Balansen mellan rättighet och risk - En kvalitativ studie om boendepersonals förhållningssätt till självbestämmande och skydd i arbetet med personer med intellektuell funktionsnedsättning

Abstract

The purpose of this study was to get a deeper understanding of how staff working in residential care for people with intellectual disabilities reflect on their action strategies in situations where service users right to self-determination may come into conflict with the staff´s desire to protect the service user from harm. The theoretical framework is based on the theory of relational autonomy, aiming to analyze how self-determination is applied as well contributed and/or constrained in daily practice and in the relationship between staff and service users. The theory of street-level bureaucracy, discretion and types of actions aims to analyze how staffs’ actions and decision-making are motivated and shaped by the opportunities and limitations of work. A qualitative design was used as the methodological approach. Data were collected through six semi-structured interviews where the participants consisted of three support assistants and three support pedagogues working in four different city districts in Västra Götaland, Sweden. Data were analyzed using a thematic analysis method, after which statements of interest were categorized into different themes. The findings indicate a complex balancing act between respecting service users’ self-determination and ensuring their well-being, sometimes resulting in the need to deviate from promoting full self-determination to protect service users from potential harm. In challenging situations staff reported facing difficult ethical dilemmas where some chose to respect the users´ right to self-determination and instead find alternative solutions, such as building trusting relationships or encouraging support, while others took action to ensure service users' safety. Staff highlighted the importance of peer support, routines and experience-based knowledge for managing difficult situations.