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Chapter 2: Literature Review
information about the biography or life story of the resident, which should be utilised
to enhance resident autonomy. It was reported that routine and task-based care
impact negatively on residents’ autonomy. An approach to care that recognises the
importance of decision-making was suggested to be key to partnership, sharing
power and ultimately enhancing residents’ autonomy and quality of life. Autonomy
was recognised as an integral ingredient in providing person-centred care, and
person-centred care is viewed as essential to achievement of quality of life. Knowing
the person is key to person-centred care and this involves knowing the older person’s
needs, wants, values and history thus leading to the development of a negotiated life
plan. Positive staff attitudes were associated with the type of care experienced. It was
suggested that staff attitudes may be positively influenced by education. There was
no consensus on whether or not the work environment influences attitudes. The next
section of this literature review will analyse the research studies that have
specifically examined autonomy for older people.
2.4 Autonomy for Older People
Very little research has been undertaken that has specifically examined and explored
autonomy for older people. Some studies have examined the issues that impact upon
the operationalisation of autonomy (Persson and Wasterfors, 2008; Solum, Slettebo
and Hauge, 2008; Scott et al., 2003; Proot et al., 2002; Davies, Ellis and Laker,
2000; Davies et al., 1999) while one study investigated how autonomy and
participation in residential care can lead to an enhanced quality of life (Barkay and
Tabak, 2002). It is suggested that knowledge of the issues that impact upon the
operationalisation of autonomy contributes to our understanding of what autonomy
actually is.
2.4.1 The Operationalisation of Autonomy
Some researchers suggest that nurses adopt “strategies” or practices that may
positively or negatively impact upon an older person’s autonomy (Slettebo and
Haugen-Bunch, 2004; Davies, Ellis and Laker, 2000) and often find themselves
ethically challenged between enabling autonomy and giving what they believe is “the
best type of care” (Scott et al., 2003; Solum, Slettebo and Hauge, 2008). It has also
been suggested that there is a link between the educational preparation of nurses and