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Chapter 7 Discussion
adequate time for planning needed to be allocated (Coghlan and McAuliffe,
2003). It was found that there were changes that could be made to promote and
enhance resident autonomy that are not over-reliant on resources.
Persson and Wasterfors (2009) add that staff struggle to enable resident
autonomy when there are fixed impersonal schedules such as meal times. Staff in
this study referred to the day as “structured”. It was also stated by Persson and
Wasterfors (2009) that residents are allowed to exercise influence only as long as
it does not conflict with the efficient running of the institution as a whole. In
theory residents could make decisions, but in reality this was often not the case.
For example, it was stated that residents could choose what time to go to bed, but
there were limits placed on the number of residents who could still be up when
the night staff came on duty. Similar observations were noted in this study and
many residents were put back to bed early in the afternoon as this was the
“routine”.
Many researchers agree that in order for autonomy to be realised there must be a
degree of flexibility in the approach to caregiving (McCormack et al., 2008;
Faulkner and Davies, 2006; Hofland, 1994; Agich, 1990; Collopy, 1988).
Rodgers and Neville (2007) explain that diminished autonomy is experienced
when an individual is controlled by others, as is often the case when communal
interests are involved; hence impersonal organisational needs are privileged over
the rights of the individual. Barkay and Tabak (2002) also state that the degree of
institutional flexibility affects one’s autonomy and ultimately one’s quality of
life, and Scott et al. (2003) suggest external constraints have a direct impact on
the exercise of autonomy. Persson and Wasterfors (2009) explain that staff often
find themselves “between a rock and a hard place” when they try to balance
efficiency and standards of care with honouring autonomy. Staff in this study
referred to this as “not working in a factory….working with people” and
described the challenges of trying to reduce the “rushing” culture in order to
promote resident autonomy.
Organisational needs such as reducing staffing levels may impact on the overall
atmosphere of a residential unit and reduce staff willingness to invest time and