Power and autonomy in the nursing home

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dc.contributor Allen, Rebecca S.
dc.contributor Parmelee, Patricia A.
dc.contributor Hartmann, Christine
dc.contributor Dautovich, Natalie D.
dc.contributor Hamilton, James C.
dc.contributor.advisor Snow, Andrea Lynn
dc.contributor.author Jacobs, Mary Lindsey
dc.date.accessioned 2017-03-01T17:11:45Z
dc.date.available 2017-03-01T17:11:45Z
dc.date.issued 2014
dc.identifier.other u0015_0000001_0001720
dc.identifier.other Jacobs_alatus_0004D_12088
dc.identifier.uri https://ir.ua.edu/handle/123456789/2169
dc.description Electronic Thesis or Dissertation
dc.description.abstract As with all organizations, nursing homes have an internal hierarchy that guides decision-making practices and policies. Nursing assistants (NAs) are positioned at the bottom of the hierarchy. They are generally the last nursing home employees to be solicited for input regarding practices and the last to learn about mandated policies created by upper level management. Consequently, they have the most limited amount of power compared to other staff. The one group of people that is impacted by all levels of the hierarchy and generally positioned at the bottom of all power relations in long-term care is nursing home residents. Residents' daily life is directly influenced by nursing policies and practices, staff shortages, staff's ability to provide timely care, and staff's opinions about what type of care residents should receive. This dissertation is a compilation of three publishable manuscripts that describe the balance of power and hierarchy within the nursing home. Data were collected through observations and interviews with NAs in long-term care settings at one Veterans Affairs Medical Center (VAMC). All data were analyzed using grounded theory. Nursing homes are slowly shifting from a paternalistic medical model to a biopsychosocial model of care that promotes quality of life and autonomy. Unfortunately, the current conceptualizations of autonomy are not appropriate for long-term care settings. Without a cohesive framework for autonomy in long-term care, nursing home staff are apt to continue their approach to daily care consistent with a paternalistic, medical model of care. Therefore, the aim of the first paper is to present an applied conceptual framework for "everyday autonomy" in the nursing home. Additionally, a decisional framework is presented to assist NAs in determining what degree of resident autonomy to support. Within the framework of everyday autonomy, NAs are challenged to explore ways to support resident autonomy. The purpose of the second paper is to describe how NAs can support resident autonomy in long-term care. Through observations and interviews with NAs, ten autonomy-supportive approaches were identified. Suggestions for future research are presented. Several barriers to successful recruitment emerged during this study. The purposes of the final paper presented in this dissertation are to describe my recruitment process in detail, present challenges to recruitment, and reflect on the strengths and weaknesses of my recruitment strategies. Additionally, I summarize the characteristics of NAs in relation to power and hypothesize links between these characteristics and barriers to recruitment of the NA population. Finally, I propose possible strategies for effective recruitment of NAs for research in long-term care settings.
dc.format.extent 94 p.
dc.format.medium electronic
dc.format.mimetype application/pdf
dc.language English
dc.language.iso en_US
dc.publisher University of Alabama Libraries
dc.relation.ispartof The University of Alabama Electronic Theses and Dissertations
dc.relation.ispartof The University of Alabama Libraries Digital Collections
dc.relation.hasversion born digital
dc.rights All rights reserved by the author unless otherwise indicated.
dc.subject.other Ethics
dc.subject.other Gerontology
dc.title Power and autonomy in the nursing home
dc.type thesis
dc.type text
etdms.degree.department University of Alabama. Dept. of Psychology
etdms.degree.discipline Psychology
etdms.degree.grantor The University of Alabama
etdms.degree.level doctoral
etdms.degree.name Ph.D.


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