Facilitating and constraining factors on autonomy: the views of stroke patients on admission into nursing homes.
This article describes a model changing autonomy which was developed in a grounded theory study among stroke patients on admission into nursing homes for rehabilitation. Three dimensions of autonomy were identified: self-determination, independence, and self-care. On admission, patients' conditions (disabilities, multimorbidity, emotional state, and feeling like a layperson) and patients' strategies (waiting and seeing, and acting as a subordinate) constrain autonomy. Several environmental factors facilitate patient autonomy. The nursing home sustains patient autonomy by providing a hopeful atmosphere and room for autonomy. The health professionals facilitate autonomy by giving therapy, support and information, attentiveness and respect, paternalism and teamwork, Facilitating strategies of the family encompass emotional and instrumental support Care routines, lack of privacy, an unfamiliar environment, waiting periods, boredom, and lack of information were identified as constraining environmental factors. Developing guidelines and multidisciplinary courses regarding the approach to patient autonomy on admission is recommended.
Proot
I M
IM
Institute for Bioethics, Maastricht, The Netherlands.
Crebolder
H F
HF
Abu-Saad
H H
HH
Macor
T H
TH
ter Meulen
R H
RH
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D006272:Health Facility Environment / Q000592:standards; D006801:Humans; D007389:Internal-External Control; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D020380:Needs Assessment; D009426:Netherlands; D009735:Nursing Homes / Q000592:standards*; D015404:Nursing Methodology Research; D010343:Patient Admission; D010348:Patient Care Team / Q000592:standards; D010353:Patient Education as Topic / Q000592:standards; D026684:Personal Autonomy; D011787:Quality of Health Care; D012648:Self Care / Q000379:methods / Q000523:psychology*; D012944:Social Support; D020521:Stroke / Q000503:physiopathology / Q000523:psychology*; D000071939:Stroke Rehabilitation