This article reports findings from a three-year project on ‘Communication patterns and their consequences for effective care’ that explored communication in dementia-care settings. As the proportion of people with dementia living in British care-homes continues to grow, there is a need to understand better their care. Using a range of qualitative methods, the project set out to identify the constituent elements of dementia-care practice and the patterns that characterise day-to-day relations in care homes. The tightly prescribed and standardised nature of the interactions between staff and residents is described: it raises questions about the capacity for dementia care to be truly person-centred. The project found that people with dementia are both capable of communication, and invest much effort in seeking to engage those around them, but are excluded from the monitoring, planning and provision of care in ways that we argue are discriminatory. The case is made for promoting and supporting communication as key skills and competencies for care workers. The value of measuring the level and quality of communication as a means to evaluate care is demonstrated. The authors question the priorities that currently guide care practice and argue that we need to listen to people with dementia and rethink what lies at the heart of dementia care.
Little is known about the experiences of people with dementia, as there has been relatively little research carried out that includes their perspectives. In the past, user perspectives on experiences of dementia and on services have mostly been solicited from family carers, rather than from people with dementia themselves. It has been suggested that these studies may lack information and insight into the experiences of people with dementia. This study aimed at eliciting the views and feelings of people in all stages of dementia, as well as those of their relatives, on care services and on experiences of dementia. Twenty-seven people with dementia from residential and day care settings were interviewed and their daily lives videotaped. Interviews were also conducted with next of kin. This article reports on findings and issues arising from the study.
This article explores descriptions of the sexuality and sexual expression of people with dementia residing in care. It is argued that accounts offered by care workers are mediated by their own perspectives and interests. Data from the study, alongside a review of existing research findings, suggest that gender has a crucial influence upon the interpretation and response to sexual expression in care settings. Interviews with care staff revealed that such expression is often deemed problematic. Factors maintaining the invisibility of the homosexual population in care are also discussed. It is concluded that there exists a need for greater consultation with residents regarding sexuality and for an exploration of the range of sexualities in care.
This article offers a critical account of the ethical issues arising from the conduct of a research project investigating communication with and between people who have a dementia. These issues are examined with the background knowledge that there are no legal precedents to guide ethical procedures when carrying out research with this client group. Yet, if such research were not undertaken, there would be no opportunity to empirically evaluate present communication and care, or to recommend alternatives to this care. To address this situation, this article outlines a protocol for addressing a variety of ethical considerations. Finally, a working model of ethical procedures when undertaking research with people who have a dementia is presented. It is recognized that this is a dynamic process and will change over time. However, a starting point is needed to begin the process of accounting for ethical issues when undertaking research with this vulnerable group.
The community service order has been in operation for over a decade. In the course of time the order has seen considerable praise and success. But there have been problems too. In this brief paper, the author summarises the major problems that have been identified in the period and calls for afresh review of the purpose and content of community service. He then selects what he regards to be the most pressing issues that need to be addressed by administrators and policymakers and suggests what possible changes could be introduced to improve matters further.
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