Autonomy in nursing homes: Viewpoints of residents with physical impairments and staff

Introduction: Although the importance of maintaining autonomy for nursing home residents is recognised, little is known about this process in daily practice. Aim: The aim was to explore how residents maintain autonomy and how staff acts in relation to the autonomy of residents. Method: Shadowing, a non-participative observational method, including a short interview at the end, was used. Seventeen residents with physical impairments living in two different nursing homes were shadowed in their own environment during daily activities. Moreover, fifteen staff members, working in the same nursing homes, were shadowed. Field notes of the shadowing were typed out and the recorded interviews were transcribed verbatim resulting in a report per respondent. These were coded and thematically analysed. Results: Residents maintained autonomy by; ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. Four activities of staff were identified; ‚getting to know each older adult as a person and responding to her/his needs‘, ‚encouraging an older adult to self-care‘, ‚stimulating an older adult to make choices‘ and ‚being aware of interactions‘. Discussion and Conclusion: Maintaining autonomy requires effort from both residents and staff. Although most residents with physical impairments experience restrictions in their autonomy because of the care-environment they live in, residents seemed to maintain autonomy in daily life. Moreover, staff consider it important to strengthen the autonomy of residents and use different activities to enhance autonomy. Relevance for research and practice: These insights help to improve autonomy of nursing home residents because the perspectives of both residents and staff are included. Therefore, the next step is to transfer th