They are Still People: An Ethnographic Investigation into a Reconfiguration of Personhood Practice in Residential Dementia Care

Author: Jenny Slape

Slape, Jenny, 2019 They are Still People: An Ethnographic Investigation into a Reconfiguration of Personhood Practice in Residential Dementia Care, Flinders University, College of Nursing and Health Sciences

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This doctoral research develops a reconfiguration of personhood practice in residential dementia care settings. The specific focus of the study is the level of prioritisation assigned to personhood by the organisation, and the level to which personhood care is consistently supported in dementia care practices. My original contribution to knowledge is the recognition and demonstration that societal and organisational cultures frequently stigmatise and undervalue people with dementia, thus justifying strategic under-resourcing. In order to reverse this trend, this study argues for the positioning of personhood at the forefront of dementia care, thus appropriately valuing and prioritising the person with dementia. In the context of this study, the concept of personhood acknowledges the intrinsic value of a person and understands that person’s need to feel respected and included in their environment. The fulfilment of these needs is particularly important in the residential dementia care environment, given the stigmas associated with ageing and dementia, as well as the vulnerability of this group of people.

An integrative review of the literature was undertaken to ascertain current understandings of a personhood model of dementia care, and how these insights are considered and practiced within the contemporary culture of residential dementia care. This review revealed differing approaches towards personhood from the organisational, daily care practice and personal perspectives. The theories and concepts of Tom Kitwood form the theoretical framework for this study, in particular his identifications of psychological needs of people with dementia, and the types of interactions which either undermine or support personhood.

Ethnography was chosen as the methodology to investigate the culture of personhood in residential dementia care. Fieldwork was undertaken at two RACFs, and data was collected from interviews with staff members, observations of interactions between staff and residents, and field notes collected during the fieldwork period.

The research findings reveal that both personhood preservation and personhood violation occur in the psychosocial environment in which the person with dementia lives. Factors influencing these themes include: the level of organisational connectedness to the practicalities of dementia care; aspects linked to staffing and support of staff members; staff interactions which result in either respect or disrespect for the person with dementia; and the degree to which the living space feels safe and homelike. The influencing factor on whether personhood is predominantly preserved or violated is the dominating culture of the psychosocial environment which is, in the main, controlled by the organisational culture. Ultimately, it is the ideologies of dementia and ageing that frame organisational culture. This thesis makes the case for the suppression of societal and organisational stigma which negatively impacts on dementia care, and argues, instead, for the positioning of personhood at the forefront of residential dementia care practices.

Keywords: Dementia Care, Personhood, Care Staff, Ageism, Organisational Culture, Kitwood, Ethnography

Subject: Ageing Studies thesis

Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Nursing and Health Sciences
Supervisor: Professor Tara Brabazon