Impaired autonomy--the challenge of caring

The aim of this paper is to present an informed argument in favour of changing power relationships between learning disability nurses and their clients and to do so through an examination of the influence that they have on quality of life issues for people whose autonomy is impaired. The challenge of empowerment and enhanced autonomy is considered to be at the 'cutting edge' of the learning-disability agenda with its increasing focus on the provision of supported living opportunities for clients in the community. Features related to institutional methods of care delivery continue to exist in some services and as a result clients may still be expected to conform to the dominant themes of time, order, control and regimentation. The application of social and environmental engineering techniques to the field of learning disability care is prerequisite for the development of more positive alternatives to the mental-handicap hospital as a focus for care provision. The main requirement for persons whose autonomy is impaired will be the promotion of equal power sharing between clients and carer. This process will involve a number of transactional considerations such as advocacy, risk taking and shared action planning. The emergence of a new paradigm for nursing practice will result in the solution for shifting the balance of power in the emergent world of consumerism for clients whose autonomy is impaired.