Seeking exemptions from nursing home routines: Residents' everyday influence attempts and institutional order

Using ethnographic data collected from a Swedish nursing home, this article analyzes residents' everyday or subtle influence attempts relative to the maintenance of institutional routines. Residents' efforts to carve out some autonomy or fulfill personal preferences in everyday matters could be categorized as (1) disruptions, (2) disturbances, or (3) “good matches” relative to ongoing and up-coming nursing home routines. Striking disruptions were often fruitless, while attempts rendered as disturbances were typically postponed or modified. In general, the outcomes of residents' maneuvers were shaped by brief and situational negotiations of whether (and how) temporary exemptions from the institutional order were deemed accountable or not by the staff. Although the staff sometimes arranged situations in which residents were given some defined or symbolic decision-making authority, the findings of this study show how an inflexible local routine culture can constitute a constraining and only occasionally porous framework for residents' self constructions and everyday life.