Corazzini, K.N., Meyer, J., McGilton, K.S., Scales, K., McConnell, E.S., Anderson, R.A., Lepore, ... more Corazzini, K.N., Meyer, J., McGilton, K.S., Scales, K., McConnell, E.S., Anderson, R.A., Lepore, M. and Ekman, I., 2016. Person-centered nursing home care in the United States, United Kingdom, and Sweden: Why building cross-comparative capacity may help us radically rethink nursing home care and the role of the RN. Nordic Journal of Nursing Research, 36(2), pp.59-61.
Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and ... more Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and treatment are important for quality improvement. To be pragmatic, quality improvement depends on sensitive case identification using nursing home records; however, no studies have examined the reliability of different methods of pneumonia case finding from records. The current authors compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes: recorded diagnosis of pneumonia, modified McGeer criteria (chest x-ray infiltrate plus specified signs/symptoms), and antibiotic prescription plus pneumonia-specific signs. Chart diagnosis detected 107 cases, modified McGeer criteria detected 84 cases, and antibiotic prescription detected 47 cases. Diagnosis included all cases identified by the McGeer criteria and all but one case identified by antibiotic use. Based on findings, recorded diagnosis of pneumonia is a highly sensitive and pr...
Background/Objectives: Personalisation of mental health care is seldom questioned but some aspect... more Background/Objectives: Personalisation of mental health care is seldom questioned but some aspects of inpatient experience may bring it into question. Mieke Verhaeghe and Piet Bracke investigated the stigma experiences of clients of mental health services in Flanders. One important finding was that more individualised treatment appears to inhibit the formation of a strong peer group and thus the creation of a positive group atmosphere on the ward. This implies that individualised treatment is antithetical to the creation of a good ward ...
Inpatient care for people with dementia: Inpatient care for people with dementia: ... Staff well-... more Inpatient care for people with dementia: Inpatient care for people with dementia: ... Staff well-being and the implications for ... Joanne Lloyd, Kezia Scales and Simon Bailey University of Nottingham ... • Dementia on the increase 700,000 > 1.4 million by 2030 as population ages • Increasing number of health care professionals in hospitals caring for people with dementia • NHS dementia wards caring for populations with higher behavioural disturbance and distress ... • Healthcare assistants (HCAs) • On frontlines of care • Physical & emotional strain with ...
Addressing criticisms of the routine-driven, task-oriented, depersonalising nature of conventiona... more Addressing criticisms of the routine-driven, task-oriented, depersonalising nature of conventional services, and reflecting a broader trend across health and social care, person-centered care has become the watchword for quality in long-term care for older people in recent years. Person-centered care requires recognizing the unique personhood of each individual regardless of their physical or mental capacity. Efforts to realize this approach depend largely on the non-professional nursing staff who deliver the majority of direct care in this context. However, little is known about how new knowledge, including ideas and evidence about person-centered care, translates into the daily practices of this cadre of staff, who have little formal training, low job status, and limited access to traditional forms of research dissemination and knowledge exchange.
Building on the existing knowledge-translation literature, therefore, the aim of this study was to explore the mechanisms of knowledge translation about person-centered care among care assistants in long-term care. The objectives were to examine how these staff develop their understanding of person-centered care; identify the personal and contextual factors involved; and explore what can be learned about person-centered care from their current practices. The study used ethnographic methods, including 500 hours of participant observation, in-depth interviews, and document analysis, to conduct case studies of two private nursing homes located in the East Midlands and the north-eastern United States. Without claiming to demonstrate causality, extending the research across two policy settings did facilitate the identification of pertinent issues within and beyond each individual facility. Data analysis was informed by practice theory, which provided an alternative to the individualist assumptions which characterize popular representations of long-term care, on the one hand, and, on the other, structural explanations that renounce individual agency altogether.
From this theoretical perspective, drawing in particular on Bourdieu‘s theory of practical logic and the neo-institutional concept of institutional logics, this study identified how the interconnection of particular practices within each setting produced different situated understandings and implementation of person-centered care. A key finding was that care assistants‘ individualized knowledge about each resident, obtained through their direct daily care, represented an important form of symbolic capital in this field. Their willingness or reluctance to share such knowledge, consequently, corresponded to the extent to which other practices, including communication and teamwork, supported or threatened this limited source of power. The second, related finding was that care assistants derived from this individualized knowledge a certain amount of autonomy, or discretion, over the organization and delivery of daily care. This discretion, together with the agency that care assistants exercised in navigating different institutional logics in this context of care – which was the third main finding – signified a potential nexus of practice change. Conversely, new knowledge or ideas that undermined this limited discretion and agency tended to engender denial or resistance.
As the population ages, demand for long-term care for older people is increasing exponentially, prompting concerns about the capacity and sustainability of this sector. One significant area of concern is workforce recruitment, retention, and competence. This study, located at the intersection of research on long-term care and knowledge translation, contributes to efforts to address these concerns by identifying opportunities for intervention in education, training, and support, in order to build a workforce that is equipped to provide high-quality, evidence-based, person-centered care for older people throughout the years ahead.
The short report describes the development from page to stage of a work of theatre based on an et... more The short report describes the development from page to stage of a work of theatre based on an ethnographic study. The originating research focused on the work of health care assistants (nurse's aides) whose direct impact on the quality of life of highly dependent people is often overlooked. The research followed hospital personnel on wards specialising in the 'challenging behaviour' associated with dementia in central England. Conventional research outputs failed to engage the health care assistants themselves, so we turned to theatre to remedy this. The development of the field notes into theatre was characterised by the artistic freedom given to the playwright, in contrast to more data-led approaches to theatre making. The account of the process of creating the play, Inside Out of Mind, is followed a description of how the work was received by specialist and general audiences totalling 2000+. The discussion seeks to locate the whole enterprise in relation to the field of research-based theatre and explores how the production and its associated learning events relate to definitions of research-based theatre in the light of recent attempts to encapsulate this broad and diverse methodology.
Although there is much written on the emotional labour of nursing, there is little research groun... more Although there is much written on the emotional labour of nursing, there is little research grounded in the experience of so-called ‘unqualified’ care assistants. This paper is drawn from an ethnographic study conducted with care assistants on three dementia care wards in one mental health trust within the United Kingdom National Health Service (NHS). We describe the emotional labour carried out by care assistants in their attempts to provide personalised care for people whose cognitive degeneration renders conventional relationship-building very difficult, produces unpredictable ‘challenging behaviour’ and calls into question the notion of ‘feeling rules’. This context requires the ability to strike a balance between emotional engagement and detachment, and it is the complexities of this relationship that are the focus of this paper, arguing that a degree of detachment is a prerequisite to engagement in this context. In conclusion, we argue that the contribution of care assistants in this context needs to be better acknowledged, supported and remunerated.
Rising dementia incidence is likely to increase pressures on healthcare services, making effectiv... more Rising dementia incidence is likely to increase pressures on healthcare services, making effective well coordinated care imperative. Yet, barriers to this care approach exist which, we argue, might be understood by focussing on identity dynamics at the frontlines of care. In this article, we draw upon findings from an ethnographic study of healthcare assistants (HCAs) from three dementia wards across one National Health Service mental health trust. Data revealed that the HCAs are a close-knit ‘in-group’ who share low group status and norms and, often highlight their own expertise in order to promote self worth. HCAs’ social identity is considered as a barrier to effective teamwork with strong ingroup behaviour suggested as a consequence of their marginalisation. We explore these findings with reference to social identity theory (Tajfel, 1974; Turner, 1978) and discuss implications for delivering multiprofessional and interprofessional care.
Ethnography has classically been conducted by a single scholar, often referred to as a ‘Lone Rang... more Ethnography has classically been conducted by a single scholar, often referred to as a ‘Lone Ranger’, who develops an interpretation of a cultural setting based on their immersion within it. Overshadowed by this historical icon and located within an academe that privileges individual achievement, ethnography as a group effort has received less consideration in the methodology literature. Nevertheless, team ethnography conducted by multiple researchers at one or more research sites is becoming increasingly common and requires explicit attention. With reference to the existing literature and a recent team ethnography of in-patient dementia care, this paper argues that team ethnography is not just a case of ‘add researchers and stir’, but rather a methodology entailing specific issues and considerations. In particular, the paper explores how the two-phase design of the dementia care ethnography – which entailed researchers collecting data first as conventional lone ethnographers, then as a team with shared understandings and objectives – brings to light the opportunities and challenges of this methodology.
Background: Stigmatizing attitudes can impair the quality of life of people with mental health pr... more Background: Stigmatizing attitudes can impair the quality of life of people with mental health problems. Psychiatric hospitalization can generate stigma. Are some approaches to care less stigmatizing than others?
Aims: This study was designed to replicate findings from Flanders, Belgium in an English context, investigating how ward size and treatment approach affected service users’ expectations and experiences of stigma.
Methods: The translated Belgian questionnaire was administered to 70 service users in 15 inpatient adult mental health settings in central England. Adjustments were made to the multivariate analysis in light of the smaller sample size, in order to replicate the original equation as closely as possible.
Results: Neither ward size nor individualized care proved significant in the smaller English sample, which was subject to the risk of type II error. Across two models, self-rejection correlated with age (negatively), social rejection and stigma expectations.
Conclusions: This analysis shows that attempts to translate evidence about psychiatric inpatient services must take into account differences between the settings, populations and models of care. Expectations as well as outcomes of stigma may be relevant when assessing the impact of psychiatric hospital treatment on individual patients.
Attempts to improve the provision of long-term care for older people, especially but not exclusiv... more Attempts to improve the provision of long-term care for older people, especially but not exclusively people with dementia, often invoke the concept of “person-centred care”. Usually contrasted against depersonalised, routine-driven, task-focused approaches, person-centred care purportedly takes into account the unique history, identity, needs, and wishes of each individual, to the extent possible and regardless of physical or mental capacity. However, despite its discursive proliferation, the evidence base for person-centred care remains limited. This may be both cause and consequence of the lack of specificity and consistent usage of the concept. This presentation will explore, in particular, the similarities and dissonances between the discourse of person-centred/-centered care in the United Kingdom and United States, drawing on published research, policy documents, and grey literature from care organisations and providers. The argument will be elaborated with findings from recent ethnographic fieldwork undertaken in two private nursing homes which have explicitly endorsed a person-centred care approach at the operational level. One facility is located in the East Midlands and the other in the northeast United States. The aim of this larger project is to critically assess how nonqualified nursing staff in long-term care facilities develop, engage with, and implement knowledge about person-centred care as well as to distil cross-national differences in the definition of this approach to care. The presentation will conclude with a brief discussion of the implications of attempts to translate research findings from one health-care policy and delivery context to another in the absence of conceptual clarity and consensus.
Corazzini, K.N., Meyer, J., McGilton, K.S., Scales, K., McConnell, E.S., Anderson, R.A., Lepore, ... more Corazzini, K.N., Meyer, J., McGilton, K.S., Scales, K., McConnell, E.S., Anderson, R.A., Lepore, M. and Ekman, I., 2016. Person-centered nursing home care in the United States, United Kingdom, and Sweden: Why building cross-comparative capacity may help us radically rethink nursing home care and the role of the RN. Nordic Journal of Nursing Research, 36(2), pp.59-61.
Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and ... more Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and treatment are important for quality improvement. To be pragmatic, quality improvement depends on sensitive case identification using nursing home records; however, no studies have examined the reliability of different methods of pneumonia case finding from records. The current authors compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes: recorded diagnosis of pneumonia, modified McGeer criteria (chest x-ray infiltrate plus specified signs/symptoms), and antibiotic prescription plus pneumonia-specific signs. Chart diagnosis detected 107 cases, modified McGeer criteria detected 84 cases, and antibiotic prescription detected 47 cases. Diagnosis included all cases identified by the McGeer criteria and all but one case identified by antibiotic use. Based on findings, recorded diagnosis of pneumonia is a highly sensitive and pr...
Background/Objectives: Personalisation of mental health care is seldom questioned but some aspect... more Background/Objectives: Personalisation of mental health care is seldom questioned but some aspects of inpatient experience may bring it into question. Mieke Verhaeghe and Piet Bracke investigated the stigma experiences of clients of mental health services in Flanders. One important finding was that more individualised treatment appears to inhibit the formation of a strong peer group and thus the creation of a positive group atmosphere on the ward. This implies that individualised treatment is antithetical to the creation of a good ward ...
Inpatient care for people with dementia: Inpatient care for people with dementia: ... Staff well-... more Inpatient care for people with dementia: Inpatient care for people with dementia: ... Staff well-being and the implications for ... Joanne Lloyd, Kezia Scales and Simon Bailey University of Nottingham ... • Dementia on the increase 700,000 > 1.4 million by 2030 as population ages • Increasing number of health care professionals in hospitals caring for people with dementia • NHS dementia wards caring for populations with higher behavioural disturbance and distress ... • Healthcare assistants (HCAs) • On frontlines of care • Physical & emotional strain with ...
Addressing criticisms of the routine-driven, task-oriented, depersonalising nature of conventiona... more Addressing criticisms of the routine-driven, task-oriented, depersonalising nature of conventional services, and reflecting a broader trend across health and social care, person-centered care has become the watchword for quality in long-term care for older people in recent years. Person-centered care requires recognizing the unique personhood of each individual regardless of their physical or mental capacity. Efforts to realize this approach depend largely on the non-professional nursing staff who deliver the majority of direct care in this context. However, little is known about how new knowledge, including ideas and evidence about person-centered care, translates into the daily practices of this cadre of staff, who have little formal training, low job status, and limited access to traditional forms of research dissemination and knowledge exchange.
Building on the existing knowledge-translation literature, therefore, the aim of this study was to explore the mechanisms of knowledge translation about person-centered care among care assistants in long-term care. The objectives were to examine how these staff develop their understanding of person-centered care; identify the personal and contextual factors involved; and explore what can be learned about person-centered care from their current practices. The study used ethnographic methods, including 500 hours of participant observation, in-depth interviews, and document analysis, to conduct case studies of two private nursing homes located in the East Midlands and the north-eastern United States. Without claiming to demonstrate causality, extending the research across two policy settings did facilitate the identification of pertinent issues within and beyond each individual facility. Data analysis was informed by practice theory, which provided an alternative to the individualist assumptions which characterize popular representations of long-term care, on the one hand, and, on the other, structural explanations that renounce individual agency altogether.
From this theoretical perspective, drawing in particular on Bourdieu‘s theory of practical logic and the neo-institutional concept of institutional logics, this study identified how the interconnection of particular practices within each setting produced different situated understandings and implementation of person-centered care. A key finding was that care assistants‘ individualized knowledge about each resident, obtained through their direct daily care, represented an important form of symbolic capital in this field. Their willingness or reluctance to share such knowledge, consequently, corresponded to the extent to which other practices, including communication and teamwork, supported or threatened this limited source of power. The second, related finding was that care assistants derived from this individualized knowledge a certain amount of autonomy, or discretion, over the organization and delivery of daily care. This discretion, together with the agency that care assistants exercised in navigating different institutional logics in this context of care – which was the third main finding – signified a potential nexus of practice change. Conversely, new knowledge or ideas that undermined this limited discretion and agency tended to engender denial or resistance.
As the population ages, demand for long-term care for older people is increasing exponentially, prompting concerns about the capacity and sustainability of this sector. One significant area of concern is workforce recruitment, retention, and competence. This study, located at the intersection of research on long-term care and knowledge translation, contributes to efforts to address these concerns by identifying opportunities for intervention in education, training, and support, in order to build a workforce that is equipped to provide high-quality, evidence-based, person-centered care for older people throughout the years ahead.
The short report describes the development from page to stage of a work of theatre based on an et... more The short report describes the development from page to stage of a work of theatre based on an ethnographic study. The originating research focused on the work of health care assistants (nurse's aides) whose direct impact on the quality of life of highly dependent people is often overlooked. The research followed hospital personnel on wards specialising in the 'challenging behaviour' associated with dementia in central England. Conventional research outputs failed to engage the health care assistants themselves, so we turned to theatre to remedy this. The development of the field notes into theatre was characterised by the artistic freedom given to the playwright, in contrast to more data-led approaches to theatre making. The account of the process of creating the play, Inside Out of Mind, is followed a description of how the work was received by specialist and general audiences totalling 2000+. The discussion seeks to locate the whole enterprise in relation to the field of research-based theatre and explores how the production and its associated learning events relate to definitions of research-based theatre in the light of recent attempts to encapsulate this broad and diverse methodology.
Although there is much written on the emotional labour of nursing, there is little research groun... more Although there is much written on the emotional labour of nursing, there is little research grounded in the experience of so-called ‘unqualified’ care assistants. This paper is drawn from an ethnographic study conducted with care assistants on three dementia care wards in one mental health trust within the United Kingdom National Health Service (NHS). We describe the emotional labour carried out by care assistants in their attempts to provide personalised care for people whose cognitive degeneration renders conventional relationship-building very difficult, produces unpredictable ‘challenging behaviour’ and calls into question the notion of ‘feeling rules’. This context requires the ability to strike a balance between emotional engagement and detachment, and it is the complexities of this relationship that are the focus of this paper, arguing that a degree of detachment is a prerequisite to engagement in this context. In conclusion, we argue that the contribution of care assistants in this context needs to be better acknowledged, supported and remunerated.
Rising dementia incidence is likely to increase pressures on healthcare services, making effectiv... more Rising dementia incidence is likely to increase pressures on healthcare services, making effective well coordinated care imperative. Yet, barriers to this care approach exist which, we argue, might be understood by focussing on identity dynamics at the frontlines of care. In this article, we draw upon findings from an ethnographic study of healthcare assistants (HCAs) from three dementia wards across one National Health Service mental health trust. Data revealed that the HCAs are a close-knit ‘in-group’ who share low group status and norms and, often highlight their own expertise in order to promote self worth. HCAs’ social identity is considered as a barrier to effective teamwork with strong ingroup behaviour suggested as a consequence of their marginalisation. We explore these findings with reference to social identity theory (Tajfel, 1974; Turner, 1978) and discuss implications for delivering multiprofessional and interprofessional care.
Ethnography has classically been conducted by a single scholar, often referred to as a ‘Lone Rang... more Ethnography has classically been conducted by a single scholar, often referred to as a ‘Lone Ranger’, who develops an interpretation of a cultural setting based on their immersion within it. Overshadowed by this historical icon and located within an academe that privileges individual achievement, ethnography as a group effort has received less consideration in the methodology literature. Nevertheless, team ethnography conducted by multiple researchers at one or more research sites is becoming increasingly common and requires explicit attention. With reference to the existing literature and a recent team ethnography of in-patient dementia care, this paper argues that team ethnography is not just a case of ‘add researchers and stir’, but rather a methodology entailing specific issues and considerations. In particular, the paper explores how the two-phase design of the dementia care ethnography – which entailed researchers collecting data first as conventional lone ethnographers, then as a team with shared understandings and objectives – brings to light the opportunities and challenges of this methodology.
Background: Stigmatizing attitudes can impair the quality of life of people with mental health pr... more Background: Stigmatizing attitudes can impair the quality of life of people with mental health problems. Psychiatric hospitalization can generate stigma. Are some approaches to care less stigmatizing than others?
Aims: This study was designed to replicate findings from Flanders, Belgium in an English context, investigating how ward size and treatment approach affected service users’ expectations and experiences of stigma.
Methods: The translated Belgian questionnaire was administered to 70 service users in 15 inpatient adult mental health settings in central England. Adjustments were made to the multivariate analysis in light of the smaller sample size, in order to replicate the original equation as closely as possible.
Results: Neither ward size nor individualized care proved significant in the smaller English sample, which was subject to the risk of type II error. Across two models, self-rejection correlated with age (negatively), social rejection and stigma expectations.
Conclusions: This analysis shows that attempts to translate evidence about psychiatric inpatient services must take into account differences between the settings, populations and models of care. Expectations as well as outcomes of stigma may be relevant when assessing the impact of psychiatric hospital treatment on individual patients.
Attempts to improve the provision of long-term care for older people, especially but not exclusiv... more Attempts to improve the provision of long-term care for older people, especially but not exclusively people with dementia, often invoke the concept of “person-centred care”. Usually contrasted against depersonalised, routine-driven, task-focused approaches, person-centred care purportedly takes into account the unique history, identity, needs, and wishes of each individual, to the extent possible and regardless of physical or mental capacity. However, despite its discursive proliferation, the evidence base for person-centred care remains limited. This may be both cause and consequence of the lack of specificity and consistent usage of the concept. This presentation will explore, in particular, the similarities and dissonances between the discourse of person-centred/-centered care in the United Kingdom and United States, drawing on published research, policy documents, and grey literature from care organisations and providers. The argument will be elaborated with findings from recent ethnographic fieldwork undertaken in two private nursing homes which have explicitly endorsed a person-centred care approach at the operational level. One facility is located in the East Midlands and the other in the northeast United States. The aim of this larger project is to critically assess how nonqualified nursing staff in long-term care facilities develop, engage with, and implement knowledge about person-centred care as well as to distil cross-national differences in the definition of this approach to care. The presentation will conclude with a brief discussion of the implications of attempts to translate research findings from one health-care policy and delivery context to another in the absence of conceptual clarity and consensus.
Uploads
Building on the existing knowledge-translation literature, therefore, the aim of this study was to explore the mechanisms of knowledge translation about person-centered care among care assistants in long-term care. The objectives were to examine how these staff develop their understanding of person-centered care; identify the personal and contextual factors involved; and explore what can be learned about person-centered care from their current practices. The study used ethnographic methods, including 500 hours of participant observation, in-depth interviews, and document analysis, to conduct case studies of two private nursing homes located in the East Midlands and the north-eastern United States. Without claiming to demonstrate causality, extending the research across two policy settings did facilitate the identification of pertinent issues within and beyond each individual facility. Data analysis was informed by practice theory, which provided an alternative to the individualist assumptions which characterize popular representations of long-term care, on the one hand, and, on the other, structural explanations that renounce individual agency altogether.
From this theoretical perspective, drawing in particular on Bourdieu‘s theory of practical logic and the neo-institutional concept of institutional logics, this study identified how the interconnection of particular practices within each setting produced different situated understandings and implementation of person-centered care. A key finding was that care assistants‘ individualized knowledge about each resident, obtained through their direct daily care, represented an important form of symbolic capital in this field. Their willingness or reluctance to share such knowledge, consequently, corresponded to the extent to which other practices, including communication and teamwork, supported or threatened this limited source of power. The second, related finding was that care assistants derived from this individualized knowledge a certain amount of autonomy, or discretion, over the organization and delivery of daily care. This discretion, together with the agency that care assistants exercised in navigating different institutional logics in this context of care – which was the third main finding – signified a potential nexus of practice change. Conversely, new knowledge or ideas that undermined this limited discretion and agency tended to engender denial or resistance.
As the population ages, demand for long-term care for older people is increasing exponentially, prompting concerns about the capacity and sustainability of this sector. One significant area of concern is workforce recruitment, retention, and competence. This study, located at the intersection of research on long-term care and knowledge translation, contributes to efforts to address these concerns by identifying opportunities for intervention in education, training, and support, in order to build a workforce that is equipped to provide high-quality, evidence-based, person-centered care for older people throughout the years ahead.
Aims: This study was designed to replicate findings from Flanders, Belgium in an English context, investigating how ward size and treatment approach affected service users’ expectations and experiences of stigma.
Methods: The translated Belgian questionnaire was administered to 70 service users in 15 inpatient adult mental health settings in central England. Adjustments were made to the multivariate analysis in light of the smaller sample size, in order to replicate the original equation as closely as possible.
Results: Neither ward size nor individualized care proved significant in the smaller English sample, which was subject to the risk of type II error. Across two models, self-rejection correlated with age (negatively), social rejection and stigma expectations.
Conclusions: This analysis shows that attempts to translate evidence about psychiatric inpatient services must take into account differences between the settings, populations and models of care. Expectations as well as outcomes of stigma may be relevant when assessing the impact of psychiatric hospital treatment on individual patients.
Building on the existing knowledge-translation literature, therefore, the aim of this study was to explore the mechanisms of knowledge translation about person-centered care among care assistants in long-term care. The objectives were to examine how these staff develop their understanding of person-centered care; identify the personal and contextual factors involved; and explore what can be learned about person-centered care from their current practices. The study used ethnographic methods, including 500 hours of participant observation, in-depth interviews, and document analysis, to conduct case studies of two private nursing homes located in the East Midlands and the north-eastern United States. Without claiming to demonstrate causality, extending the research across two policy settings did facilitate the identification of pertinent issues within and beyond each individual facility. Data analysis was informed by practice theory, which provided an alternative to the individualist assumptions which characterize popular representations of long-term care, on the one hand, and, on the other, structural explanations that renounce individual agency altogether.
From this theoretical perspective, drawing in particular on Bourdieu‘s theory of practical logic and the neo-institutional concept of institutional logics, this study identified how the interconnection of particular practices within each setting produced different situated understandings and implementation of person-centered care. A key finding was that care assistants‘ individualized knowledge about each resident, obtained through their direct daily care, represented an important form of symbolic capital in this field. Their willingness or reluctance to share such knowledge, consequently, corresponded to the extent to which other practices, including communication and teamwork, supported or threatened this limited source of power. The second, related finding was that care assistants derived from this individualized knowledge a certain amount of autonomy, or discretion, over the organization and delivery of daily care. This discretion, together with the agency that care assistants exercised in navigating different institutional logics in this context of care – which was the third main finding – signified a potential nexus of practice change. Conversely, new knowledge or ideas that undermined this limited discretion and agency tended to engender denial or resistance.
As the population ages, demand for long-term care for older people is increasing exponentially, prompting concerns about the capacity and sustainability of this sector. One significant area of concern is workforce recruitment, retention, and competence. This study, located at the intersection of research on long-term care and knowledge translation, contributes to efforts to address these concerns by identifying opportunities for intervention in education, training, and support, in order to build a workforce that is equipped to provide high-quality, evidence-based, person-centered care for older people throughout the years ahead.
Aims: This study was designed to replicate findings from Flanders, Belgium in an English context, investigating how ward size and treatment approach affected service users’ expectations and experiences of stigma.
Methods: The translated Belgian questionnaire was administered to 70 service users in 15 inpatient adult mental health settings in central England. Adjustments were made to the multivariate analysis in light of the smaller sample size, in order to replicate the original equation as closely as possible.
Results: Neither ward size nor individualized care proved significant in the smaller English sample, which was subject to the risk of type II error. Across two models, self-rejection correlated with age (negatively), social rejection and stigma expectations.
Conclusions: This analysis shows that attempts to translate evidence about psychiatric inpatient services must take into account differences between the settings, populations and models of care. Expectations as well as outcomes of stigma may be relevant when assessing the impact of psychiatric hospital treatment on individual patients.