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Chapter 2: Literature Review
teamwork, attentiveness/respect, giving information, assessment/training, enhancing
patient choice, co-operation with family/patient, and risk-taking. They also identified
one constraining factor, which is “institutionalisation” created by care providers.
They conclude that autonomy is not static and changes over time, thus reiterating the
work of Agich (1993).
In summary, while not all of these studies were conducted in residential care units,
there are some identified factors that impact upon the operationalisation of older
people’s autonomy in healthcare environments. These include factors related to the
physical environment, factors related to the patient’s pre- and post-illness personality
and lifestyle, and factors related to the strategies nurses use in their practice.
2.4.2 Autonomy and Quality of Life
One small Israeli study by Barkay and Tabak (2002) specifically investigated the
importance of the concept of autonomy among older people in residential care. The
aim of the research was to describe and evaluate the degree of autonomy,
participation and well-being of frail old residents. For the purpose of this study,
autonomy was defined as “a set of values, related to a person’s natural right to
autonomously choose among several possibilities; that is, a right within their
independent personality, motivated by ambition and choice” (Barkay and Tabak,
2002: 199). The study was conducted in two wards. Thirty-nine residents completed
a questionnaire that was designed for the study. The questionnaire contained eight
items that examined the residents’ degree of autonomy and was completed by the
researchers in collaboration with the residents. The analysis focused on clarifying a
correlation between autonomy and well-being. The study revealed that autonomy has
a positive influence on residents’ social functioning and that a high level of
autonomy has a positive influence on satisfaction and quality of life. There was a
significant correlation between autonomy and participation and encouragement to
participate. There was also a significant correlation between autonomy and friends’
visits. The researchers concluded that the degree of autonomy a resident is given is
pertinent to their quality of their life. The small sample size in one healthcare setting
is a limitation of this study. The questionnaire takes three hours to complete and this
would be of concern if the study was to be replicated on a larger scale, as this is both
time consuming for the researchers and may also be tiring for the participants.