Bodywork in dementia care: recognising the commonalities of selfhood to facilitate respectful care in institutional settings

Abstract

This paper draws on two data sources (Kelly's ethnographic study and a British Broadcasting Corporation television programme) to explore the practice of bodywork in the care of frail people with dementia in institutional settings. It explores the complexity of engaging in bodywork, particularly work that is distasteful to the care-worker, and shows how non-recognition of the selfhood of the person with dementia can result in practices that are demeaning and potentially abusive to those in receipt of such work. In contrast to a person-centred approach that urges practitioners to acknowledge people with dementia as unique individuals, with unique needs, wishes, abilities and desires, this paper argues for the use of Sabat's Selfs 1-3 construct to look for commonalities of selfhood, enabling care workers to recognise aspects of themselves in their patients as they carry out care, thereby facilitating care that empathically respects their patients' dignity and potential for vulnerability. Thus, it aims to advance theory and improve practice by arguing for the necessity of putting selfhood at the forefront of bodywork in order to facilitate respectful care that dignifies rather than objectifies the person

Enhancing Critical Reflection amongst Social Work Students: The Contribution of an Experiential Learning Group in Care Homes for Older People

“…How far 'good practice' is driven by a formal defined set of practices or a more nuanced 'felt experience' built on empathy, attachment and established relationships is another dimension of micro-culture (Browne & Shlosberg, 2006;Kelly, 2013). The extent to which staff expertise, which could be conceptualised as a fusion of these two dimensions, is a recognised facet of care delivery is also relevant.…”

Dressing disrupted: negotiating care through the materiality of dress in the context of dementia

“…Identity thus becomes relationally constructed between the materiality of dress and the bodies of care‐workers, families, and people with dementia, a process of ‘becoming’ or ‘being‐with’ (Latimer : 37). Care‐workers often described how in deciding what the person should wear, they engaged in ‘empathic reflection’ (Kelly : 5), thinking about how clothes were important to them, and how they might feel ‘in their shoes’. Such reflection promotes consideration of ‘commonalities of selfhood’, supporting person‐centred approaches to care (Kelly ).…”

“…Care‐workers often described how in deciding what the person should wear, they engaged in ‘empathic reflection’ (Kelly : 5), thinking about how clothes were important to them, and how they might feel ‘in their shoes’. Such reflection promotes consideration of ‘commonalities of selfhood’, supporting person‐centred approaches to care (Kelly ). However, it could sometimes lead to presumptions about what was aesthetically preferable.…”

“…We also observed care-workers using clothes as a 'talking point' and a way of relating to residents with more advanced dementia at a sensory level, who would 'respond to different textures' and 'the feel' and 'touch' of tactile fabrics like velvet and silk. In this way the material properties of dress can afford possibilities for relating to someone with dementia as a person, rather than a body to be processed (Kelly 2014).…”

Living with dementia in hospital wards: a comparative study of staff perceptions of practice and observed patient experience

“…() identifying continued variable assessment and management of pain in cognitively impaired people in hospital, with the consequence that many people with cognitive difficulties will have unrecognised and untreated pain. Aminoff and Adunsky (), in their study of people with dementia who were dying, suggested that they experienced a higher degree of suffering, including restlessness and screaming; this can be attributed to unrecognised need, including pain, or non‐recognition of selfhood (Kelly, ). It is clear from this literature that people with dementia are at risk of receiving suboptimal care in the last years or months of their lives; this is, in part, due to the challenging nature of the work and insufficient knowledge of dementia held by practitioners in direct contact with people with dementia (Ryan et al ., ).…”