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’ condition...

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Bibliographic Details
Published in:Clinical nursing research 2000-11, Vol.9 (4), p.460-478
Main Authors: Proot, Ireen M., Crebolder, Harry F.J.M., Abu-Saad, Huda Huijer, Macor, Ton H.G.M., Meulen, Ruud H. J. Ter
Format: Article
Language:English
Subjects:
Activities of Daily Living
Aged
Aged, 80 and over
Attitude of Health Personnel
Attitude to Health
Autonomy
Facilitation
Female
Health Facility Environment - standards
Humans
Internal-External Control
Life Change Events
Male
Middle Aged
Models, Psychological
Needs Assessment
Netherlands
Nursing
Nursing homes
Nursing Homes - standards
Nursing Methodology Research
Patient Admission
Patient Care Team - standards
Patient Education as Topic - standards
Patients
Personal Autonomy
Quality of Health Care
Rehabilitation
Self Care - methods
Self Care - psychology
Social Support
Stroke - physiopathology
Stroke - psychology
Stroke Rehabilitation
Strokes
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Summary: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.
ISSN:1054-7738
1552-3799
DOI:10.1177/10547730022158690