Abram Oudshoorn

Mother-Adult Daughter Relationships Within Dementia Care A Critical Analysis

Evidence suggests that intergenerational caregiving between mothers and daughters will become increasingly common, and yet, we know very little about the specific relationships between adult daughters and their mothers with dementia. Guided by socialist-feminist theory and a life-course perspective, 15 mother-adult daughter dyads participated in two individual, semistructured interviews. Data analysis revealed four dynamic types of mother-daughter relationships: custodial, combative, cooperative, and cohesive. Custodial and cooperative relationships mainly focused on the provision of and receipt of tasks, whereas combative and cohesive are emotion focused. At the same time, custodial and combative relationships are based on deficits compared with strength based cohesive and cooperative relationships. In addition, certain contextual factors, such as expectations of care and levels of support, shaped the development of these relationships. Moreover, study findings highlight a number of implications for practice, policy, and research necessary to support individuals with dementia and their families.

Making care decisions in home-based dementia care: Why context matters

D’ici à 2038, le nombre d’heures de soins non rémunérées aux aînés offert par les membres de la famille devraient tripler. Les membres des familles sont souvent suppliés d’aider dans le processus parce que vivre avec la démence peut inhiber la capacité pour prendre une décision. Cette étude ethnographique a soumis les relations au sein de soins de la démence à domicile à un examen critique par le biais des entrevues face-à-face et les observations des participants des clients, des aidants naturels et des prestataires de soins à domicile. Les résultats ont révélé comment les décisions sont imposées dans le contexte du système de soins à domicile formels, et ont mis en évidence trois thèmes: (1) L’accommodation de la compétence/incompétence, comme définie cliniquement; (2) La prise de décisions inopportunes; et (3) Le renforcement de l’exclusion des déments dans la prise de décision. Ces thèmes illuminent la façon dont les valeurs culturelles (la compétence), les croyances (l’immuabilité du système) et les pratiques (le réglage des décisions) dans le système de soins à domicile sont finalement déterministes dans la prise de décisions pour les déments et leurs aidants. Afin d’optimiser la santé des déments qui se font soignés à domicile, il faut accorder d’attention supplémentaire aux pratiques collaboratives et inclusives des membres des familles. The hours of unpaid elder care by family members are projected to triple by 2038. Because living with dementia can inhibit decision-making abilities, family members are often besought to assist in this process. In this ethnographic study, relationships within home-based dementia care were critically examined through face-to-face interviews and participant observations with clients, family caregivers, and home care providers (n = 51). The findings revealed how the formalized home care system contextually imposes decisions, and revealed three themes: (1) accommodating clinically defined competence/incompetence, (2) making untimely decisions, and (3) reinforcing exclusion in decision making. These themes shed light on how cultural values (competency), beliefs (immutability of the system), and practices (timing of decisions) of the home care system are ultimately deterministic in decision making for persons with dementia and caregivers. Additional attention to the collaborative and inclusive practices of all family members in dementia home care is imperative in order to optimize health.

Dementia Home Care Resources: How Are We Managing?

With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future.

Relational Experiences of Family Caregivers Providing Home-Based End-of-Life Care

The multiple relationships involved in home-based end-of-life care have received little systematic analysis. As part of a focused ethnographic study examining client–caregiver–provider relational care experiences within the sociocultural context of home-based end-of-life care, this article describes the provision of end-of-life care to older adults with advanced cancer from the perspective of family caregivers. Data were collected through in-depth interviews (n = 16) with 4 family caregivers and participant observations in each of the 4 households over a 6- to 8-month period. Family caregiving in home-based end-of-life care was portrayed in this study as 3 dialectical relational care experiences: (1) prioritizing care recipient needs–ignoring own needs, (2) feeling connected–feeling isolated, and (3) juggling to manage–struggling to survive. Study findings suggest that the sociocultural context of end-of-life care is not conducive to quality care and provide several insights for future directions in nursing practice, policy, and research.

Comment on: Archibald M.M. & Clark A.M. (2014) Twitter and nursing research: how diffusion of innovation theory can help uptake. Journal of Advanced Nursing 70(3), e3-5. doi:10.1111/jan.12343.

In Archibald and Clark’s (2014) editorial, they provide an interesting and intriguing examination of Twitter’s adoption by nurses and researchers into the profession through the lens of Rogers’ (2003) Diffusion of Innovations Theory. Although the authors outline a variety of reasons as to why Twitter has failed to take hold in nursing academic circles, we believe that their editorial misses a few important considerations when exploring the adoption of social media platforms such as Twitter. Foremost, Twitter is a social technology. Correspondingly, the modality of communication that Twitter enables is a trait of the technology, and also co-created through the role and value its users have inscribed onto the technology. In other words, Twitter as an innovation is exceedingly mouldable, scalable and non-static. In this vein, both the innovation (i.e. Twitter) and its users help to generate the current dynamic that is the Twittersphere, and the inherent culture, attitudes and etiquette that are allowed to exist and operate on Twitter. As a by-product of this continuously evolving relationship, some nursing researchers have found value in using Twitter as a means to distribute information related to research. Just as Facebook is an ‘accidental health platform’ (Fox 2014), Twitter too has become an accidental mechanism for distributing information of all genres, including nursing research. Therefore, as an accidental platform for nursing research dissemination, it is important to appreciate that the platform likely only resonates with potential users (and nurses) who are able to internalize both the technical competencies required to use the platform, but more importantly, to also appreciate the larger social implications and value of this communication modality. From an ontological perspective, the Diffusion of Innovation approach typically privileges the innovation in question (i.e. Twitter), conceptualizing the innovation as an entity that compels other elements in the surroundings to conform around its presence. As outlined by Archibald and Clark, the adoption of Twitter by nursing has not been comparable to the adoption rates of adults in the general population, leading them to question this ‘inertia’ from the perspective of the profession (p. e3). As Twitter is an innovation that holds the potential to exponentially amplify the social abilities of its users, any person wishing to adopt and use Twitter in a sustained fashion is subject to an array of complex socio-technical considerations, which may not be present in other types of technical innovations that are less socially mediated. In an effort to outline how social platforms (and their users) are shaped by the networked nature of social media, Kietzmann et al. (2011) outlined a ‘social media ecology’ (p. 241) as a means of understanding a user’s audience and needs within situations involving social technology. In this ecology, the elements of presence, sharing, conversations, groups, relationships, reputation and identity are outlined as potential factors that influence engagement in social media dynamics. Therefore, depending on the context, role and responsibilities of a nurse (or researcher), the need or value of Twitter may not resonate enough to support adoption, or sustain use. Insomuch, the presence of the innovation itself is not sufficient to drive adoption; rather, the depth of understanding of Twitter and need of the potential user to undertake elements like identity building, maintenance of reputation, and sharing of information in the user’s role and life are likely more important predictors of adoption and sustained use in the postadoptive phase. Subsequently, it is not surprising that nursing researchers have largely ignored Twitter, particularly those established in their careers who have found sufficient translation of their body of work through other, traditional platforms, and who find limited utility for social media platforms in other facets of their daily lives. As clearly outlined by MacVaugh and Schiavone (2010), the ‘[u]tility [of an innovation], regardless of its nature or source, has never been a complete explanation for the behaviour of humans’ (p. 204). Therefore, a more fruitful area of exploration of Twitter within the profession would be to explore postadoptive behaviours of the platform, and how certain cross-sections of nurses utilize the platform, to what intensity, and for what purpose.

Community health promotion with people who are experiencing homelessness.

Homelessness is an experience of being displaced. Once removed from their personal places, homeless people are barred access to healthy places in which to be. Health clinics for people who are experiencing homelessness offer an opportunity to create health-promoting places. In this study, we explore how place is experienced within a community health clinic for people who are experiencing homelessness. A critical ethnographic methodology was used. Results illustrate how clients and providers contested the space of the clinic. Discourses of safety, health promotion, and privacy were enacted, altered, and resisted in a constant practice of culture-making. Physical components of the space became conceptual components of how place and power in place were understood by clients and providers. Results point to the importance of conceptualizing service users as the key stakeholders in their care, considering how places may be more or less health promoting, and rethinking how safety is conceptualized.

The geographic scope of opiate substitution therapy in an urban area in Canada

Abstract Opiate substitution therapy (OST) is an interdisciplinary treatment method for individuals experiencing opiate addictions. Municipalities internationally are working through a process of responding to both the need for OST clinics and community concerns around these clinics. The purpose of this quantitative descriptive study was to better understand the geographic spread of those currently accessing OST in an urban area in Canada. This will serve to assist related policy-making. Postal codes of 796 individuals accessing OST were obtained from one clinic and one dispensing pharmacy. Representing 581 unique data points, these were mapped across the 26 residential neighbourhoods in the city of study. Individuals accessing OST were located within an 11 km radius of the clinic and pharmacy. Situated in every neighbourhood in this radius, individuals accessing OST were in 24 of the 26 possible residential neighbourhoods. Ultimately, data support the hypothesis that individuals accessing OST are located in all residential neighbourhoods in the urban area of study. This supports current literature indicating that addiction exists throughout all urban areas rather than being limited to only certain neighbourhoods. This has implications for zoning of OST clinics and pharmacies, as municipalities must balance neighbourhood concerns while not overly restricting access throughout the municipality.

Evidence-Based Refinement of Health and Social Services: Exploring the Possibilities of Intravention Research

To promote evidence-based refinement of quality health and social services delivery and care, decision makers, researchers, and practitioners often undertake intervention research. Intervention research tests and describes new strategies for achieving desired outcomes. But theoretical, methodological, and practical issues continue to plague even alternative participatory approaches to intervention research, raising questions about its potential for promoting quality health and social services and care. In response to this persistent challenge, the authors of this article propose a radical solution, namely intravention research, laying out its unique features as well as its theoretical and practical implications. Their conceptualization sets the stage for dialogue on options for advancing research methodologies and methods that might better promote evidence-informed health and social services.