Analysis of key decision-making incidents in the life of a nursing home resident.
OBJECTIVE
This study examined change in the decision-making autonomy of a single nursing facility resident.


METHODS
This case analysis was part of a larger 3-year ethnographic investigation of decision-making events in four nursing facilities. In this case analysis, the resident, her daughter, and three staff members closely associated with the resident's care were each interviewed five times over a 15-month period.


RESULTS
Analysis of interview transcripts revealed four themes in decision making. Temporal change was evident in a complex scenario regarding room changes. Spatial context reflected the need for predictability and adaptability in decisions using space. Interdependence of decisions and decision makers was most evident with medical treatment and health care decisions. Awareness, being informed, and knowing what was going on was the final theme.


CONCLUSIONS
Despite having the best interests of the resident in mind, the process of decision making in nursing facilities may contribute to a pattern of gradual withdrawal of decisional autonomy from residents regardless of their ability to make decisions.
Shawler
C
C
University of Kentucky College of Nursing, Lexington 40536-0232, USA. mcshaw0@pop.uky.edu
Rowles
G D
GD
High
D M
DM
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over / Q000523:psychology*; D001364:Awareness; D003071:Cognition; D003657:Decision Making; D005260:Female; D006707:Homes for the Aged / Q000592:standards; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007407:Interviews as Topic; D008137:Longitudinal Studies; D009735:Nursing Homes / Q000592:standards; D028701:Patient Rights; D010550:Personal Space