Supporting stroke patients' autonomy during rehabilitation.
In a qualitative study, 22 stroke patients undergoing rehabilitation in three nursing homes were interviewed about constraints on and improvements in their autonomy and about approaches of health professionals regarding autonomy. The data were analysed using grounded theory, with a particular focus on the process of regaining autonomy. An approach by the health professionals that was responsive to changes in the patients' autonomy was found to be helpful for restoration of their autonomy. Two patterns in health professionals' approach appeared to be facilitatory: (1) from full support on admission through moderate support and supervision, to reduced supervision at discharge; and (2) from paternalism on admission through partial paternalism (regarding treatment) to shared decision making at discharge. The approach experienced by the patients did not always match their desires regarding their autonomy. Support and supervision were reduced over time, but paternalism was often continued too long. Additionally, the patients experienced a lack of information. Tailoring interventions to patients' progress in autonomy would stimulate their active participation in rehabilitation and in decision making, and would improve patients' preparation for autonomous living after discharge.
Proot
Ireen M
IM
Department of Health Care Studies, Section of Health Ethics and Philosophy, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. i.proot@zw.unimaas.nl
ter Meulen
Ruud H J
RH
Abu-Saad
Huda Huijer
HH
Crebolder
Harry F J M
HF
D000203:Activities of Daily Living; D006801:Humans; D009723:Nurse-Patient Relations; D009735:Nursing Homes; D026684:Personal Autonomy; D012648:Self Care; D020521:Stroke / Q000451:nursing; D000071939:Stroke Rehabilitation