Perceptions of participation: how nursing home staff and managers perceive and strive for participation of older residents

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ABSTRACT User participation is increasingly emphasised in policies guiding social services. However, translating policy into practice is fraught with difficulties. The staff’s approaches to user participation are crucial for the users’ opportunities to participate in decision-making, particularly for users with extensive care needs and reduced autonomy. The aim of this article is to explore how nursing home staff and managers perceive the participation of older residents and what the implications are for residents’ involvement in decision-making in everyday life. Interviews and future workshops were carried out with staff and managers in two Swedish nursing homes. The analysis identified differing and partly conflicting perceptions of user participation that have different implications for the residents’ opportunities to be involved in decisions. The staff’s and managers’ approaches to participation ranged from encouraging independent decision-making to excluding the residents from decisions, depending on the situation and the assessment of residents’ abilities. In addition, the analyses showed that perceptions of participation are intertwined with perceptions of good care and with the staff’s and managers’ understandings of their mission and responsibilities. The findings indicate that increasing user participation in nursing homes requires organisational policies that clarify what user participation is and strategies for implementation in daily practice.