Darla Fortune

Theoretical foundations guiding culture change: The work of the Partnerships in Dementia Care Alliance

Longstanding concerns about quality care provision, specifically in the area of long-term care, have prompted calls for changing the culture of care to reflect more client-driven and relationship-centred models. Despite an increase in culture change initiatives in both Canada and the United States, there is insufficient information about the theories and approaches that guide culture change. The purpose of this paper is to describe a culture change initiative currently underway in Canada, the Partnerships in Dementia Care Alliance, and the theoretical foundations informing our work. More specifically, we describe how the theoretical and philosophical underpinnings of the Alzheimer Disease and Related Dementias framework, the authentic partnership approach, participatory action research and Appreciative Inquiry have been integrated to guide a culture change process that encourages working collaboratively, thinking and doing differently and re-imagining new possibilities for changing the culture of dementia care.

Social justice and women leaving prison: beyond punishment and exclusion

Questions related to social justice are often considered frivolous or irrelevant in the context of people who come into conflict with the law. Young (1990, Justice and the politics of difference, Princeton University Press) has pointed to the importance of social justice, especially in societies where the dominant perspective of the privileged is regarded as neutral (and presumably fair), while others remain oppressed and excluded. We investigate the relevance of social justice in the treatment of women who are in prison. Based on more than a decade of practice and four years of research with women in one of Canadas federal prisons for women, we explore the question of social justice in the context of a recreation and leisure initiative whose aim is to assist women not only while they are incarcerated but most especially on release. The social recreation program is brought into the prison by a restorative justice community‐based organization. Men and women from the community come into the prison to recreate together and, in that context of natural conversation, relaxation and dialogue, Circles of support may develop. If a Circle is formed, volunteer members then follow the woman into the community and support her efforts to live as a participating citizen on release. The relevance of the work of Circles in furthering social justice within a system that, despite recent potentially innovative approaches to incarcerating women, has struggled to move beyond traditional practices of punishment and exclusion, which tend not to encourage strong and healthy community life, will be explored.

Notes from the Sports Club: Confessional Tales of Two Researchers

Reflexive forms of field research acknowledge the impact of the researcher in the production and interpretation of ethnographic data. In this article we highlight and discuss issues that stemmed from their critical reflection while conducting field research in a small sports club in rural Canada. We give consideration to the nature of their role relationships, participation, performances, and negotiation of balance and distance. The resultant self-revealing text provides the basis for discussion on issues relating to power, representation, subjectivity, and interpretation.

Community (Dis)connection Through Leisure for Women in Prison

This article examines incarcerated womens leisure and re-entry into community. Framed in creative analytic practice, two poems reflect two major themes: (1) womens experiences of disconnection from community prior to and deepened by experiences in prison and (2) leisure and community re-entry, which describes complex meanings of leisure for women in prison and implications for return to community. These poems elucidate six often incongruous facets of leisure experience. Structures embedded in leisure service provision stigmatize and limit rather than encourage opportunities for incarcerated women to make personal choices regarding leisure. Leisure also provides contexts of relationship and humanity for women as they re-enter community.

“It is like stepping into another world”: Exploring the possibilities of using appreciative participatory action research to guide culture change work in community and long-term care

This paper highlights the possibilities for transformation that exist when a diverse group of participants interested in working together to change the culture of dementia care in long-term care and community care settings use appreciative participatory action research to guide their culture change efforts. These transformations happened throughout the culture change process using appreciative participatory action research. For instance, using appreciative participatory action research to guide the culture change process provided participants with the opportunity to build stronger professional and personal relationships in their respective care communities. Culture change transformations also stemmed from the appreciative participatory action research process, as participants recognized the importance of finding ways to include persons with dementia/residents in the process and they developed an appreciation for the valuable contributions persons with dementia/residents can make to culture change work. These culture chance possibilities demonstrate the value in using appreciative participatory action research to guide culture change in long-term care and community care contexts. These possibilities also illustrate the importance of paying closer attention to the culture change process itself, rather than solely the outcomes of the process, given that the possibilities for transformation that can take place throughout the process can help to build momentum, propelling culture change efforts forward in healthcare contexts.

Sharing the Journey: Exploring a Social Leisure Program for Persons with Dementia and Their Spouses

ABSTRACT In this article, we highlight the marginalization and exclusion persons with dementia and their spouses often face in leisure practices and spaces. We then explore aspects of a peer-led community social program aimed at inclusion. Framed in creative analytic practice, the experiences of members of the social program are shared through a composite narrative. This narrative tells the story of a couple from the point of diagnosis who seek support and education and eventually find deep social connections with others who are on a shared journey. We draw from this narrative to explore meanings of inclusion for spousal couples on the dementia journey and use a social justice lens to consider how to address experiences of exclusion in leisure practices and spaces.

It was like reading a detective novel: Using PAR to work together for culture change.

Participatory action research (PAR), with its focus on engagement and collaboration, is uniquely suited to enhancing culture change initiatives in dementia care. Yet, there is limited literature of its application to culture change approaches in care settings, and even less in dementia specific care contexts. To address these gaps in the literature, the purpose of this paper is to examine the complexities of a PAR project aimed at changing the culture of dementia care in two diverse dementia care settings, including a long term care (LTC) and community care setting. Drawing from data gathered throughout the PAR process, we unpack the challenges experienced by participants working together to guide culture change within their respective care settings. These challenges include: overextending selves through culture change participation; fluctuating group membership; feeling uncertainty, confusion and apprehension about the process; frustratingly slow process; and seeking diverse group representation in decision making. We also highlight the potential for appreciative inquiry (AI) to be integrated with PAR to guide a process whereby participants involved in culture change initiatives can develop strategies to mitigate challenges they experience. We view the challenges and strategies shared here as being constructive to would-be culture change agents and hope this paper will move others to consider the use of PAR when engaging in culture change initiatives.

Re-imagining institutional spaces: the communitizing potential of leisure

In this article, we critically examine an alternative to the theoretical concepts of dividing practices (Foucault, M. (1982). The subject and power. Critical Inquiry, 8, 777–795) and total institutions (Goffman, E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. Garden City, NY: Anchor Books) by exploring the communitizing potential of long-term care facilities and prisons. In doing so, we highlight the possibility for meaningful leisure experiences to open these institutions to the broader community and foster a more inclusive vision of community. We believe that opportunities for leisure involvement can provide community members and those residing in institutions with the chance to come together in ways that are mutually enhancing; however, these opportunities have not yet been realized to an extent that will truly bring about authentic social change. We argue that a re-imagining of these spaces as sites for inclusive leisure experiences can foster much needed social support not only for citizens residing in institutions, but equally so for citizens living in the broader community.

Relationship-centered dementia care: Insights from a community-based culture change coalition

This article reports on the work of a community-based culture change coalition affiliated with the Partnerships in Dementia Care Alliance, a research network committed to strengthening dementia care through supporting relationship-centered care approaches. Research to date emphasizes negative aspects of dementia care relationships. Drawing on data the culture change coalition collected as part of their culture change work using participatory action research guided by appreciative inquiry, this article examines what relationship qualities contributed to positive dementia care experiences and how positive relationships were created. Five types of care partners participated in the study through questionnaires, focus groups, and a mini appreciative inquiry summit. Data were analyzed collaboratively with culture change coalition members. Early in the analysis process, the aspiration statement “Relationships are at the heart of dementia care in [name of] County,” was developed and informed further thematic analysis. Findings revealed several relationship characteristics including friendship, commonality of experience, developing trust and feeling appreciated, reciprocity, and taking time/making time for relationships. As this article illuminates, relationship-centered programs and policies have the potential to foster positive dementia care experiences among diverse care partners in community settings.

Natural leisure spaces in long-term care homes: challenging assumptions about successful aging through meaningful living

ABSTRACT In promoting high physical activity and productive engagement as the motto of successful aging, society has cast individuals living in long-term care (LTC) homes as aging unsuccessfully [Holstein, M. B., and M. Minkler. 2003. “Self, Society and the ‘New Gerontology’.” The Gerontologist 43: 787–796]. The purpose of this paper is to explore ways natural leisure spaces within an LTC home can challenge deficit-based assumptions of decline and dependence in later life. Interviews were conducted with 9 residents, 8 family members and 11 staff recruited from one mid-sized LTC home in Ontario, Canada. The study used a hermeneutic phenomenological method, as described by van Manen [1997. Researching Lived Experience: Human Science for an Action Sensitive Pedagogy. London, ON: The Althouse Press]. Lived experiences of participants throughout the interviews revealed how natural leisure spaces sparked continued expressions of individuality, opportunities to nurture relationships and maintain family social roles.