Congruence between nursing home resident and staff caregiver perceptions of residents' self-perceived autonomy

This qualitative cross-sectional study examines autonomy among long-term care residents and how certified nurse aides (CNAs) understand resident autonomy as expressed through residents' preferences. The study took place at one long-term care facility with N = 12 (7 residents and 5 CNAs). A phenomenological perspective is utilized in order to describe the meaning residents ascribe to personal preferences and the influence frailty has on those preferences. In addition, certified nurse aides, self-described as competent to report on a participating resident's preferences were interviewed separately. Open-ended interviews were conducted and the data obtained was examined for congruence between the resident's and CNA's perception of resident autonomy. Congruence and incongruence was examined as well within the individual resident interviews and within dyads.;Findings indicate that resident autonomy as expressed in resident preferences is subjective, complex, durable, fluid, and in some instances, a rigid phenomenon. Long-standing preferences can endure and new preferences can evolve. Resident frailty can influence resident preferences to change and in some instances, reinforce a preference. Resident preferences can evolve from care giving interactions between the resident and CNA. Findings also indicate that CNA perception or understanding of resident autonomy often involves an intuitive process and is subjective in nature. Implications for social work are discussed including interdisciplinary opportunities in long-term care for social work and the nursing profession.