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Chapter 7 Discussion
themselves. However, they were also observed bringing residents back to bed
without consultation. Freedom to move around and outside of the research unit
was limited to those who could do so independently.
Davies, Laker and Ellis (1997) state that even making small day-to-day decisions
can impact greatly on the residents’ sense of control and autonomy. Persson and
Wasterfors (2009) state that residents often have restricted opportunities to make
decisions about everyday matters. This study found that some staff and family
participants felt that confused residents or residents with dementia were
incapable of making decisions and that only those who were “compos mentis”
should be consulted. The majority of participants spoke about the restricted
number of choices available to the residents for decision-making, but yet staff
did not recognise that they could take a more active part in changing those
options. Gaventa’s (1980) model of power suggests that if there is a shift in the
power relations then a challenge occurs: there must be a loss of power by A or a
gain of power by B for a change to occur; B must take some steps to overcome
his powerlessness. A can interfere with B’s plans, can interfere with B obtaining
resources and developing abilities, and can incite against the opening up of
issues. This study suggests that staff need to be more proactive about resident
autonomy and reflect upon what is within their power to change in order to
enhance that autonomy. Phase two of this research demonstrated how staff can
promote resident autonomy by working together to bring about changes that can
enhance resident decision-making through negotiated care planning.
Family participants spoke about their desire for the residents to have more
choices. The literature suggests that family members do want to be involved in
planning care and making decisions about their relatives (Hertzberg and Ekman,
2000; Ryan and Scullion, 2000). However, this research also found that some
family members expressed a level of apathy and disbelief that the residents were
capable of doing more for themselves, if the choices were made available. Phase
two of this research commenced the process of including family members in care
planning for their relatives in order to enhance their autonomy.