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Power, ethics, and person-centred care: using ethnography to examine the everyday practices of unregistered dementia care staff

Scales, Kezia; Bailey, Simon; Schneider, Justine M.

Authors

Kezia Scales kezia.scales@duke.edu

Simon Bailey Simon.Bailey@mmu.ac.uk

JUSTINE SCHNEIDER justine.schneider@nottingham.ac.uk
Professor of Mental Health & Social Care



Abstract

The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In institutional settings, person-centred approaches place particular emphasis on ‘empowering’ unregistered care staff to translate this idea into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power and the ethical constitution of subjects, this paper examines the complex ways that dementia care staff engage with their own ‘dis/empowerment’ in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers’ general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. By examining the daily dilemmas that care staff navigate, this paper contributes to our understanding of the complex risks and responsibilities entailed in direct care work, with implications for the provision of ethical and person-centred dementia care.

Journal Article Type Article
Publication Date Feb 8, 2017
Journal Sociology of Health and Illness
Print ISSN 0141-9889
Electronic ISSN 1467-9566
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 39
Issue 2
APA6 Citation Scales, K., Bailey, S., & Schneider, J. M. (2017). Power, ethics, and person-centred care: using ethnography to examine the everyday practices of unregistered dementia care staff. Sociology of Health and Illness, 39(2), https://doi.org/10.1111/1467-9566.12524
DOI https://doi.org/10.1111/1467-9566.12524
Keywords ethnography, care work, dementia, Foucault, nursing, empowerment
Publisher URL http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.12524/full
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf
Additional Information This is the peer reviewed version of the following article: Scales, K., Bailey, S., Middleton, J. and Schneider, J. (2017), Power, empowerment, and person-centred care: using ethnography to examine the everyday practice of unregistered dementia care staff. Sociol Health Illn, 39: 227–243. doi:10.1111/1467-9566.12524 which has been published in final form at http://onlinelibrary.wi...11/1467-9566.12524/full This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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