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7.3.1 Being Personal: Being Impersonal
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Chapter 7 Discussion
The concept analysis of resident autonomy suggests that residential care should
be flexible and non-routine in order to promote resident autonomy. Historically,
gerontological nursing was recognised as being largely about routine, and was
associated with work of a heavy nature that focused on “getting the work done”
(Norton et al., 1962). Miller (1994) suggested that healthcare staff contribute to
this by imposing routinised systems of work upon older people, thus creating a
culture of “getting the work done”. The interview participants in this study
concurred and spoke at length about the routine, and some indicated that it was
certain members of staff who enforced and drove the routine. Higgs et al. (1998)
concluded from their study of 377 nursing home residents and 291 patients on
long-stay geriatric wards that the difference between nursing homes and hospital
wards in terms of their institutionalising capacities is not as profound as policy-
makers believe.
Hooks and Roberts (2007) found that staffing levels tend to dictate the routine of
the day. Similar to this study, staffing levels were considerably higher in the
morning, thus reducing the scope to negotiate evening care delivery with the
residents. Foucault’s power theory refers to “governmentality”, which refers to
the processes that individuals and groups use to assert power. Whether or not one
accepts the institution’s routines or not reflects whether or not they are willing to
be passive about their governmentality. Tuckett (2005) described older persons
passively accepting ward routines and according to Brown, McWilliam and
Ward-Griffin (2006), nurses tend to enact their status as “professional
expert”within the hierarchical medical structure that continues to dominate health
care. The expert approach allocates more power to nurses and less to clients. This
was also reflected in this study where residents spoke about “falling into line”
and staff talked about residents adapting to the routines.
Tuckett (2005) reported that a residential care worker described their work as
“production line nursing” where work practices and culture take precedence over
the residents’ individual needs. This ultimately prohibits resident autonomy.
They reported that staff felt “time-starved” due to staff shortages. This was also
reflected in this study whereby a family participant compared the care approach