Improving Quality of Life for Older People in Long-Stay Care ...

was that they had a choice. In some study sites staff were able to facilitate residentchoice while others, which appeared to have similar staff resources and facilities,could not. Observation within the sites indicated that some sites were fully committedto the organisational change required to facilitate choice and others were not.In some places, what Kane (2001) refers to as the ‘unshakable routines of theorganisation’ militates against the expression of personal autonomy. The tensionbetween routine and personalised care was evident in all of the study sites.Some residents reported that they felt at ‘home’ in residential care and that theywere able to continue to live their life as normal. The experience of residents wholived in facilities where routine dominated was very different. They felt constrainedby the ‘rules’ and feared being considered a ‘troublemaker’. Best practice wouldsuggest that residents’ lives should be as similar as possible to the lives they wouldchoose to live at home. Quality care requires the collection of prior informationon residents’ normal routines and preferences. Residents need to be asked abouttheir likes and dislikes. Collecting this information is mere tokenism, however,unless greater flexibility is built into the routine to enable residents’ choices to bemet. This should include extending dining times, meeting bathing preferences andaccommodating preferred times of rising and going to bed.It would seem, therefore, that one of the most significant factors to impact on aresident’s quality of life is the care philosophy of the unit in which they live. Thisdictates the general approach to care, staff attitudes, care priorities and residentautonomy. It, therefore, has a tangible impact on residents’ quality of life. In somefacilities residents felt empowered, whereas in others residents appeared powerlessand constrained. The current trend in gerontological nursing is a move to a moreperson-centred service. A person-centred service is one which is based on consultation,autonomy, choice, individual care and resident involvement in decision-making(McCormack, 2003; Clarke et al., 2003; Davies et al., 1999). If the services are tobecome more person-centred, it is important that these concepts drive the philosophyof facilities and steps are taken to embed these concepts into the way in whichcare is delivered. The findings of this research would suggest that a move toperson-centred care will require a fundamental shift in the way in which servicesare managed and delivered. The international literature would suggest that thenurse manager is key to making this shift; many studies have found that the nursemanager has a powerful role in shaping the philosophy of the facility/unit and inleading change (Wright and McCormack, 2001; Redfern et al., 2002; Kitson, 1991).Management training and continuing education for staff should focus on developingan understanding of quality of life issues and putting in place person-centredmodels of care within facilities. All staff need to prioritise quality of life objectivesif they are to provide good quality of care for residents.219