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Chapter 7 Discussion
possessions rather than to a “homely” atmosphere. This may account for why
some of the residents personalised their bed spaces with their personal
possessions. Cook (2010) adds that personalised objects can be useful aids for
communicating with residents with cognitive impairment. The concept analysis
revealed that a homely atmosphere is a consequence of resident autonomy.
The documentary analysis revealed that the majority of the residents did not have
a personalised care plan even though Davies, Laker and Ellis (1997) have
suggested that individualised assessment and care planning underpins the
realisation of autonomy.The interviews and observations revealed that a
resident’s autonomy can be affected by the level of personalised daily life they
experience. In other words, how the resident spends their day and whether or not
it is according to their wishes and hobbies. All participants felt that the residents
were not experiencing enough meaningful activity and that this was prohibiting
their autonomy. Cook (2010) refers to the “social death” in residential care
whereby meaningful activity for the resident is not facilitated. The observations
revealed long periods during the day when nothing really happened for the
residents. Staff expressed their dismay at not being able to take residents out or
to do activities with them due to time constraints. Residents expressed apathy
and loss at no longer being able to do the things they enjoyed doing at home.
Similarly, Armstrong-Esther et al. (1989) observed in their study that staff did
not engage in any social activities with residents at any time and Erlander,
Drechler and Wallin Pearson (1993) found that residents may have little choice
over daily activities that are of importance to them unless the staff attach a
similar degree of importance to a particular activity. An emergent theme from
this study was also about recreational activity and its importance for resident
autonomy. Hofland (1994) added that people with dementia also require age
appropriate activities. Higgs et al. (1998) found that respondents felt isolated or
lonely and felt that they had nothing to do all day but sit around. This study
affirmed this and one resident commented that every day is the same.
Nolan et al. (1995) found that many patients continue to spend most of their time
inactive. They further add that nurses do not perceive providing activity as a
legitimate part of their role. Observations from this study would support this