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Perspectives on Walking and Supportive Interventions Provided by Residential Care Staff for Residents With Dementia Who Walked: A Critical Ethnographic Study

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Thesis(12.46 MB)

Date

2025

Authors

Supervisor

Brannelley, Tula

Item type

Thesis

Degree name

Doctor of Health Science

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Publisher

Auckland University of Technology

Abstract

Walking (commonly referred to as ‘wandering’) has been seen as problematic and stigmatised in persons living with dementia who walk. Walking is one of the increased symptoms of dementia (BPSD) as it progresses uniquely in each person. Studies indicate 15% to 60% persons with dementia will walk. In New Zealand, currently, 70,000 persons live with dementia, 78,000 persons are projected to live with it by 2026 and 170, 212 by 2050. The stigma associated with walking and dementia has been consequential, resulting in dehumanisation, a lack of respect for personhood, and social disregard as equal and social citizens. This impacts the psychological, holistic well-being and the quality of life of persons affected, with ripple effects on families. International studies reported a questionable common practice of administering antipsychotic medications to manage BPSD in residents in aged care facilities in urban and rural settings worldwide. This was widely condemned due to adverse effects of the medications. Best practice guidelines recommend non-pharmacological strategies as first-line interventions with antipsychotic medications as a last resort. This research set out to explore how residential care staff provided relational and supportive interventions to residents living with dementia who walked. The study had five aims: to explore the perspectives of all participants on the walking of residents with dementia; to investigate the supportive interventions provided in two aged care facilities in a city in New Zealand; to explore the concept of person-centred care; to examine the impact of built environment on residents’ walking; and to contribute to the destigmatisation of the residents, advocating for a shift to using dignifying language for residents’ optimal support. Critical ethnography with a social construction theoretical orientation was used to conduct the qualitative study. The design gives authority to participants’ voices to be heard. Social constructionism argues that no single meaning is sufficient to explain a human activity, that knowledge is constructed in every interaction using language, and that every new knowledge created as a result, needs to be acknowledged. Purposive sampling was used to recruit residents living with dementia who walked, their EPAs, RNs and HCAs. Data were collected through participant observations, in-depth interviews, and unobtrusive methods. All data were transcribed and thematically analysed. Three main themes were identified with ‘Carrying on normal life’ permeating throughout. First, ‘Perspectives on walking’ revealed residents wanted to ‘carry on normal life’. Second, ‘Supporting walking’ unfolded how staff used empathy, and relational solidarity to support residents’ walking by being proactive, reinforcing positive behaviours, and providing non-pharmacological interventions and third, ‘Environment and walking’, highlighted the importance of environment for residents’ walking. With the evidence presented in these findings, I argue that it is time to provide alternative and salutogenic support for residents to carry on normal life. In addition, there is a need for a national policy that supports the walking of the residents with dementia. All stakeholders should consider this support as an ethical obligation and work collaboratively and independently to achieve person-centred care goals for the residents using humanising language that enhances the psychological health, well-being, and quality of life of the residents.

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http://hdl.handle.net/10292/20123

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Doctoral Theses