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Chapter 7 Discussion
energy into making changes to practice. The concept analysis indicated that
atmosphere is important for resident autonomy. Phase two of this research
encountered this when the progress of the planned change was slow due to
staffing shortages and low staff morale. Impersonal external factors such as the
national staffing embargo impacted negatively on the research unit. A creative
organisational climate has been shown to support patient autonomy (Mattiasson
and Andersson, 1995) but in the early days of phase two the climate both
nationally and in the research unit was strained. Furthermore, associations
between job satisfaction and work environment have been made (Lovgren,
Rasmussen and Engstrom, 2002) and thus it became paramount to nurture the
staff and support them during such a difficult time. It was at this point that the
researcher commenced the critical companionship approach to the
implementation of the intervention and began to spend more time on the research
unit. The staff participants in the interviews spoke about not feeling appreciated
or valued, and expressed their dismay at the way the unit was staffed and
managed. Flynn and McCarthy (2007) suggest that Irish hospitals need to take
greater focus on valuing the nurses currently employed and that greater
uniformity would perhaps contribute to higher staff retention rates. The concept
analysis for resident autonomy revealed that staff retention was important. Flynn
and McCarthy (2007) also suggest that Irish hospitals would benefit from
adopting the USA “Magnet hospitals” approach. Magnet hospitals are defined as
organisations able to attract and retain a staff of well-qualified nurses and
therefore consistently able to provide quality care. Magnet hospitals focus on the
leadership attributes of nursing administration along with the professional
attributes of staff nurses, whilst maintaining an environment that supports
professional practice. It is important to realise and understand the impersonal
factors in order for resident autonomy to be promoted and enhanced.
7.3.2 Being Personal: Being Personalised
In this study it was found that personalised care is essential for resident
autonomy. Observations revealed that some residents had personalised their bed
space with family photos, etc. However, space was limited and thus the
opportunity to personalise their space was also limited. Higgs et al. (1998)
suggest that an older person’s “attachment” is to their home and their personal