Mikelyte, Rasa

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Kent Academic RepositoryFull text document (pdf)Copyright & reuseContent in the Kent Academic Repository is made available for research purposes. Unless otherwise stated allcontent is protected by copyright and in the absence of an open licence (eg Creative Commons), permissions for further reuse of content should be sought from the publisher, author or other copyright holder. Versions of researchThe version in the Kent Academic Repository may differ from the final published version. Users are advised to check http://kar.kent.ac.uk for the status of the paper. Users should always cite the published version of record.EnquiriesFor any further enquiries regarding the licence status of this document, please contact: researchsupport@kent.ac.ukIf you believe this document infringes copyright then please contact the KAR admin team with the take-down information provided at http://kar.kent.ac.uk/contact.htmlCitation for published versionMikelyte, Rasa  (2015) The importance of micro-cultures: Preliminary findings from an actionresearch study on improving mealtimes in dementia care.    In: 14th National Conference of EmergingResearchers in Ageing, Newcastle-upon-Tyne, UK.     (Unpublished)DOILink to record in KARhttps://kar.kent.ac.uk/70486/Document VersionPresentationResearch SummaryThe research project aims to collaboratively develop small-scale interventions that will improve meals and mealtime experiences for people with dementia, their relatives, and ward staff in two NHS Continuing Care facilities. ❖Example interventions involve:❖Changes to when and what type of food is available❖Mealtime environment (e.g. table layout)❖Opportunities to share and interact during mealtimes  All changes decided by the stakeholders                                                                                Conceptualising MealtimesNutrition & Hydration;  Eating Ability & AssistanceFood & Mealtime EnvironmentEngagement Activity Emotion Communication Quality of LifePhysical    Aspects of Meals & MealtimesPsycho-Social Aspects of  Meals & MealtimesPhysiological Aspects of Meals & MealtimesWider Societal ContextInstitutional ContextMealtimes in ContextNutrition & Hydration;  Eating Ability & AssistanceFood & Mealtime EnvironmentEngagement Activity Emotion Communication Quality of LifePhysical    Aspects of Meals & MealtimesPsycho-Social Aspects of  Meals & MealtimesPhysiological Aspects of Meals & MealtimesMicro-CulturesMicroculture -    Òa system of knowledge, beliefs, values and behaviours shared by the members of an interacting group to which the members can refer and which serves as the foundations for new interactions.Ò (Fine, 1987, p. 125)  ❖members recognise that they share experiences  ❖there is an expectation that these shared experiences will be understood by all members ❖shared understanding constructs a reality for the participants Most micro-cultural groups are groups of individuals who have much in common with the larger macro-culture (e.g., use common verbal and nonverbal symbols),  but in some way the micro-cultures vary from the larger, often dominant cultural milieu.Micro-CulturesMicro-cultures and micro-cultural groups are localised, distinctive cultures of a small group of people, which can be categorised by:  ❖Ethnicity (e.g.: ethnicity-based groups in South London; Hollos, 1991) ❖Sexuality (e.g.: gay pubs and other meeting places; Albro, 1997)  ❖Interest groups (e.g.: British horse-racing enthusiasts; Fox, 2012) ❖Online cultures (e.g.: Anomic internet-based micro-cultures; Rickman & Solomon, 2007)  ❖Institutional / organisations settings:  ❖companies (Schein, 2010) ❖schools/classrooms (Lopez & Allal, 2007) ❖Ébut no research specifically focussing on                         micro-cultures in Long-Term Care for                                     People with Dementia Research ExpectationsMicro cultures can influence people's actions and motivation in micro-specific ways, so that findings from any given setting should not be generalised to other comparable settings (Smith & Mackie, 2007) ❖ it was therefore hypothesised that co-created interventions would differ across settings It was expected that mealtime interventions co-created by the key stakeholders will have a high implementation/retention rate and show positive outcomes, as co-creation would ensure the interventions are tailored to specific social and cultural settings (micro-cultures) within which they are to be implemented (Kitwood & Benson, 1995). FindingsThis hypothesis was generally confirmed:Site 1Problem InterventionUnhelpful meal serving routine Routine amendedLack of food outside meantimes Extra snacks purchased  Few opportunities to socialise Furniture allowing communal diningFew cues at mealtim Changing table set-upStaff unsure about patient weight-change over time Clearer and more frequent monitoringSite 2Problem InterventionStressful teatimes Dividing up the mealNot enough staff at teatimes Rota changes A couple of patients not managing portion size Food provided in small portions throughout the day High proportion of people who need physical promoting, but not full assistance Hanging mealtime set-up from individual to communal Some disagreement between staff and relatives about mealtime approachesGroup meetingsFindingsHowever, the influence of micro-cultures on the research process transcended the static function of an Ôideas platformÕ. The processes that distinguished the micro-cultures and the way they impacted on mealtimes between research sites included: ❖ social dynamics  ❖ adherence to organisational structures and power hierarchies ❖ knowledge and attitudes related to dementia care ❖ infrahumanisation  ❖ identity negotiation ❖structural and environmental factors  ❖ ward size and layout ❖ shift patterns and composition ❖ ward routines Social  DynamicsStructural &  Environmental  FactorsFindingsThe dynamic way in which these processes and factors intersected to maintain micro-cultures influenced: ❖ research participation (especially PWD) ❖ willingness to implement co-created mealtime changes ❖ their retention ❖ and the overall success of the project It also led to questioning how suitable collaborative / participatory methodologies are in institutional settings ❖ as stakeholder collaboration and ÔempowermentÕ does not fit in with institutional micro-cultures  ❖ and is met with considerable resistance ConclusionsDue to the dynamic nature of micro-cultures, facilitating positive change in the experiences of PWD in long-term care settings is a highly complex process ❖ this further emphasises the need for research input ❖ especially methodologies that capture the role of micro-cultures It is not only the improvements, but also research approaches and methodologies should emerge from the research process ❖ Although some difficulties are anticipated (e.g. staffing), Participatory Action Research (PAR), where stakeholders retain full control of every research aspect, should be attemptedResearch DetailsResearcher: Rasa Mikelyte Tel:            07842 257607 Email:       rm457@kentforlife.net  Address:   SSPSSR, University of Kent                    Gillingham Building                    Chatham Maritime                    ME4 4AG The study has been approved by the Social Care Research Ethics Committee. REC reference: 13/IEC08/0018Supervisors: Alison Culverwell Head of Older Adult Psychological Services for Eastern & Coastal Kent KMPT Prof. Alisoun Milne School of Social Policy, Sociology &        Social Research, University of Kent This research project is hosted by KMPT and University of Kent, and sponsored by Kent HealthMicro-Cultures & Action researchPotential for immediate Impact:❖ Justifies doing research❖ Encourages cooperation❖ Ensures findings are applied in practice (Bate, 2000)Relevance to the ÔHere & NowÕ:❖ Accounts for the micro-cultures within and across settings❖ Specific settings allow for a board and in-depth research investigations and evaluations of intervention impactCollaboration and Ownership:❖ Brings patients, staff and relatives together❖ Is led and owned by the above groups❖ Researcher as informant and facilitatorThe Setting: NHS Continuing Care UnitsFew Continuing Care (CC) Settings across the UK:❖ Under-researched ❖ Invisible to the publicCompared to other forms of dementia care, CC settings are characterised by:❖ (highest) level of need ❖ complex multiple needs❖ hospital environment❖ institutional structure                            and goalsCon$nuing(Care(Wards(Care(Homes(and((Nursing(Homes(Care(in(the(Community(0.01%60.98%39.01%

The importance of micro-cultures: Preliminary findings from an action research study on improving mealtimes in dementia care

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The importance of micro-cultures: Preliminary findings from an action research study on improving mealtimes in dementia care

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