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Facilitating and Constraining Factors on Autonomy

The Views of Stroke Patients on Admission Into Nursing Homes

Institute for Bioethics

Harry F.J.M. Crebolder

Huda Huijer Abu-Saad

Maastricht University

Ton H.G.M. Macor

Martinushof, Tegelen, the Netherlands

Ruud H. J. Ter Meulen

Institute for Bioethics and Maastricht University

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.

Clinical Nursing Research, Vol. 9, No. 4, 460-478 (2000)
DOI: 10.1177/10547730022158690


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