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Analysis of Key Decision-Making Incidents in the Life of a Nursing Home Resident

^a University of Kentucky College of Nursing, Lexington
^b Department of Geography, Behavioral Science, and Nursing; PhD Program in Gerontology; and Sanders-Brown Center on Aging, University of Kentucky, Lexington
^c Department of Philosophy, University of Kentucky, Lexington

Correspondence: Celeste Shawler, RN,, University of Kentucky College of Nursing, Room 501G, 800 Rose Street, Lexington, KY 40536-0232. E-mail: mcshaw0{at}pop.uky.edu.

Decision Editor: Laurence G. Branch, PhD

Purpose: This study examined change in the decision-making autonomy of a single nursing facility resident. Design and Methods: This case analysis was part of a larger 3-year ethnographic investigation of decision-making events in four nursing facilities. In this case analysis, the resident, her daughter, and three staff members closely associated with the resident's care were each interviewed five times over a 15-month period. Results: Analysis of interview transcripts revealed four themes in decision making. Temporal change was evident in a complex scenario regarding room changes. Spatial context reflected the need for predictability and adaptability in decisions using space. Interdependence of decisions and decision makers was most evident with medical treatment and health care decisions. Awareness, being informed, and knowing what was going on was the final theme. Implications: Despite having the best interests of the resident in mind, the process of decision making in nursing facilities may contribute to a pattern of gradual withdrawal of decisional autonomy from residents regardless of their ability to make decisions.

Key Words: Long-term care • Case study • Decision making • Progressive surrogacy

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