BackgroundClinical practice guidelines have been a popular tool for the improvement of health care through the implementation of evidence from systematic research. Yet, it is increasingly clear that knowledge alone is insufficient to change practice. The social, cultural, and material contexts within which practice occurs may invite or reject innovation, complement or inhibit the activities required for success, and sustain or alter adherence to entrenched practices. However, knowledge translation (KT) models are limited in providing insight about how and why contextual contingencies interact, the causal mechanisms linking structural aspects of context and individual agency, and how these mechanisms influence KT. Another limitation of KT models is the neglect of methods to engage potential adopters of the innovation in critical reflection about aspects of context that influence practice, the relevance and meaning of innovation in the context of practice, and the identification of strategies for bringing about meaningful change.DiscussionThis paper presents a KT model, the Critical Realism and the Arts Research Utilization Model (CRARUM), that combines critical realism and arts-based methodologies. Critical realism facilitates understanding of clinical settings by providing insight into the interrelationship between its structures and potentials, and individual action. The arts nurture empathy, and can foster reflection on the ways in which contextual factors influence and shape clinical practice, and how they may facilitate or impede change. The combination of critical realism and the arts within the CRARUM model promotes the successful embedding of interventions, and greater impact and sustainability.ConclusionCRARUM has the potential to strengthen the science of implementation research by addressing the complexities of practice settings, and engaging potential adopters to critically reflect on existing and proposed practices and strategies for sustaining change.

Explicit in the current construction of Alzheimer's disease is the assumption that memory impairment caused by cognitive deficiencies leads to a steady loss of selfhood. The insistence that selfhood is the exclusive privilege of the sphere of cognition has its origins in the modern western philosophical tradition that separates mind from body, and positions the former as superior to the latter. This dichotomy suggests a fundamental passivity of the body, since it is primarily cognition that is held to be essential to selfhood. In contrast to the assumed erasure of selfhood in Alzheimer's disease, and challenging the philosophical underpinnings of this assumption, this paper presents the findings of an ethnographic study of selfhood in Alzheimer's disease in a Canadian long-term care facility. It argues and demonstrates that selfhood persists even with severe dementia, because it is an embodied dimension of human existence. Using a framework of embodiment that integrates the perspectives of Merleau-Ponty and Bourdieu, it is argued that selfhood is characterised by an observable coherence and capacity for improvisation, and sustained at a pre-reflective level by the primordial and socio-cultural significance of the body. The participants in this study interacted meaningfully with the world through their embodied way of ‘being-in-the-world’.

Dementia care practices are premised on a model of Alzheimer's disease that denies the body an agential role in the constitution and manifestation of selfhood. As a consequence, despite advances in person-centred care, the body, which is a substantive means by which persons with advancing dementia engage with the world, is treated as passive rather than active and intentional. My central argument is that dementia care practices must embrace the idea that the body is a fundamental source of selfhood that does not derive its agency from a cognitive form of knowledge. With an interest in bringing the body into a theoretical re-visioning of selfhood in Alzheimer's disease, I advance this idea with the notion of embodied selfhood. I suggest ways that the notion of embodied selfhood could enhance person-centred dementia care; however, further research is required in order to fully conceptualize this notion in the context of dementia care.

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Over the past several decades, researchers have taken an interest in theatre as a unique method of analysing data and translating findings. Because of its ability to communicate research findings in an emotive and embodied manner, theatre holds particular potential for health research, which often engages complex questions of the human condition. In order to evaluate the research potential of theatre, this article critically examines examples of evaluated health research studies that have used theatre for the purposes of data analysis or translation. We examine these studies from two perspectives. First, the literature is divided and categorized into four theatre genres: (1) non-theatrical performances; (2) ethnodramas, which can be interactive or non-interactive; (3) theatrical research-based performances; and (4) fictional theatrical performances. This categorization highlights the importance of these genres of theatre and provides an analysis of the benefits and disadvantages of each, thus providing insight into how theatre may be most effectively utilized in health research. Second, we explore the efficacy of using theatre for the purposes of data analysis and knowledge transfer, and critically examine potential approaches to the evaluation of such endeavours.

Despite the recognized health and psychosocial benefits of exercise for older adults with end-stage renal disease (ESRD), exercise participation remains poor. Previous research has attributed low levels of exercise to patient-related factors such as lack of motivation and fear of adverse consequences. This qualitative study involving focus group discussions with hemodialysis patients, nephrology nurses, and family care providers explored specific motivators and barriers to exercise participation in older adults requiring hemodialysis. Nurse participants were chosen for the health care provider focus groups because their prolonged and sustained contact with hemodialysis patients during the dialysis treatment sessions positions them well to encourage and promote exercise. Motivators to exercise included patient aspirations to exercise and their experiences of improvements from exercising, as well as the formal incorporation of exercise into the overall dialysis treatment plan. Barriers to exercise included nurses' lack of encouragement to exercise, transportation issues, and the use of exercise equipment that precludes participation by patients who recline during dialysis and inhibits exercise encouragement by nurses due to concerns of equipment-related injury. These findings support the need for a broader recognition of the systemic factors that may impede exercise participation by older adults requiring hemodialysis. A shift is required in the culture of ESRD treatment programs towards a wellness perspective that includes expectations of exercise encouragement by the health care team and participation by patients.

The physical, symbolic and experiential aspects of receiving long-term care are examined in this paper using Bourdieu's concepts of habitus and field. We draw on data from an ethnographic study of home care in 16 homes in urban, rural and remote locations in Ontario, Canada. Across all cases, data about domestic and caregiving routines were gathered through observation, interviews with clients and/or the primary family caregiver, interviews with service providers and videotaped tours of the home. Based on the analysis of these data, we argue that a transposition of logics and practices occurred when the domestic and health care fields were superimposed within the spaces of the home. Although all of the care recipients and their family caregivers indicated a strong preference for home care over institutional care, their experiences and practices within their homes were disrupted and reconfigured by the insertion of logics emanating from the healthcare field. These changes were manifested in three main themes: the politics of aesthetics; the maintenance of order and cleanliness; and transcending the limitations of the home. In each of these dimensions, it became apparent that care recipients engaged in improvisatory social practices that reflected their ambiguous and changing habitus or social location. The material spaces of their homes signified, or prompted, altered or changing social placement.

Purpose: The Resident Assessment Instrument–Minimum Data Set (RAI/MDS) is an interdisciplinary standardized process that informs care plan development in nursing homes. This standardized process has failed to consistently result in individualized care planning, which may suggest problems with content and planning integrity. We examined the decision making and care practices of personal support workers (PSWs) in relation to the RAI/MDS standardized process. Design and Methods: This qualitative study utilized focus groups and semi-structured interviews with PSWs (n = 26) and supervisors (n = 9) in two nursing homes in central Canada. Results: PSWs evidenced unique occupational contributions to assessment via proximal familiarity and biographical information as well as to individualizing care by empathetically linking their own bodily experiences and forging bonds of fictive kinship with residents. These contributions were neither captured by RAI/MDS categories nor relayed to the interdisciplinary team. Causal factors for PSW exclusion included computerized records, low status, and poor interprofessional collaboration. Intraprofessional collaboration by PSWs aimed to compensate for exclusion and to individualize care. Implications: Exclusive institutional reliance on the RAI/MDS undermines quality care because it fails to capture residents’ preferences and excludes input by PSWs. Recommendations include incorporating PSW knowledge in care planning and documentation and examining PSWs’ nascent occupational identity and their role as interprofessional brokers in long-term care.