Promoting autonomy and independence for older people within nursing practice: a literature review

Abstract

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.

Individualized Care in Practice: Communication Strategies of Nursing Aides and Residents in Nursing Homes

“…It may improve satisfaction with care in hospital settings (Suhonen, Valimaki, & Leino-Kilpi, 2005) and promote greater autonomy and independence for older people who need care (Davies, Laker, & Ellis, 1997;Flesner & Rantz, 2004). In long-term care settings, individualization has been used to improve the quality of care for individuals with severe dementia (Allen-Burge, Stevens, & Burgio, 1999;Hallberg & Norberg, 1993;Morgan & Stewart, 1997) and for individuals who need end-of-life care (Heyland et al, 2006).…”

Care work and quality of care for older people: a review of the research literature

“…11,18,21,22 Other studies have focused on factors closely related to management style and organizational climate. [23][24][25][26][27][28][29][30] Typical of these studies is Schaefer and Moos' 29 investigation of the effect of work stressors and work climate on job morale and functioning of staff in continuing-care settings for older people. They found that both specific work stressors and overall work climate have a significant impact on job morale and functioning.…”

A Declaration of Healthy Dependence: The Case of Home Care

“…Self-care equipment is typically said to empower care recipients, promote their autonomy and independence (Ellenbecker et al, 2008) -central concepts/aims within medicine and health care (Russel, 2007). In particular, measures to improve the quality of nursing care for elderly people are often motivated by independence (Davies et al, 1997). In-need persons are generally assumed to prefer self-care over traditional institutionalized care (Kenner, 2008).…”