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Chapter 7 Discussion
to being like “a factory floor” and a resident spoke about the constant hurrying
and rushing of staff and their apparent lack of time to do anything other than
follow the routine. Tuckett (2005) argues that work practices and a culture that
prioritises “doing-for” over “being-with” cannot claim convincingly to be
meeting the needs of residents. The observations of this study reported many
missed opportunities for residents to do things for themselves due to the staff
members’ approach to care, and observations where staff talked over the
residents rather than spending time “being with” them.Fundamentally, Murphy
(2007) reported that lack of time, resistance to change and being bound by
routine ultimately affect a resident’s quality of life and Whitaker (2004) reported
that everyday life in nursing homes is controlled more by staff routines than by
residents’ needs. This was also found to be the case in this study, both from the
interview data and the observation data. Davies, Laker, and Ellis (1997) suggest
that one of the most effective actions nurses could take to promote greater
autonomy for patients would be to campaign for greater flexibility around the
provision of care. However, nurse participants in this study described a passivity
with trying to challenge the approaches to care. The overall feeling was one of
acceptance and frustration with the impersonal routines, the impersonal
environment and the impersonal staffing issues.
Interestingly, Whitaker (2004) described the nursing home environment as both a
place where older people are living the last days of their life and a workplace for
staff. The staff live in a hurried or pressed culture and the older people live in a
waiting or expecting culture. Whitaker (2004) states that these two cultures never
interact.Hodges’ model, which was used for phase two of this research,
recognises the interrelatedness of groups and individuals for the purposes,
practices, policies and processes that influence care. Alabaster (2006) suggested
that routine is determined by the organisation’s approach to care provision. If the
organisation provides impoverished environments and low staffing levels then it
reinforces routines and prohibits autonomy. Phase two of this study was
conducted at a time of national cuts to staffing levels. Hodges’ model recognises
that these political decisions can be an outside influence on care. Phase two
reflection excerpts describe the initial challenges of finding a way to implement a
change in practice during a time of reduced resources. Providing support and