Working Together to Enhance Autonomy: A Participatory Action Research Among Residents and Staff in a Nursing Home

Abstract

Care in nursing homes is evolving from a medical to a person-centered orientation. Principles such as participation and autonomy are seen as the basis for person-centered care to live life as a resident prefers. However, often decisions are made for and about the resident by others, which might hinder autonomy. How can a more person-centered way of caring be achieved at the level of the unit with a focus on autonomy and participation? Participative action research (PAR) has promising elements to bring about a change. The aim of this study is to enhance autonomy in day to day practice, with a PAR approach. This led to the following research question: what processes between residents and staff in the participative action research enabled the enhancing of autonomy on the unit level? An action group consisting of residents and staff in one unit of a nursing home identified, undertook, and evaluated actions to enhance residents’ autonomy. The generated data were analyzed with the critical creative hermeneutic analysis. In total, eight themes to describe the process were found. Although there was no evidence that the actions undertaken during the PAR directly led to enhanced autonomy, the learning process and the collaboration of residents and staff is promising. It is recommended to include residents and staff as partners in actions to enhance autonomy in the nursing home. The PAR process worked well for this objective. However, participants’ physical conditions should be considered when choosing working methods. Creative work forms are not always appropriate for the population targeted.