Rethinking Relationships

8/2/2019 Rethinking Relationships

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Rethinking person centred care 2

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Trevor Adams RN PhD


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enabling the expression of personhood

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Personhoodas an action

creativity

embodiment

voice

story telling

decision

making

relationships

spirituality

citizenship


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personhood expressed through

embodiment

Pia Kontos draws on Merleau-Ponty and

Bourdieu and argues that the body is a

fundamental source of personhood. Sheasserts the embodied nature of personhood

in people with dementia and offers dementia

care a broader theoretical framework from thatoffered by Kitwood.

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embodiment

Embodied selfhood highlights how selfhood is

displayed through self-expression and arisesout of a complex interplay between pre-

reflective and sociocultural characteristics.

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embodiment

personhood must be understood in its full

corporeal complexity

Pia Kontos

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personhood

as an action

citizenship

spirituality

narrative

embodiment

relationships

voice

decision-

making

creativity

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spirituality

... that which lies at the core of each persons

being, an essential dimension which bringsmeaning to life

Elizabeth MacKinlay

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spirituality

... spirituality is not constituted only by

religious practices, but must be understood

more broadly, as relationship with God,however God or ultimate meaning is perceived

by the person, and in relationship with other

people.

Elizabeth MacKinlay

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creativity

embodiment

voice

story telling

decision

making

relationships

spirituality

citizenship


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relationship

John Keady with Mike Nolan highlight the

relational nature of personhood in whichit exists in the person with dementia,

family carer(s), and paid-for carer(s) and is

maintained through mutual and reciprocalrelationships between each party.

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the senses framework

mike nolan and colleagues

A sense of purpose - opportunities to engage

in purposeful activities or to have a clear set

of goals to aspire to;

A sense of fulfilment - achieving meaningful or

valued goals and feeling satisfied with ones

efforts;

A sense of significance - to feel that you

matter, and that you are valued as a person

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the senses framework

mike nolan and colleagues

A sense of security - of feeling safe andreceiving or delivering competent andsensitive care;

A sense of continuity - the recognition ofbiography, using the past to contextualise thepresent;

A sense of belonging - opportunities to formmeaningful relationships or feel part of ateam.

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inclusion and exclusion in dementia

care triads Trevor Adams

Three parties are involved in dementia care:

the person with dementia; the family; and the

dementia care worker;

People in dementia care triads may be

included or excluded by verbal and non-verbal

interaction and affect peoples how the are

seen by others and sense of personhood;

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marginalisation and cohesion within

dementia care triads trevor adams

trevor adams highlighted within dementia

care triads one person may be marginalisedand cohesion may take place between the

other two.

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Disabling dementia communication occurs

when a member of a dementia care triad

are excluded or represented as not able tomake their own decisions.


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Interrupting

Speaking on behalf of

Reinterpreting

Using too technical language

Talking out of earshot

Taking sides Ignoring

Ridicule

Not inviting the person with dementia

Interrupting

Speaking on behalf of

Reinterpreting

Using too technical language

Talking out of earshot

Taking sides

Ignoring

Ridicule

Not inviting the person with dementia

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Enabling dementia communication occurs when

caregivers and dementia care practitioners help

the person with dementia make their feelings,views, opinions known and helps them fully

participate within decisions about their own

care.

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Removing unwanted stimuli

Getting in the right position

Promoting equal participation

Demonstrating enabling communication

Providing opportunities to talk

Valuing and respecting contributions

Overcoming poor communication

Promoting joint decision making

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personhood

as an action

citizenship

spirituality

narrative

embodiment

relationships

voice

decision-

making

creativity

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story telling

person-centred care viewed people with

dementia having a voice which is expressed

through verbal and non-verbal language.

voice is now increasingly seen as somethingthat is expressed through narrative.

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story telling

Clive Baldwin argues that

...personhood is more of a process - and a

narrative process at that - in which we all

contribute.

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story telling

Clive Baldwin develops the idea of narrative

agency which is the

ability and opportunity to reconstruct

ones own narrative,

opportunity to contribute to thenarrative of others.

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story telling

giving people with dementia the opportunity to

tell their stories - talking mats, reminiscence.

art, music and dance

attention to small-scale stories

in groups such as life history work

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story telling

Clive Baldwin examines how personal and

collective narratives offer people with dementiadifferent subject positions that give rise to

rights, obligations, and responsibility and also

their inclusion, and possibly exclusion,degrading and powerlessness.

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story telling

... The personal, interpersonal and the

interstructural are inter-related through thestories we tell and are told about us,

whereby individuals or collectives.

Clive Baldwin

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creativity

embodiment

voice

story telling

decision

making

relationships

spirituality

citizenship


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Personhood expressed through

citizenship

Clive Baldwin develops narrative citizenship

and argues is developed by maintaining

narrative agency in people with dementia inwhich

(1) they are able to express themselves in

a form that is recognisable as a narrative; and,(2) given the opportunity to do so.

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citizenship

Bartlett and OConnor argue that the idea of

personhood and citizenship need to combineand give a better lens to understand the agency

of people with dementia and the contribution of

also power relations.

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citizenship

Citizenship a status bestowed on those who are

full members of a community. All who possessthe status are equal with respect to the rights

and duties which the status bestows.

Marshall 1949

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Rethinking Relationships