AbstractBackground: Tom Kitwood’s theory of dementia care centres on the concept that personhood is maintained and promoted through person centred care, and when personhood is maintained the person is more likely to experience well-being. Nursing has adopted Kitwood’s theory across most specialities, particularly dementia care, and it is now a major part of the education curriculum, policies and guidelines. Family caregivers are increasingly seen on acute hospital wards providing direct care mostly helping their relative in regard to eating and drinking. The assumption is that a family caregiver would instinctively practice person centred care, yet in reality relatives do not always implement the model as defined by Kitwood. This study was developed to explore the transferability of person-centred care in a family context.
Aim: The aim of this study was to measure and explore the applicability and acceptability of Kitwood’s theory of person-centred care to family caregivers when their relatives with moderate/advanced dementia refuse to eat.
Methods: The study focused on mealtimes. A mixed method convergent parallel methodology was utilised using a combination of the Beliefs about Caregiving questionnaire, Dementia Care Mapping, cognitive function, calorie intake, semi-structured interviews and participatory observations. Thirty-one dyads enrolled in phase 1 (quantitative phase) 18 of those completing phase 2 (qualitative phase). The quantitative data were analysed using appropriate statistical analysis, while the qualitative data were analysed using analytic induction methodology. Both sets of data were integrated to facilitate a deeper understanding of how transferable Kitwood’s theory of person centre care is to family caregivers.
Findings: Patient-centered care, as depicted by Kitwood, is replicated in the care given by the majority, but not all, family caregivers in this study. The results from this study demonstrate that person-centered care delivered by family caregivers was associated with higher levels of patient well-being and calorie intake. However, the family caregiver’s attachment style affects their person-centered decision making. These findings identify the need for further research replicating the quantitative methodology with a larger sample size to see if these findings can be re-produced with a greater level of confidence.
Contribution to knowledge: For those family caregivers who do not adopt a person-centred approach to the care of the family member with dementia, good dementia care may necessitate health care professionals choosing between conflicting responsibilities, values and the bioethical principles of autonomy, justice, and non-maleficence. Conceptualising care through a model of person centeredness may not provide healthcare professionals with a relevant framework when family caregivers play such a pivotal role. Should further research findings support the proposition that a patient’s tendency towards well-being and eating more is dependent on the delivery of person-centred care, family and professional caregivers would need to know, if they are concerned about calorie intake, they should focus on the person's well-being through the delivery of person-centred care.
|Date of Award
|Susan Proctor (Supervisor)