How is autonomy promoted in care home settings from entry to the end of life?

Abstract

Background: Autonomy and empowerment of residents are important considerations in the study of end of life care, particularly in a care home setting. Person centred care suggests that residents should be involved in their own care at the end of life, however there is little known on how self-efficacy and empowerment are promoted in care homes. The aim of the current study is to investigate how staff, working in nursing and residential care homes conceptualise and promote autonomy among residents from entry into care homes to the end of life. Methods: Face to face, in-depth, semi structured interviews were conducted with 22 care home staff from 2 nursing and 2 residential care homes. The data were analysed using Thematic Analysis. Findings: Participants’ understanding and implementation of resident’s autonomy differed according to their level of professional training and peer experiences. At the point of entry into a care home, staff felt that residents experienced a lack of control and their primary task was to help residents regain control of their own care. This enabled staff to learn about resident’s values, beliefs and preferences, which facilitated personalised care in the later stages of life. In contrast, residents who were approaching the end of the life were required to relinquish control and staff’s primary responsibility was to cater to the resident’s basic needs. Conclusions: While working in vulnerable settings, staff struggle to find a balance between promoting personal autonomy and relinquishing control from residents to provide quality end of life care.