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Title: Pre-therapy and dementia : an action research project
Author: Dodds, Penny
ISNI:       0000 0001 3427 0082
Awarding Body: University of Brighton
Current Institution: University of Brighton
Date of Award: 2008
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This study explores the introduction of an approach called Pre-Therapy to staff working with people with dementia. Pre-Therapy contributes to the existing range of therapeutic approaches which aim to engage with the subjective experience of the world of people with dementia who have severe difficulty communicating. Pre-Therapy aims to facilitate engagement and create relationships with people who are traditionally seen as beyond contact or out of reach. The approach involves using contact reflections. The worker reflects back to the person their words, facial expressions, actions and surroundings. Until now, the application of Pre-Therapy to dementia care has not been explored in depth. An Action Research process examined the research question - What happens when staff learn and use Pre-Therapy contact reflections with people with dementia? The question involved three aspects: the response of people with dementia to contact work, the use of contact work by staff, and the learning process undergone by staff. Underpinned by values of inclusion, participation, democracy and collaboration, the study demonstrates joint inquiry and cyclical exploration. The research process involved self-participation, participation with health care staff and engagement with an expert community (The International Pre-Therapy Network). The entire research process spanned five years. Eleven staff in three residential settings participated as colearners for 18 months of the process. Located in the real world context, the study accommodated organisational flux, service instability and changes of personnel in a climate of modernization and reorganisation. Data were generated through observation, which included 14 hours of video recordings of interactions, and ongoing dialogue with health care staff and the expert community. The analytic process accompanied the research activity, using comparative analysis and Schatzman's Dimensional Analysis. Findings indicate that Pre-Therapy Contact Work has the potential to add to existing approaches in dementia care, facilitating greater self-expression of the experience of the subjective world of the person with dementia and promoting greater communication with workers. However, minor adaptations of the approach are indicated. Despite the apparent simplicity, contact work challenged staff. Barriers to learning and using contact work arose from intrapersonal, interpersonal and contextual factors. Factors which mediated the learning and use of contact work led to the emergence of a theoretical model of the emotional management of interactions. Resting on theories of constructed role identities, the model contains two contrasting positions: the emotional custodian and the emotional container. The thesis proposes that the model may be part of an underlying social process around maintaining emotional social order in interactions with people with dementia. In turn, this may help understand difficulties workers face when engaging in the emotional world of people with dementia and enacting values of being person-centred which are inherent in the policy and literature.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: B700 Nursing and Midwifery