Thecla Damianakis

Qualitative Research With Small Connected Communities: Generating New Knowledge While Upholding Research Ethics

Qualitative researchers have a dual mission: to generate knowledge through rigorous research and to uphold ethical standards and principles. Qualitative researchers often conduct studies with small connected communities in which relationships exist among community members. When engaging such communities, researchers might face ethical issues in upholding confidentiality standards while they work to achieve their dual mandate. Qualitative scholars have paid little attention to the ethical challenges that might arise in this context. Drawing on our experiences conducting studies with such communities, we expand the dialogue concerning qualitative research ethics by making explicit conceptual and practical tensions that emerge at various stages of the research process; articulating our respective reflective processes; and exploring issues associated with strategies for upholding confidentiality. We conclude with lessons learned to guide researchers who might face similar challenges.

Multimedia Biographies: A Reminiscence and Social Stimulus Tool for Persons with Cognitive Impairment

The multimedia biography tells the story of the life of an elderly person with a cognitive impairment in motion picture format. The multimedia biography combines family photographs, film clips, audio narration, and music. It is intended to be screened on an ongoing basis to provide spaces for reminiscence and communication between cognitively impaired persons and their families. Using a production process in which we collaborated with family caregivers, we created 12 multimedia biographies for persons having Alzheimers disease or mild cognitive impairment. This article describes our production and screening processes. We also share lessons learned from the multimedia biography research to assist practitioners, families, or researchers who wish to use similar technologies and processes for eliciting and sharing life stories.

Postmodernism, Spirituality, and the Creative Writing Process: Implications for Social Work Practice

Social work, as a profession, is struggling to determine the value of postmodernism and spirituality, and how these approaches to life provide alternative ways of interpreting the universe and the nature of social work practice. Although social work is founded on both a liberal arts and a social science education, some authors are challenging social works historical emphasis on the social sciences; they advocate that social work instead reconsider the role of the humanities as a force affecting practice. While social work continues to root its practice in modernity, determinism, and the social sciences, the possibility should be considered that postmodernism, spirituality, and the creative writing process have the potential to expand social work to a more creative and meaningful kind of practice. By exploring the relationships between power and knowledge, pathology and creativity, core identity and multiple selves, it becomes clear that our subjectivity, our human potential, and our voices can facilitate very deep intuitive, creative, and transpersonal levels of communication between the social worker and the client.

Social Workers' Experiences of Virtual Psychotherapeutic Caregivers Groups for Alzheimer's, Parkinson's, Stroke, Frontotemporal Dementia, and Traumatic Brain Injury

ABSTRACT The objective of this study was to examine the challenges for social workers who transition from facilitating face-to-face psychotherapeutic groups to online web-based video groups with family caregivers of persons with chronic disease. Study data consisted of survey responses of a group of therapists who had facilitated a series of web-based video-conferencing caregiver groups over a period of 4 years. All therapists were trained using an intervention training manual and weekly supervision. They received minimal training with regard to using technology (computers, Internet, web cams, and headsets). Despite reported challenges in how the technology affected the group process, therapists described overall positive experiences transitioning from face-to-face to working online. All therapists reported that group interactions and client outcomes in the Internet environment were overall comparable to those that occur in face-to-face groups.

Clinical practice standards and ethical issues applied to a virtual group intervention for spousal caregivers of people with Alzheimer's.

Abstract Advances in technology have improved access to health and social services by offering more abundant and convenient choices for clients. In particular, the use of technology for delivering services to older adults and their families offers new possibilities for service delivery, by reaching people who are often isolated, and have difficulty accessing traditional services. Despite the continued advances in technology development and its integration into healthcare delivery, health care practitioners need to consider how to adapt and uphold clinical practice standards and address ethical issues in an e-health environment. Given the gap in the literature with respect to discussing these issues, this paper illustrates relevant issues in the context of developing and evaluating an Internet-based intervention for spousal caregivers of persons with dementia. Based on a four year project, a psychotherapeutic group intervention was delivered via the Internet to three groups of spousal caregivers. This article identifies some of the key practice standards and ethical issues that arise when using computer technology to deliver a psychotherapeutic group intervention. The article will also provide examples of relevant issues related to maintaining practice standards and ethical procedures that need to be addressed during the application of a computer-based psychotherapeutic group intervention for spousal caregivers of people with dementia.

Barriers and facilitators to communicating nursing errors in long-term care settings.

Objective To explore nurses’ perceptions about communicating nursing errors. Design Cross-sectional, descriptive study. Participants Approximately 289 nurses working in long-term care facilities in Ontario, Canada. Methods A cross-sectional, descriptive study of approximately 289 nurses working in long-term care facilities in Ontario, Canada. Solicited nurses’ perceptions concerning the disclosure of nursing errors and adverse events by including an open-ended item at the conclusion of a 60-item (multiple choice) questionnaire on the same topic. A qualitative content analysis was conducted using a multi-step process. Results A total of 245 responses were included in the content analysis. The main categories related to error communication that were derived from the analysis were as follows: (1) differences in the definition of terms; (2) the day-to-day working conditions and their impact on defining and reporting errors; (3) organizational factors that both help and hinder the reporting of errors in ensuring both personal and organizational responsibility; (4) communication styles that both help and hinder disclosure and adherence to proper protocols; and (5) external factors such as policies and professional standards and codes of ethics, which can provide clarity of process; and (6) recommendations for implementation of professional standards in long-term care settings to facilitate supportive working conditions. Conclusion Eliminating the barriers to error communication requires moving toward a culture of safety. This involves both top-down and bottom-up approaches that allow nurses to feel comfortable being active participants in the error communication process.

Volunteers' Experiences Visiting the Cognitively Impaired in Nursing Homes: A Friendly Visiting Program

Aujourd’hui les soins médicaux en maisons de santé sont confrontésà la compréhension du concept de « qualité de vie » puisqu’ils touchent des personnes atteintes de déficits cognitifs, et à la recherche de moyens permettant l’application de ce concept. Le documentaire du réalisateur canadien Allan King, intitulé Memory for Max, Claire, Ida and Company (Mémoire pour Max, Claire, Ida et compagnie), filmé à Baycrest, dépeint une méthode utilisée pour améliorer la qualité de vie de six résidants atteints de déficits cognitifs. Bien que le film montre un modèle d’intervention effectué par des volontaires, il souligne aussi les problèmes spécifiques aux programmes d’intervention dans les établissements de santé, c’est à dire recruter et garder les volontaires. La peur que les volontaires peuvent éprouver en interagissant avec les personnes atteintes de déficits cognitifs représente un grand défit. Nous avons conduit une étude pilote sur un modèle de formation de volontaires qui vise à assurer une « visite sympathique » et avons étudié les effets obtenus sur les résidants ayant participé à l’étude. Les données concernant l’observation des interactions entre volontaires et résidants ainsi que sept interviews de volontaires ont été analysées et donnent lieu à plusieurs thèmes: a) la création des relations volontaires-résidants, b) l’effet de l’environnement, c) la préservation de l’intégrité de la personne, d) la nécessité d’être centré sur les besoins et la qualité du moment des résidants, ainsi que plusieurs autres thèmes liésau rôle des volontaires. L’implication de ces résultats pour les programmes de volontaires dans les établissements de santé à long terme est discutée. Two challenges facing nursing-home care today are understanding the concept of quality of life as it relates to cognitively impaired residents and finding effective ways to ensure that it is achieved. Canadian director Allan King’s documentary, Memory for Max, Claire, Ida and Company, filmed at Baycrest, captures a method for enhancing the quality of life of six cognitively impaired residents. While the film suggests an intervention model implemented by volunteers, there are challenges unique to institution-based programs (i.e., the recruitment and retention of volunteers). One of the challenges is the fear that volunteers may experience when interacting with the cognitively impaired. We conducted a pilot study of a model for training volunteers to provide friendly visiting and evaluated the impact on the participating residents. Observational accounts of volunteer–resident interactions and seven volunteer interviews were analysed and yielded several themes—(a) relationship building, (b) contribution of the environment, (c) preserving personhood, (d) resident-centred presence and the quality of the moment—and several themes related to the volunteers’ role and their perceived impact on the residents. Discussed are the implications for volunteer programs in long-term health care settings.

Falls Communication Patterns Among Nursing Staff Working in Long-Term Care Settings

Effective fall-risk communication both among staff and between staff and family members is vital for ensuring the safety of residents in long-term care (LTC) settings. This study uses focus group methodology to investigate how information about falls is identified, communicated, and responded to by licensed staff (registered nurses/registered practical nurses) and unlicensed staff (personal support workers) in four LTC facilities. The authors report on the major themes that emerged throughout the focus groups relating to falls management and report on similarities and differences in the communication processes between the two sampled groups. Results highlight communication of the resident’s fall risk, reporting procedures to staff and family members, care plan communication and adherence information, a falls quality improvement knowledge deficit, and barriers to falls quality improvement. Recommendations toward improved communication networks among diverse LTC staff to enhance fall-reduction efforts in LTC settings are provided.

Therapy Online: A Web-Based Video Support Group for Family Caregivers of Survivors With Traumatic Brain Injury.

Objective:This innovative descriptive study explores the benefits of a traumatic brain injury (TBI) caregiver support group intervention provided using videoconferencing within a password protected Web-based platform. Methods:Ten caregivers of family members with TBI were registered to a password-protected Web site (Caring for Others) that provided information about caring for a person with TBI and access to a videoconferencing support group intervention program. Where needed, caregivers were provided with computer equipment, Internet access, and training to negotiate the Web site links. Two groups of 5 caregivers of survivors of TBI participated (average age of survivor—20 years, average time since injury—4.6 years) and met online with a trained clinician weekly for 10 sessions. Using directed content analysis, transcripts of each session were coded with NVivo software. Results:The content analysis reported group process themes, therapeutic interventions used, caregiver outcomes, and the challenges for clinicians delivering a therapeutic intervention online. Conclusions:Traumatic brain injury caregivers shared similar concerns and problem-solving strategies for managing caregiving tasks. Overall, participants found the sessions helpful for managing the emotional impact of caring for a family member with TBI.

Social Work's Dialogue With the Arts: Epistemological and Practice Intersections

Despite historical acknowledgements and recent advancements in conceptualizing the arts for social work, the calls for arts inclusion have yet to stimulate a sustained research program. Taking creative writing as exemplary art, this inquiry gathered accounts of key constructs related to the arts. Using M. van Manens (1997) phenomenological-hermeneutic methodology, 31 creative writers, teachers of creative writing, “arts inclusive” social workers, and social work researchers completed in-depth interviews. The participants’ accounts illustrated that the arts’ intersection with social work facilitated integrated, nondual epistemologies for practice. The social workers also highlighted the limits and benefits of including the arts in practice. The proposed arts infusion approach calls upon an enlarged view of human reality for social work within an ongoing ethic of care.