Aim: The aim of this study was to understand volition in people with moderate dementia. The study provided an in-depth description and analysis of volition in eight older people in a memory-support assisted living unit.Method: Guiding questions focused on understanding past life interests, demonstration of volition, volitional continuity, and the relationship among the social environment, volition and daily occupations. Data collection included participant observation, family and staff interviews, and the Volitional Questionnaire. The Mini-Mental State Examination provided a measure of cognitive impairment.Findings: Three interacting themes emerged: variation in volitional expression, redefining meaningful occupation and potency of the social environment. The participants differed in volitional expression, showed changes in continuity between past and present interests, and tended to modify their occupations to match their abilities.Conclusion: The participants' lived experiences consistently reflected dynamism between the social environment and the person in volitional expression.
A key element in persons with dementia's occupational engagement is the degree to which the social environment supports participation. This article summarizes the results of a qualitative study of eight assisted living facility residents, that explored volition in persons with moderate dementia. Extensive interviewing and observation were followed by the primary researcher's engagement and documentation of each resident in therapeutic activity sessions. Data were analyzed using van Manen's phenomenological approach, and three themes emerged. One, potency of the social environment, is the focus of this article. From the eight participants, two case studies are presented, one demonstrating the positive impact of therapeutic communication and social support on volitional behavior and occupational engagement and the other demonstrating the inhibiting effect of lack of therapeutic social interaction. Each case is analyzed using Epp's (2003, Person-centred dementia care: A vision to be refined. The Canadian Alzheimer's Disease Review, 14-18) Person-Centered Care model techniques and interaction modes recommended by Taylor's (2008, The intentional relationship: Occupational therapy and use of self. Philadelphia: F.A. Davis.) Intentional Relationship Model. The article concludes with recommendations for promoting positive social interactions at the client, staff/family, and systems levels.
Introduction:Resource constraints and high staff turnover are perceived as substantial barriers to high quality residential aged care. Achieving relationship-focused, person-centered care (PCC) is an ongoing challenge. This paper reports on an international project that explored how residential care leadership understand meaningful engagement for residents with dementia from culturally and linguistically diverse (CALD) backgrounds.Method: This paper critically appraises the process, and outcomes, of an adapted Delphi method. Participants were the residential care leadership (i.e. staff in supervisory capacity) from four international facilities.Findings: Participation in the Delphi process was limited even though surveys were designed to require minimal time for completion. No participants opted for the alternative option of being interviewed. Findings indicate that residential care leadership recognised the importance of meaningful engagement for residents from CALD backgrounds. Limitations of time, resources and policy infrastructure were cited as barriers to achieving PCC. Conclusion:These findings suggest that facility leadership understand the importance of PCC, but identify multiple barriers rather than enablers for delivering PCC. Alternative methods, such as collecting data in interactive sessions allowing real-time discussion should be initiated to more effectively engage residential care leaders for a collaborative approach to explore PCC practices.
Introduction: This qualitative study systematically examined occupational therapists' use of a model of human occupation intervention, the Remotivation Process, for individuals with dementia. Method: An international sample of therapists participated in an on-line survey and in-depth interviews, resulting in 33 respondents and eight participants, respectively. The survey gathered general information regarding therapists' use of the Remotivation Process with persons experiencing dementia, and was used to recruit interview participants. Interviews were conducted using SKYPE or telephone, and were audio-recorded and transcribed. Descriptive statistics were derived from the survey results, and van Manen's phenomenological approach was used to describe therapists' experiences using the intervention. Results: Use of the Remotivation Process for this population was most common among mid-career therapists, and a majority of respondents had been using the intervention less than two years. Three themes identified from the interviews were: (1) Therapist beliefs: Commitment to the Remotivation process; (2) Does it work? Evaluating success; (3) It's more than me: External factors. Conclusion: Survey and interview data revealed that use of the Remotivation Process intervention for persons experiencing dementia is fairly complex yet clinically applicable. Therapists' experiences of using the Remotivation Process underscored the importance of therapist volition and clinical reasoning in achieving desired outcomes.
A scholarship of practice approach sets the stage for collaborative partnerships across academic and clinical practice settings that result in positive gains for all stakeholders. These gains include an enhanced ability to generate and apply relevant evidence in practice, disseminate knowledge and innovation, and ensure best practice is relevant to and effective for, people receiving services and their caregivers. This paper discusses national and international examples of collaborative, research-based practice initiatives that have implemented a scholarship of practice approach. The exemplars described here are framed within the Model of Human Occupation, which addresses the importance of volition, habits, roles, environment, and performance capacities in facilitating engagement in occupation for people with dementia. Research that focuses on how therapists adopt and use evidence in practice, as well as the opportunities and challenges for supporting therapists and their use of theory and evidence are discussed.
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