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Chapter 7 Discussion
Rodgers and Neville (2007) remind us that older people enter residential care
with a lifetime of culturally embedded individual experiences and coping
strategies, and that these experiences influence their decision-making and desire
for autonomy in residential care. Hofland (1994) reminds us that people with
dementia also have a past and a life history, and it is knowledge of this aspect of
their personhood that enables us to facilitate their present autonomy.
Furthermore, the concept analysis of autonomy for older people in residential
care also delineated the importance of knowing the past life of the resident with
cognitive impairment in order to plan for their present needs. All of the staff
participants in this study spoke about their difficulties with communicating and
understanding the needs of residents with cognitive impairment. It is suggested
in the literature that this can be overcome by getting to know who the person was
in their past and how that might shape their current wishes and desires (Cook,
2010; Rodgers and Neville, 2007; Clarke, Hanson and Ross, 2003; Clifford,
1999;; Hofland, 1994; Agich, 1990).
In person-to-person communication and interaction another person who is
integral to maintenance of a resident’s autonomy is the family person and how
they interact with staff. Lynn-McHale and Deatrick (2000) discuss the
importance of residents’ families building trusting relationships with care
providers in order to help them to get to know the resident. Robinson (1994)
suggests that family involvement in nursing homes serves to individualise care
and to provide a continuing link to the residents personal history and preferences,
and may ultimately influence quality of life for residents. Family involvement in
care planning has been advocated by numerous authors (Hertzberg and Ekman,
2000Ryan and Scullion, 2000; Duncan and Morgan, 1994; Robinson, 1994;
Ekman and Norberg, 1988). Swagerty, Lee and Smith (2005) reported that family
members provide important support to residents and to care planning. Hertzberg
and Ekman (2000) suggested that family involvement in nursing homes serves to
individualise care and provide a link between the residents’ personal history and
preferences. Relatives in this study also expressed that it is of utmost importance
for their care preferences or requests fo their family member to be taken
seriously.