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Chapter 7 Discussion
often allowed routine to dominate their work. Therefore it is recommended that
staff working in residential care receive training and education focused on the
development of skills which can be used to engage the resident in order to
negotiate care and encourage resident autonomy. Phase two of this research
demonstrated how resident centred care planning can enhance resident
autonomy. The initial step in this process was care planning education. Equipped
with this knowledge there was subsequent exploration of care planning
approaches that can facilitate residents autonomy by taking account of their
needs and wishes.
The findings from this study also reported that residents often felt that staff did
not know them as a “person” therefore it is recommended that nurse education
programmes should focus on developing nurses skills so that they can undertake
biographical care planning. These include a range of interpersonal skills such as
listening, communicating verbally and non-verbally and being approachable to
family members.
The concept analysis of autonomy for older people in residential care revealed
that residents with reduced capacity should be facilitated to delegate the actions
of their decisions. This research also reported links between residents physical
ability to perform tasks independently and the level of autonomy they
experienced. It is therefore recommended that practitioners strive at all times to
facilitate residents to delegate their wishes appropriately. For example, if a
resident wishes to go to the dining room but cannot physically walk there
themselves then staff would ensure that the resident has the opportunity to ask
them for assistance. The documentary analysis in phase one of this research
found that while the staff had documented the residents level of independence-
dependence they did not provide any detail about what they can and can’t do
without assistance and therefore what they may wish to delegate. It is
recommended that all practitioners should use positive care plan statements about
what residents can do for themselves and subsequent to that they should detail
what assistance has been agreed. For example: Mary will comb her own hair if
she is given her hair brush and Mary is in agreement of assistance from one
person for the remainder of her personal care needs. For phase two the care plan