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Chapter 7 Discussion
colleagues would think they weren’t “working” if they sat talking to residents.
Observations further revealed that staff often missed opportunities to
communicate with residents, particularly very dependent or cognitively impaired
residents, and that at times they spoke to each other when providing care rather
than to the resident. Similarly, Patterson (1995) observed that nurses did not
engage in chit-chat with residents but did spend their free time talking amongst
themselves. Staff participants in the interviews for this study explained that they
communicate with the resident as they get to know them over time and that this
informs them of the resident’s care preferences. However, there was little or no
evidence of this in the residents’ sets of documentation. Hence phase two of this
research aimed at enhancing this element of autonomy. In this study one nurse
participant spoke about the value of listening to residents. Tuckett (2005)
suggests that speaking with and listening to residents is the only way to facilitate
autonomous decision-making and that socially isolating environments and lack
of interpersonal relationships can hinder residents’ autonomy. Tuckett (2005)
also suggests that residential care homes are inadequate sites for communication
and decision-making. Nolan (1997), Davies et al. (1999), Nolan et al. (2001,
2002, 2004) and Cook (2010) all suggest that person-to-person interaction is
essential for a successful relationship between the healthcare professional and the
older person. This successful relationship subsequently leads to resident
autonomy as their care can be discussed and negotiated together with the
healthcare professional.
The Health Advisory Service (1998) reported that negative interactions between
patients and staff could be exacerbated by other pressures such as poor physical
environments, workload, staff shortages and lack of basic equipment. Reflection
excerpts from this research study describe the staff shortage problems during the
research project, and staff spoke about their frustration at not having the time to
interact with the residents. Resident interviews made reference to the little time
that staff seemed to have for them and to the constant rushing and hurrying,
which prevented meaningful interaction and communication from person to
person. The description of the research unit’s physical environment and the floor
plan (Appendix 13) also reveal that there was very little physical space for one-