Perspectives of decision making in a UK care home: a grounded theory study

Wood, Julia (2012) Perspectives of decision making in a UK care home: a grounded theory study. (PhD thesis), Kingston University.

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Abstract

Older people resident in care homes are amongst the most vulnerable and dependent in any society. This study aimed to explore perspectives on decision making in a care home in the United Kingdom (UK), considering the appropriateness of who made the decisions, how and under what authority. It used grounded theory methodology in a case study framework, in a single care home. Field work was conducted between December 2009 and January 2011 in an inner metropolitan area. Participants were twenty one residents, eight relatives, five registered nurses and six care workers. Data were collected using; interviews; informal conversations; observation and examination of documentation. Participants' perspectives were considered through a values based lens with emphasis on autonomy and dignity as the most dominant in policy, ethical discourse, professional and empirical literature. Findings were constructed from systemic analysis of the data. Two central phenomena were identified, resident as decision maker and others decide for resident. Decisions were categorised into three types, everyday, infrequent and advance decisions. Each group of participants viewed different decision types as most important. Staff appeared to have little knowledge of policy and law and notably, they appeared not to consider mental capacity in relation to decision making, nor did they demonstrate recognition of the ethical dilemmas they faced. All participants found it difficult to articulate values underpinning decision making. Despite staff accepting that residents were able to make decisions and had a right to do so, residents' preferences were not always respected. There was a tension between staff's desire to offer choice, the need to minimise risk and provide good care within the constraints of the organisation with a finite number of staff. If operationalised, the value of solidarity could help relieve the tension and potential dissonance experienced by actors in the care home under study and similar care home environments. Solidarity promised mutuality and reciprocity which would allow all actors to be recognised and valued, ultimately benefiting the residents' quality of life.

Item Type: Thesis (PhD)
Physical Location: This item is held in stock at Kingston University library.
Research Area: Allied health professions and studies
Faculty, School or Research Centre: Faculty of Health and Social Care Sciences (until 2013)
Depositing User: Katrina Clifford
Date Deposited: 25 Apr 2013 10:09
Last Modified: 25 Apr 2013 10:09
URI: http://eprints.kingston.ac.uk/id/eprint/24603

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