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Chapter 7 Discussion
in older age. Alabaster (2006) stated that care that denies older people of their
own histories excludes them from autonomous participation. McCormack (2006)
suggests that life histories can capture the essence of many experiences over time
that are truly authentic and invaluable in understanding the person for whom we
care. Clarke, Hanson and Ross (2003) and Cook (2010) state that in order for
practitioners to learn more about the patient as an individual they must take the
biographical (life history) approach to care planning. Taking the biographical
approach enables the practitioner to see behind the “mask” of ageing, illness or
disability (Clarke, Hanson and Ross, 2003). In phase one of this study one
resident stated that staff “don’t think of me as a person” and felt that it was only
his disability that was cared for. Clifford (1999) describes life histories as useful
in social assessment for understanding how individuals could be understood by
others who may have different historical and social circumstances. Bartol (1989)
proposed that listening to a person’s life story is a powerful way of showing that
they are valued as an individual. This approach is viewed as a low-cost
intervention that can be incorporated into everyday care activities, thus
improving the quality of life of residents and the self-esteem of health workers
(Pietrukowicz and Johnson, 1991). It is viewed as useful for assessing the older
person, in communicating with the older person, and in completing the care
planning process (Clarke, Hanson and Ross, 2003). Staff in this study expressed
their dismay at knowing very little about some of the residents’ past lives and
how this made caring for their wishes difficult, especially when the resident
could not communicate themselves. Phase two planned to address this in order to
enhance the residents’ autonomy.
Many years ago Agich (1990) called for a refurbished concrete concept of
autonomy which would systematically attend to the history and development of
persons. “We need to learn how to acknowledge their habits and identifications
(Agich, 1990: 12). Yet more recently, Pearson and Peels’ (2009) review revealed
that most papers published are expert opinion papers rather than papers reporting
change initiatives, interventions, or examples of how to acknowledge residents’
habits and identifications, and we still have research that reports that residents
feel staff do not know them or communicate with them as “persons” rather they
treat them as “patients”.