Older people's experiences of their free will in nursing homes

Older people in institutional care should be allowed to live a meaningful life in a home-like environment consistent with their own free will. Research on actualisation of older people's own free will in nursing home context is scarce.

The purpose of this study was to describe older people's experiences of free will, its actualisation, promoters and barriers in nursing homes to improve the ethical quality of care.

Fifteen cognitively intact older people over 65 years in four nursing homes in Southern Finland were interviewed. Giorgi's phenomenological method expanded by Perttula was used to analyse the data.

Chief administrators of each nursing home gave permission to conduct the study. Informants' written informed consent was gained.

Older people described free will as action consistent with their own mind, opportunity to determine own personal matters and holding on to their rights. Own free will was actualised in having control of bedtime, dressing, privacy and social life with relatives. Own free will was not actualised in receiving help when needed, having an impact on meals, hygiene, free movement, meaningful action and social life. Promoters included older people's attitudes, behaviour, health, physical functioning as well as nurses' ethical conduct. Barriers were nurses' unethical attitudes, institution rules, distracting behaviour of other residents, older people's attitudes, physical frailty and dependency.

Promoting factors of the actualisation of own free will need to be encouraged. Barriers can be influenced by educating nursing staff in client-orientated approach and influencing attitudes of both nurses and older people.

Results may benefit ethical education and promote the ethical quality of older people's care practice and management.