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2.4.3 Section Summary
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Chapter 2: Literature Review
This section revealed that there has been very little research undertaken that has
specifically explored and examined autonomy for older people in residential care.
The few studies that were conducted were small in scale and recommended further
research. There were, however, suggestions that nurses are a central and important
element in the realisation of resident autonomy and that they sometimes use
strategies that ultimately override the older person’s autonomy. Further research is
required that will gather perspectives of autonomy from residents, healthcare staff
and family members in order to contribute further to our understanding of what
resident autonomy is or is not, and whether or not we can operationalise it in
residential care.
2.5 Summary of the Literature Review
This literature review revealed three main areas related to autonomy for older people
in residential care: definitions and determinants of autonomy, residential care
research literature, and autonomy for older people research literature.
The first part of the review revealed that the lack of a clear, concise definition of
autonomy for older people in residential care has been a major contributing factor to
the lack of operationalisation of the concept and the lack of studies relating to it.
Operationalising a concept means developing the concept from the abstract to the
concrete and practical, thus enabling practitioners to realise it in the clinical setting.
Several researchers have agreed that this “operationalisation” of resident autonomy
(a working definition) has yet to be developed and tested in practice (Rodgers and
Neville, 2007; Randers and Mattiasson, 2004; Hewitt-Taylor, 2003; Lothian and
Philip, 2001; Aveyard, 2000; Davies, Ellis and Laker, 2000). As early as 1994,
Hofland suggested that “much work needs to be done - and must be done” on
enhancing residents’ experiences of autonomy in residential care. More recently,
Boyle (2008) agrees that personal autonomy for older people in residential care still
needs to be fully considered for future research.
The second part of the review revealed that there are numerous factors that impact
upon older people’s autonomy in residential care. One main factor identified in the