JoAnn Perry

Rewriting Cultural Safety Within the Postcolonial and Postnational Feminist Project Toward New Epistemologies of Healing

The concept of cultural safety, developed by indigenous nurses in the postcolonial climate of New Zealand, has not been widely examined in North America. In this article we explicate the theoretical and methodological issues that came to the forefront in our attempts to use this concept in our research with different populations in Canada. We argue that this concept prompts us to “think critically” about ourselves and our patients, and to be mindful of our own sociocultural, economic, and historical location. This critical reflection has implications for how we live, relate to one another, and practice in our various professional disciplines. On the basis of our findings, we discuss how the concept might be rewritten within a critical postcolonial and postnational feminist discourse.

Personhood in dementia care Developing a research agenda for broadening the vision

Dementia has been understood primarily as a biomedical phenomenon with a trajectory of irrevocable decline related to neurodegenerative changes. However, growing evidence suggests that the performance and behaviour of persons with dementia are not exclusively determined by neuropathology but are also influenced by personal histories, social interactions and social contexts. This evidence shifts attention from the disease process to the need for a more in-depth understanding of the place of personhood in dementia care. Despite its intuitive appeal however, there is limited empirical research grounding this approach to care. This article articulates a framework for organizing research in this area that is based on a critical review and synthesis of research. It encompasses three interrelated and intersecting domains of inquiry: the subjective experience of the person with dementia, the immediate interactional environment and the broader socio-cultural context. Each domain encapsulates a unique but interrelated dimension of a person-centred approach to dementia care.

Effectiveness of teaching in the rehabilitation of patients with chronic bronchitis and emphysema.

A STUDY ON THE EFFECTIVENESS OF TEACHING IN THE REHABILITATION OF PATIENTS WITH CHRONIC BRONCHITIS AND EMPHYSEMA This study concerned i t s e l f with planned teaching, based on p r i n c i p l e s o f adult education, as a component o f the r e h a b i l i t a t i o n of p a t i e n t s with chronic b r o n c h i t i s and emphysema. The need f o r teaching i n t h i s area has been recognized, but as yet not researched. The purpose of t h i s study was to determine whether the teaching i n t e r v e n t i o n , conducted i n groups and on a one-to-one b a s i s , would a f f e c t the patients a b i l i t y to recognize and t r e a t h i s disease symptoms. The n u l l hypothesis was tested: there i s no s i g n i f i c a n t d i f f e r e n c e i n the patients a b i l i t y to recognize and t r e a t disease symptoms a f t e r he has p a r t i c i p a t e d i n a teaching program as compared to h i s a b i l i t y to recognize and t r e a t disease symptoms before p a r t i c i p a t i n g i n such a program. Using two r e h a b i l i t a t i o n f a c i l i t i e s i n large metropolitan h o s p i t a l s , a l l p a t i e n t s accepted f o r the r e h a b i l i t a t i o n programs over a four-month period were asked to p a r t i c i p a t e i n the study. Ultimately, twenty p a t i e n t s made up the study group. Patients were i n s t r u c t e d i n diary-keeping s k i l l s and given one d i a r y per week for four weeks before they began the r e h a b i l i t a t i o n program. These d i a r i e s were reviewed on a weekly bas i s with the researcher. A f t e r the patients had p a r t i c i p a t e d i n the teaching program they were again given d i a r i e s (one per week f o r eight weeks) which were reviewed weekly with the researcher.

Daughters Giving Care to Mothers Who Have Dementia: Mastering the 3 R’s of (Re)Calling, (Re)Learning, and (Re)Adjusting

Using the process of constant comparative analysis to examine interview data, the current study explored the process of taking on and continuing to give care to mothers with dementia. The sample consisted of 19 daughters and 1 daughter-in-law; all but one were living with the mother. The core phenomenon of mastery captured the processes of (re)calling, through (re) learning how to be with the mother to (re)adjusting as the daughters try to take care of themselves and consider placing their mother in a nursing home. Through these processes, the daughters essentially deconstruct their images of their mother and rebuild the image to include the impact of the disease process. The inclusion of the cognitive work adds an additional focus for potential intervention with daughters who, in providing care for their mothers, form such a vital part of current health care systems.

A Family's Coming to Terms with Alzheimer's Disease

Findings of a qualitative analysis of several members of a family in which one member has Alzheimer s Disease (AD) support the notion that differences in how eachfamily member defines and makes meaning of the situation have consequences for the family as a unit. Ten in-depth individual and dyadic interviews of five available fanily members were conducted during a period of 18 months. Data support the finding that each member of the family experienced a similarprocess of coming to terms with changes in theperson who has AD. Thisprocess consisted of three stages: identifying how the person with AD was the same as he was before, as well as how he was different, prior to disease onset; redefining the identity of the person with AD; and rewriting ones relationship with the person with AD. This study supports both Knajls and Deatricks concept of family management and Pattersons concept offamily meaning.

Verbal and nonverbal indicators of quality of communication between care staff and residents in ethnoculturally and linguistically diverse long-term care settings

Linguistic and ethnocultural diversity in long-term residential care is a growing trend in many urban settings. When long-term care staff and residents do not share the same language or ethnocultural background, the quality of their communication and care are jeopardized. There is very little research addressing how staff and residents communicate when they experience a mismatch in their language and ethnocultural backgrounds. Thus, the goals of the present study were to 1) document the verbal and nonverbal behaviours used by staff and residents in diverse interactions, and 2) identify and account for behaviours that either promoted or detracted from positive communication by drawing on principles from ‘Communication Accommodation Theory’. Two long-term care facilities in British Columbia Canada were selected due to the diverse linguistic and ethnocultural backgrounds of their staff and residents. Twenty-seven staff and 27 residents consented to being video-recorded during routine activities (e.g., mealtimes, recreational activities). The recorded observations were transcribed, translated, and coded using qualitative descriptive and interpretive analyses. A number of verbal and nonverbal behaviours were identified and interpreted in relation to whether they promoted or detracted from positive communication. The findings point to considering a variety of proactive strategies that staff and administrators could employ to effectively accommodate to language and ethnocultural diversity in long-term care practice.

Perceptions of family caregivers' psychosocial behavior when communicating with spouses who have Alzheimer's disease.

The literature for caregivers of persons with Alzheimer s disease (AD) notes the importance of attending to the linguistic and psychosocial dimensions of communication. The objective of this study was to investigate the relationship between psychosocial aspects of caregivers’ behavior and communication outcomes for persons with AD and their spousal caregivers. In the first part of the study, we selected 40 segments of audio-recorded conversations between persons with AD and their spouses. We then asked 20 healthy seniors who were not caregivers to listen to and read the conversation segments and evaluate each segment along four psychosocial dimensions. They were also asked to independently rate how smooth the communication was in each segment. We hypothesized that when caregivers’ speech is perceived to be respectful, caring, not controlling, and/or it ascribes competence to their spouses, it would be associated with more effective communication. Our results supported these hypotheses in that communication was more likely to be rated higher in smoothness when the content and manner of caregivers’ speech were perceived to have positive psychosocial qualities. The findings have implications for training caregivers on effective psychosocial behavior when interacting with persons who have AD.

Acute Respiratory Failure in Scoliosis.

Excerpt Acute respiratory failure in adults with severe thoracic scoliosis is said to be a preterminal event. The following analysis of 13 consecutive cases contradicts this assumption. All patient...