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Mentalization in dementia care: an autoethnographic account of a project worker’s experiences
- Authors:
- LUXMOORE Bethany, McEVOY Phil
- Journal article citation:
- Working with Older People, 21(3), 2017, pp.147-156.
- Publisher:
- Emerald
Purpose: Mentalization is a psychodynamic concept that can help us to understand our emotional responses to others. The purpose of this paper to illustrate how the concept of mentalization may be applied in dementia care. Design/methodology/approach: An autoethnographic account of the author’s experiences (first author), working as a project manager in which the author used the concept of mentalization to pay close attention to how the author’s emotional responses to people with dementia influenced thier communicative interactions. Findings: This paper outlines how the author processed the author’s own internal experiences in both mentalizing and non-mentalizing modes, as the author wrestled with feelings of conscious incompetence. In the non-mentalizing mode, the author was pre-occupied with the author’s own anxieties. The author struggled to relate to or make sense of the experiences of the individuals with advanced dementia that the author engaged with. Moving towards a mentalizing stance helped the author to attune to the embodied experiences of the people with dementia and recognise the reciprocal nature of our communicative interactions. Originality/value: This paper illustrates the role that mentalization may play in developing natural and authentic strategies to support communicative engagement in dementia care. These strategies may be of potential value to family carers. Family carers who can maintain a mentalizing stance may be more able to respond in empathic, person- centred ways to people who are living with dementia. On the other hand, non-mentalizing responses may be a root cause of mis-understanding and emotional disengagement. (Publisher abstract)
A social work perspective on how ageist language, discourses and understandings negatively frame older people and why taking a critical social work stance is essential
- Author:
- DUFFY Francis
- Journal article citation:
- British Journal of Social Work, 47(7), 2017, pp.2068-2085.
- Publisher:
- Oxford University Press
As populations age around the globe, social workers will have more and more contact with older people, particularly in the practice fields of health care and social care services. Language and dominant discourses associated with older people and ageing in politics, in the media and other institutions are often underpinned by ageism and fail to convey accurate accounts and understandings of ageing issues. In response to how this pervasive ageism plays out in health care and social care services practice settings, this paper argues that all social workers urgently ought to move beyond conventional social work, which is most dominant in practice, and embrace more aspects of critical social work in relation to ageing societies and working with older people. This is necessary to identify, critique and challenge ill-informed and oppressive language, labels and discourses used to describe older people and explain ageing issues. Embedding gerontological social work as core learning in social work education is essential to social work achieving what is required to achieve these goals. (Publisher abstract)
Care to talk? A framework for appreciative conversations about dementia: Innovative practice
- Authors:
- PAGE Sean, ROWETT Roger, DAVIES-ABBOTT Ian
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 16(8), 2017, pp.1069-1074.
- Publisher:
- Sage
When people with dementia are admitted to hospital, both they and their carers and families have crucial roles to play. They should be positioned as the only true experts in the unique individuality of the person and brought into the nursing process as an equal partner in care. ‘Care to Talk’ is a conversational model developed through Appreciative Inquiry to facilitate this way of working. The model, its development and outcomes are discussed. (Publisher abstract)
Culture and language discordance in the workplace: evidence from the National Home Health Aide Survey
- Authors:
- WENG Suzie S., LANDES Scott D.
- Journal article citation:
- Gerontologist, 57(5), 2017, pp.900-909.
- Publisher:
- Oxford University Press
Purpose of the study: Home health aides (HHAs) provide valuable resources to address existing and predicted needs for taking care of the ageing population. Both the older adult and healthcare provider populations in the United States are becoming increasingly diverse. The study examined the effect of culture and language discordance between HHAs and their patients or coworkers on worker outcomes. Design and methods: Data from this study were from the 2007 National Home Health Aide Survey. T Tests and ordinary least squares regression were used to analyse the relationships between cultural discordance and worker outcomes. Results: Cultural discordance with patients was associated with lower levels of job satisfaction among HHAs. Cultural discordance with coworkers was associated with lower levels of job satisfaction and, increased intent to leave one’s job. Implications: The current study suggests that cultural discordance does affect worker outcomes. However, home healthcare workers appear to differentiate between cultural discordance with patients and with coworkers. This article concludes with strategies for all involved in the care of older adults to improve the experience of HHAs and to ensure patients receive the best possible care. (Edited publisher abstract)
Transitions from hospitals to skilled nursing facilities for persons with dementia: a challenging convergence of patient and system-level needs
- Authors:
- GILMORE-BYKOVSKYI Andrea L., et al
- Journal article citation:
- Gerontologist, 57(5), 2017, pp.867-879.
- Publisher:
- Oxford University Press
Purpose of the Study: To describe skilled nursing facility (SNF) nurses’ perspectives on the experiences and needs of persons with dementia (PwD) during hospital-to-SNF transitions and to identify factors related to the quality of these transitions. Design and Methods: Grounded dimensional analysis study using individual and focus group interviews with nurses (N = 40) from 11 SNFs. Results: Hospital-to-SNF transitions were largely described as distressing for PwD and their caregivers and dominated by dementia-related behavioural symptoms that were perceived as being purposely under-communicated by hospital personnel in discharge communications. SNF nurses described PwD as having unique transitional care needs, which primarily involved needing additional discharge pre-planning to enable preparation of a tailored behavioural/social care plan and physical environment prior to transfer. SNF nurses identified inaccurate/limited hospital discharge communication regarding behavioural symptoms, short discharge timeframes, and limited nursing control over SNF admission decisions as factors that contributed to poorer-quality transitions producing increased risk for resident harm, rehospitalisation, and negative resident/caregiver experiences. Engaged caregivers throughout the transition and the presence of high-quality discharge communication were identified as factors that improved the quality of transitions for PwD. Implications: Findings from this study provide important insight into factors that may influence transitional care quality during this highly vulnerable transition. Additional research is needed to explore the association between these factors and transitional care outcomes such as rehospitalisation and caregiver stress. Future work should also explore strategies to improve inter-setting communication and care coordination for PwD exhibiting challenging behavioural symptoms. (Edited publisher abstract)
What works: hearing loss and healthy ageing
- Author:
- NHS ENGLAND
- Publisher:
- NHS England
- Publication year:
- 2017
- Pagination:
- 28
- Place of publication:
- London
This guide provides information for commissioners and care providers to help support older people with hearing loss in addressing their hearing and communication challenges and retain their independence. It looks at impact of hearing loss on overall health and wellbeing of the individual, the economic impact to society and the impact on an individual's independence. It outlines the responsibilities of commissioners and providers in relation to the provision of care for older people with hearing loss and provides useful advice for care providers to promote effective hearing and communication. Short case studies include screening for hearing loss in hospitals and care homes and supporting the management of hearing loss in care homes. (Edited publisher abstract)
Home modifications among community-dwelling older adults: a closer look at race and ethnicity
- Authors:
- BAKK Louanne, et al
- Journal article citation:
- Journal of Gerontological Social Work, 60(5), 2017, pp.377-394.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study investigated racial and ethnic differences in home modification use. Data from the 2011 National Health and Aging Trends Study were used (n=6,764). Compared with non-Hispanic Whites, Hispanics were less likely to have a grab bar (odds ratio (OR) = 0.6), bath seat (OR = 0.8), or raised toilet (OR = 0.6). Non-Hispanic Blacks were less likely to have a grab bar (OR = 0.7) or bath seat (OR = 0.7) than non-Hispanic Whites, but more likely to have a raised toilet (OR = 1.3). English proficiency largely explained ethnic differences, while health status partially accounted for racial disparities. (Publisher abstract)
Making a difference: building positive relationships between care staff and residents. A guide for care home managers
- Authors:
- ALIVE, BRISTOL CITY COUNCIL
- Publisher:
- Alive
- Publication year:
- 2017
- Pagination:
- 8
- Place of publication:
- Bristol
This booklet provides care managers with an introduction to relationship-centred care and includes ideas for putting this into practice in a care home. These include ideas for motivating staff to engage with residents, personalising the care home environment to reflect residents' lives and interests, positive risk taking and connecting with the wider community. It is designed to accompany the guide for care staff, which offers practical ideas for helping staff to get to know residents better. (Edited publisher abstract)
Knowledge of dementia: do family members understand dementia as a terminal condition?
- Authors:
- ANDREWS Sharon, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 16(5), 2017, pp.556-575.
- Publisher:
- Sage
Current research identifies advanced dementia to be the terminal phase of this progressive and incurable condition. However, there has been relatively little investigation into how family members of people with advanced dementia understand their relative’s condition. In this article, the authors report on semi-structured interviews with 10 family members of people with advanced dementia, in a residential aged care facility. Using a qualitative, descriptive design, they explored family members’ understandings of dementia, whether they were aware that it was a terminal condition, and the ways they developed their understandings. Findings revealed that the majority of family members could not recognise the terminal nature of dementia. Relying on predominantly lay understandings, they had little access to formal information and most failed to conceptualise a connection between dementia and death. Moreover, family members engaged in limited dialogue with aged care staff about such issues, despite their relatives being in an advanced stage of the disease. Findings from our study suggest that how family members understand their relative’s condition requires greater attention. The development of staff/family partnerships that promote shared communication about dementia and dying may enhance family members’ understandings of the dementia trajectory and the types of decisions they may be faced with during the more advanced stages of the disease. (Edited publisher abstract)
Using simple technology to prompt multistep tasks in the home for people with dementia: an exploratory study comparing prompting formats
- Authors:
- BOYD Hazel C., et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 16(4), 2017, pp.424-442.
- Publisher:
- Sage
Objectives: To investigate the relative effectiveness of different prompts for people with dementia during multistep tasks in the home, to inform prompting technology design. Methods: Nine pairs of participants (one with dementia and a partner or relative) participated at home. The participants with mild to moderate dementia (5M/4F, aged 73–86 years) functioned at the Planned or Exploratory levels of the Pool Activity Level instrument. A touchscreen computer displayed different prompts during two set tasks: “card-and-envelope” and “CD player.” The trials were scored to establish the relative effectiveness of the prompts. Individual tasks were also explored. Results: Text and audio prompts were each more effective than video or picture prompts for a card-and-envelope task, but this was not seen in a CD player task. The differences may be related to the type of actions within the tasks; the card-and-envelope actions were easier to convey verbally; the CD player actions lent themselves to visual prompts. Conclusions: Designers of technology-based prompts for people with dementia should consider that the effectiveness of different prompts is likely to be task dependent. Familiar, unambiguous language can increase the success of tailored prompts. There are significant practical challenges associated with choosing and deconstructing everyday tasks at home. (Publisher abstract)