Social citizenship, public art and dementia: Walking the urban waterfront with Paul’s Club

Among gerontologists and health researchers, there is growing recognition of the importance of social participation and inclusion towards the health, well-being and quality of life of people with dementia. This paper examines the role of public artworks to facilitate the social citizenship of people with dementia. It is based on a subset of data from a larger study on community-based programmes for persons living with dementia and examines how Paul’s Club, a social recreation group for people with young onset dementia, experience the public art they encounter on their daily walks through the downtown core and around the Seawall of Vancouver, Canada. Analysis suggests that public art not only helped members navigate urban spaces, but also provided a focus for curiosity that leads to meaningful social interaction and place-based conversations, clearly contributing to group enjoyment and a sense of community belonging. Implications of this study relate to community programming, social citizenship, community design, public art and community engaged art practice, as well as health and social care for persons with dementia

Using Video-Reflexive Ethnography to Engage Hospital Staff to Improve Dementia Care

In this article, we discuss how video-reflexive ethnography may be useful in engaging staff to improve dementia care in a hospital medical unit. Seven patients with dementia were involved in the production of patient-story videos, and fifty members of staff (nurses, physicians, and allied health practitioners) participated in video-reflexive groups. We identified five substantial themes to describe how video-reflexive groups might contribute to enacting person-centered care for improving dementia care: (a) seeing through patients’ eyes, (b) seeing normal strange and surprised, (c) seeing inside and between, (d) seeing with others inspires actions, and (e) seeing with the team builds a culture of learning. Our findings suggest that video reflexivity is not only useful for staff engagement but also effective in enhancing team capacity to enact person-centered care in the hospital setting

Ethical issues in the use of video observations with people with advanced dementia and their caregivers in nursing home environments

The use of video allows researchers to gather rich, evocative and contextualized data, yet it also opens a space fraught with ethical challenges. In this paper, the authors describe their use of video methods in ethnographic case study research examining the experiences of persons with advanced dementia who reside in nursing homes and are nearing the end-of-life. In this research, video is used to help garner a deeper understanding of the person with advanced dementia’s being-in-the-world as well as the embodied workplace practices of care staff. Drawing upon notions of emplacement and embodiment, we unpack ethical issues that arise from conducting research with a vulnerable population within a complex environment.  In addition to discussing general ethical principles such as consent, assent and privacy, we argue that to conduct ethically sound research, the researcher needs a solid understanding of the complex and dynamic nature of the nursing home environment. This is, at once, a communal living setting and a home for the residents, a place of work for a diverse group of care staff, and an organizational structure emplaced in a larger socio-political environment.  We shed light on, and discuss potential solutions to, the challenges and complexities of bringing a video camera into the nursing home space where ethical questions arise in ambiguous situations, where relationships shift and the ethical ground reconfigures over time

Creating cultures of care: exploring the social organization of care delivery in long-term care homes

Context: As a result of changing demographics, the number of older adults living in long-term care homes (LTCHs) is expected to rise dramatically. Thus, there is a pressing need for better understanding of how the social organization of care may facilitate or hinder the quality of work-life and care in LTCHs. Objectives: This study explored how the social organization of work influences the quality of work-life and care delivery in LTCHs. Method: Institutional ethnography followed by theory building provided the conceptual underpinnings of the methodological approaches. Participants included 42 care team members who were employed by one of three participating LTCHs. Data were derived from 104 hours of participant observation and 42 interviews. Findings: The resident care aides (RCAs) were found to rely on supportive work-teams to accomplish their work successfully and safely. Reciprocity emerged as a key feature of supportive work-teams. Management practices that demonstrated respect (e.g., inclusion in residents’ admission processes), recognition, and responsiveness to the RCAs’ concerns facilitated reciprocity among the RCAs. Such reciprocity strengthened their resilience in their day-to-day work as they coped with common work-place adversities (e.g., scarce resources and grief when residents died), and was essential in shaping the quality of their work-life and provision of care. Discussion: The empowerment pyramid for person-centred care model proposes that the presence of empowered, responsive leaders exerts a significant influence on the cultivation of organizational trust and reciprocating care teams. Positive work-place relationships enable greater resilience amongst members of the care team and enhances the RCAs’ quality of work-life, which in turn influences the quality of care they provide. Limitations: Whether there were differences in the experiences, opinions, and behaviour of the people who agreed to participate and those who declined to take part could not be ascertained. Further research is required to determine and understand all of the factors that support or inhibit the development of empowered leaders in LTCHs. Implications: Cultures of caring, reciprocity and trust are created when leaders in the sector have the support and capacity to lead responsively and in ways that acknowledge and respect the contributions of all members of the team caring for some of the most vulnerable people

Zeitgeist: an intergenerational storytelling project

The Zeitgeist project asks what role design students can play in enhancing creative endeavours and wellbeing of residents through an intergenerational co-design programme. Between Spring 2018 and Summer 2019, Zeitgeist brought together undergraduate design students and residents of long-term care homes for a project that challenged them to co-design publications that focused on the life experiences, stories and knowledge of the residents and emphasized an intergenerational exchange between two very different groups of people that could have a tangible, positive impact upon each other. It is often the case that residents in long-term care homes face issues of social isolation and diminishment of personal identity. In care homes opportunities for genuine creative and personal expression tend to be limited due to limited resources and a focus on medical priorities. It’s not unusual for residents to feel like they no longer have anything to contribute to society, that their story has closed and they no longer feel challenged, which can lead to cognitive decline. Design students are predominately young and tend to have limited life experience, with many still living at home and unsure about what direction they want their life to take. Zeitgeist looked to explore the possible benefits of a reciprocal relationship between the two parties by engaging participants in a range of creative activities that would allow for a mutual exchange of information and skills. This project uniquely positions an art and design university as a community partner for developing new approaches to enhance the wellbeing of seniors

Appreciative Inquiry: Bridging Research and Practice in a Hospital Setting

Purpose:  In this action study, researchers worked with a team of interdisciplinary practitioners to co-develop knowledge and practice in a medical unit of a large urban hospital in Canada. An appreciative inquiry approach was utilized to guide the project. This article specifically focuses on examining the research experiences of practitioners and their accounts on how the research influenced their practice development to enact person-centered care. Method:  The project took place in the hospital’s medical unit. A total of 50 staff participants attended focus groups including nursing staff, allied health practitioners, unit leaders, and physicians. One senior hospital administrator was interviewed individually. In total, 36 focus groups were conducted to bring participants together to co-vision and co-develop person-centered care. Results:  Analysis of the data produced three themes: (a) appreciating the power of co-inquiry, (b) building team capacity, and (c) continuous development. Furthermore, 10 key enablers for engaging staff in the research process were developed from the data. A conceptual tool, “team Engagement Action Making” (TEAM) has been created to support others to do similar work in practice development. Conclusion:  An appreciative inquiry approach has the potential to address gaps in knowledge by revealing ways to take action. Future research should further investigate how the appreciative inquiry approach may be used to support bridging research and practice

Creating Dementia-Friendly and Inclusive Communities for Social Inclusion: A Scoping Review Protocol

Introduction The number of people with dementia is increasing worldwide, with the majority of people with dementia living at home in the community. WHO calls for global action on the public health response to dementia. Social exclusion is commonly reported by people with dementia and their families. Dementia-friendly and inclusive community has emerged as an idea that holds potential to contribute to the mitigation of social exclusion. The objective of the scoping review is to answer two questions: What social inclusion strategies that have been reported in the dementia-friendly and inclusive communities’ literature? What strategies for developing dementia-friendly and inclusive communities that have shown to improve social inclusion? Methods and analysis This scoping review will follow the Joanna Briggs Institute scoping review methodology and will take place between April and September 2020. The proposed review will consider studies based in community settings with participants living at home with early to late stages of dementia and their families. This includes a three-step search strategy: (1) to identify keywords from MEDLINE and CINAHL; (2) to conduct a second search using all identified keywords and index terms across selected databases (MEDLINE, CINAHL, AgeLine, PsycINFO, Web of Science, ProQuest and Google) and (3) to handsearch the reference lists of all included articles and reports for additional studies. Further, we will search Google for grey literature on published organisational reports. Two researchers will screen titles and abstracts independently and then assess the full text of selected citations against inclusion criteria. Extracted data will be presented in a narrative accompanied by tables that reflect the objective of the review

The Impact of Pandemic Management Strategies on Staff Mental Health, Work Behaviours, and Resident Care in One Long-Term Care Facility in British Columbia: A Mixed Method Study

Context: To slow the spread of COVID-19 within the Canadian long-term residential care (LTRC) sector, a series of pandemic management strategies were introduced, including restricted visitation and single site employment. These strategies were enacted to prevent and control infection, resulting in unknown impact on direct care staff and staff capacity to deliver quality care or service. Objective: To explore staff reports of outcomes associated with LTRC pandemic management strategies, particularly their impact on LTRC staff mental health, work behaviours and quality of care or service provision. Method: This was a case study using mixed methods including a longitudinal survey and interviews with staff from one LTRC site in British Columbia. Survey data from 68 staff who participated in both survey times were analyzed using regressions with relative weight analysis. Semi-structured interviews were conducted with 26 LTRC staff and analyzed using content analysis. Findings: Survey data demonstrated that staff perceived the sick time policy and staffing levels as the most inadequate pandemic management strategies. Survey data also showed the visitation policy, the sick time policy and the single site employment policy were most significantly associated with negative outcomes to staff mental health, work behaviours and quality of care or service delivery. Qualitative data suggested connections between these policies and inadequate staffing levels and heavy workloads. Limitations: The study design along with the low response rate and the small sample size limits the generalizability of the findings to other settings. Implications: The development and implementation of pandemic management strategies must be informed by and give consideration to working conditions of LTRC staff including long standing systemic issues such as staffing shortages and heavy workloads

The Gravitational Wave Background from Cosmological Compact Binaries

We use a population synthesis approach to characterise, as a function of cosmic time, the extragalactic close binary population descended from stars of low to intermediate initial mass. The unresolved gravitational wave (GW) background due to these systems is calculated for the 0.1-10 mHz frequency band of the planned Laser Interferometer Space Antenna (LISA). This background is found to be dominated by emission from close white dwarf-white dwarf pairs. The spectral shape can be understood in terms of some simple analytic arguments. To quantify the astrophysical uncertainties, we construct a range of evolutionary models which produce populations consistent with Galactic observations of close WD-WD binaries. The models differ in binary evolution prescriptions as well as initial parameter distributions and cosmic star formation histories. We compare the resulting background spectra, whose shapes are found to be insensitive to the model chosen, and different to those found recently by Schneider et al. (2001). From this set of models, we constrain the amplitude of the extragalactic background to be 1E-12 < Omega(1 mHz) < 6E-12, in terms of Omega(f), the fraction of closure density received in gravitational waves in the logarithmic frequency interval around f.Comment: 20 pages, 17 figures, accepted for publication in MNRAS. Minor changes, including some additional population synthesis models. Conclusions and main results unchange

Bone Marrow Cells in Murine Colitis: Multi-Signal Analysis Confirms Pericryptal Myofibroblast Engraftment without Epithelial Involvement

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