Conflict between Respect for Autonomy and Care: A Grounded Theory Study on Action Strategies to Care for People with Physical Disabilities

People with physical disabilities (PWD) are a large population group in Germany. Due to functional limitations of the body, they may be dependent on nursing assistance. PWDs’ wishes for assistance can be expressed verbally to nurses. However, these wishes do not always match what nurses want to happen. As a result, nursing care and the autonomy of PWDs can be critically opposed to each other. Thirteen problem-centered interviews were conducted with nurses on the care of PWDs. According to Strauss and Corbin (2010), analysis was conducted using grounded theory. When caring for PWDs, nurses may be confronted with wishes and needs they cannot or do not want to fulfill. As a result, they experience a conflict between care and respect for autonomy. Nurses critically assess these situations, including professional, ethical, and legal-organizational aspects. They interact with PWDs as well as colleagues to manage the conflict. Positive outcomes result in the conflict being resolved; negative outcomes result in nurses stopping care. Ambivalence also exists, which is characterized by tensions in further care. Nurses want to support PWDs, enable participation, and promote independence. They want to feel comfortable with their decisions. Therefore, they weigh carefully whether wishes for nursing assistance are realized or denied. Decision coaching can be a new task for academic nurses to enable PWDs to make health-promoting decisions for themselves.