Research and Innovation, Midlands Partnership NHS Foundation Trust, Stafford, UK.
Learning & Development, Hallmark Care Homes, Essex, UK.
Health Expect. 2022 Oct;25(5):2306-2313. doi: 10.1111/hex.13563. Epub 2022 Jul 16.
It is well established that the actions and behaviour of care home workers are fundamental to the well-being of the people they care for. They not only deliver basic care but through their day-to-day presence provide an underlying continuity for residents, many of whom will have dementia or other cognitive problems. This can have many positive psychological and social benefits. A variety of ethnographic approaches have been used to explore the broader social and cultural dimensions of dementia care work. Similarly, there is a growing body of work applying micro-level approaches such as conversation analysis (CA) to describe the interactional mechanics of specific care skills.
We outline what ethnography and CA are, how they work as stand-alone methodologies and how they have been used in care work and dementia care settings. A working illustration is given of how the two approaches may be integrated.
Dementia care workers occupy a uniquely tenuous sociopolitical and professional position within healthcare. If they are to progress to a more professional status there is a pressing need for standardized systems of training to be developed. As has been common practice in most other fully professionalized sectors of healthcare, this training needs to be backed up by an understanding of how effective care work is undertaken at the micro-level. For it to be practically relevant to care workers it also needs to have been informed by the wider social context in which it occurs.
We argue that elements of ethnography and CA can be usefully combined to provide the fully contextualized micro-level descriptions of care work practice that will be needed if current moves towards the greater professionalization of care work are to continue.
The authors undertake a significant amount of Patient and Public Involvement and Engagement and study codesign with members of the public, care workers and people living with dementia. Our engagement work with care staff and family carers undertaken as part of a current National Institute for Health Research study exploring naturalistic care worker skills (see acknowledgements) has been particularly relevant in shaping this article.
众所周知，养老院工作人员的行为举止对他们所照顾的人的福祉至关重要。他们不仅提供基本护理，而且通过日常存在为居民提供基本的连续性，其中许多人患有痴呆症或其他认知问题。这可以带来许多积极的心理和社会益处。已经使用了各种民族志方法来探索痴呆症护理工作的更广泛的社会和文化层面。同样，越来越多的工作应用微观层面的方法，如会话分析（CA）来描述特定护理技能的交互力学。
我们概述了民族志和 CA 是什么，它们如何作为独立的方法运作，以及它们如何在护理工作和痴呆症护理环境中使用。给出了一个工作示例，说明这两种方法如何可以整合。
痴呆症护理人员在医疗保健中处于独特的脆弱的社会政治和专业地位。如果他们要发展到更专业的地位，就迫切需要制定标准化的培训系统。正如在医疗保健的大多数其他完全专业化的部门中常见的做法一样，这种培训需要了解在微观层面上如何进行有效的护理工作。为了使其对护理人员具有实际意义，还需要了解其发生的更广泛的社会背景。
我们认为，民族志和 CA 的元素可以有用地结合起来，提供护理工作实践的充分背景化微观描述，如果要继续推进护理工作的更大专业化，这将是必要的。
作者进行了大量的患者和公众参与和参与，并与公众、护理人员和患有痴呆症的人一起进行研究共同设计。我们与护理人员和家庭照顾者进行的公众参与工作作为当前国家卫生研究院研究的一部分，该研究探索自然主义护理人员技能（见鸣谢），对本文的形成特别相关。
