Proot Ireen M, ter Meulen Ruud H J, Abu-Saad Huda Huijer, Crebolder Harry F J M
Department of Health Care Studies, Section of Health Ethics and Philosophy, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Nurs Ethics. 2007 Mar;14(2):229-41. doi: 10.1177/0969733007073705.
In a qualitative study, 22 stroke patients undergoing rehabilitation in three nursing homes were interviewed about constraints on and improvements in their autonomy and about approaches of health professionals regarding autonomy. The data were analysed using grounded theory, with a particular focus on the process of regaining autonomy. An approach by the health professionals that was responsive to changes in the patients' autonomy was found to be helpful for restoration of their autonomy. Two patterns in health professionals' approach appeared to be facilitatory: (1) from full support on admission through moderate support and supervision, to reduced supervision at discharge; and (2) from paternalism on admission through partial paternalism (regarding treatment) to shared decision making at discharge. The approach experienced by the patients did not always match their desires regarding their autonomy. Support and supervision were reduced over time, but paternalism was often continued too long. Additionally, the patients experienced a lack of information. Tailoring interventions to patients' progress in autonomy would stimulate their active participation in rehabilitation and in decision making, and would improve patients' preparation for autonomous living after discharge.
在一项定性研究中，对三家养老院中正在接受康复治疗的22名中风患者进行了访谈，内容涉及他们自主性的限制因素和改善情况，以及卫生专业人员关于自主性的处理方式。使用扎根理论对数据进行了分析，特别关注恢复自主性的过程。研究发现，卫生专业人员采用的对患者自主性变化做出反应的方法有助于恢复他们的自主性。卫生专业人员的方法中出现的两种模式似乎具有促进作用：（1）从入院时的全力支持，到适度支持和监督，再到出院时减少监督；（2）从入院时的家长式作风，到部分家长式作风（关于治疗），再到出院时的共同决策。患者所经历的处理方式并不总是符合他们对自身自主性的期望。支持和监督随着时间的推移而减少，但家长式作风往往持续时间过长。此外，患者还经历了信息不足的情况。根据患者自主性的进展调整干预措施，将刺激他们积极参与康复和决策，并将改善患者出院后自主生活的准备情况。
