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Supporting autonomy in long-term care: Lessons from nursing assistants.

Lindsey Jacobs M, Lynn Snow A, Allen RS, Hartmann CW, Dautovich N, Parmelee PA. Supporting autonomy in long-term care: Lessons from nursing assistants. Geriatric nursing (New York, N.Y.). 2019 Mar 1; 40(2):129-137.

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Maximizing nursing home (NH) resident autonomy is a person-centered care (PCC) best practice. The purpose of this study was to identify and describe specific autonomy-supportive techniques used by nursing assistants (NAs) in three NH neighborhoods at one Veterans Affairs medical center. Thirteen interviews and approximately 80 h of behavioral observation of NAs were conducted across the three NH neighborhoods. Data were analyzed using thematic analysis. Ten autonomy-supportive tactics were identified: assisting, monitoring, encouraging, bargaining, informing, providing instructions, persuading, asking, providing options, and redirecting. Although all tactics honored some degree of resident autonomy, some were more restrictive than others. Results from the study elucidate specific actions NAs can take to promote resident autonomy, even when cognitive or physical limitations are present or there is potential concern for safety, and thereby support PCC best practice.

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