,
self-ruling and self-determining and 60% of sets of documentation showed no
evidence of this element of resident autonomy. Langer (1983) suggests that older
persons perceive that they lack ability to exercise control over their lives but
Scott et al. (2003) argue that suffering an illness or having limited personal
capacity should not automatically affect older people when making decisions
concerning their health. They further state that autonomous actions result from
autonomous decisions and thus autonomy applies to both decisions and actions.
Hofland (1994) states that decisional incapacity on some dimensions does not
mean decisional incapacity on all dimensions. Thus the capacity to make a
decision is decision-specific and while an older person may not have the
independence or capacity to make all decisions, they may in fact be capable of
making some decisions, thus contributing to their autonomy. It is suggested that
enablement of decision-specific capacity promotes resident autonomy. In
contrast, in a study by Scott et al. (2003) it was reported that there were
significant differences in the perceptions of patients and nursing staff regarding
opportunities for patients to make decisions regarding their daily care. A much
higher percentage of nursing staff always, frequently or occasionally offered
decision-making opportunities to patients, than patients reported being offered
such opportunities. In this study recognising the resident as a person with rights
to self-determine and with capacity to do so was not evident from the
documentary analysis. Residents expressed that on the one hand they needed
staff but on the other they felt too protected. Staff expressed the challenges they
have with trying to facilitate decision-making and with “getting the work done”.
The observations revealed that in some cases, mostly with the more independent
residents, they were observed to self-govern, self-rule and self-determine. At
times nurses and care staff were observed encouraging residents to do things for