‘Forgotten shopping, lost keys and hearts which forget to beat’: an exploration of nurses’ conceptualisation of dementia
Rhynas, Sarah Janet
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This thesis explores nurses’ conceptualisation of dementia and discusses the relationship between these understandings and nursing practice. Using the reflexive sociological approach of French scholar Pierre Bourdieu, the study seeks to advance practice through the enhancement of theoretical understandings. Data were collected in a range of inpatient clinical areas in Scotland using focus groups, individual interviews and observation. A range of nurses contributed, reflecting views and understandings from inpatient areas run by both general medical and mental health services. Nurses were found to conceptualise dementia in four main ways; as a disease, as a memory problem, as confusion and finally as a journey. These four conceptualisations are addressed in turn and the ways in which they inform and relate to practice are discussed. Limitations to practice arising from the nurses conceptualisations are also highlighted. Dominant approaches to care are outlined throughout the thesis, with the medical model, individualised care, person-centred dementia care and palliative care all being discussed in light of the nurses’ understandings of dementia. Throughout the thesis the work of Pierre Bourdieu shapes the analysis and presentation of data. Relationships within the social world, structures of society and of inpatient settings along with explicit reflection on the personal experiences and position of the researcher inform the work. Concepts of field, capital and habitus permeate the discussion and help to explore issues and understandings from both practice and theory. While literature on specific approaches to dementia care, treatments and relationships between patients, carers and family members form a substantial and growing body of dementia literature, information about nurses and their understandings of dementia has previously been unexplored. This study demonstrates the range of views held by nurses and the influences of education, structures of the clinical setting and ward culture in shaping those understandings. The importance of nurses’ conceptualisations of dementia in shaping their care of patients is demonstrated through the analysis and has the potential to inform and enhance practice development for dementia patients in a variety of inpatient settings.