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Chapter 2: Literature Review
the level of autonomy that older people experience (Davies, Ellis and Laker, 2000;
Davies et al., 1999), and that the healthcare physical environment may constrain
autonomy (Proot et al., 2002).
One study observed the practice of nurses who had at least six months’ experience of
working with older people (Davies, Ellis and Laker, 2000). Adopting a qualitative
design, the researchers purposively recruited 30 nurses whom they observed in
practice. Their aim was to evaluate the outcomes of educational programmes for the
nursing care of older people and to contribute to a greater understanding of resident
autonomy. The complete data set analysed included field notes from 87 observational
periods (more than 270 hours) and from more than 1,000 separate care events. The
analysis involved simple thematic content analysis. The researchers found from this
robust study that there was a wide variation in the extent to which individual nurses
implement strategies for promoting autonomy and independence for older people.
Several strategies were revealed, including negotiating care, informing older people,
encouraging physical independence, recognising individuality and personhood,
avoiding controlling language, being alert to cues, and promoting individualised care.
The researchers provided examples of how these strategies were observed positively
and negatively in practice. They recommended that nurse educators should consider
practical examples of ways in which the broad aims of promoting autonomy and
independence for older people could be realised in practice, which would in turn
reduce the strategies or practices that contribute negatively to older people’s
realisation of their autonomy. The researchers also recommended that further
research needs to be undertaken that would yield a more precise definition of
autonomy and independence for older people.
Similarly, Slettebo and Haugen-Bunch (2004) suggested that nurses use several
strategies to solve ethically difficult care situations, and in particular those related to
autonomy. Using a qualitative comparative design and a grounded theory approach
the researchers conducted interviews and observations. The aim was to investigate
how nurses apply strategies to resolve ethical dilemmas such as preserving
autonomy, integrity and self-respect. Fourteen semi-structured interviews were
conducted with nurses. Two (three-hour) observations over an eight-week period
were also conducted on four wards. Data analysis was guided by Glaser and Strauss