title: Power, empowerment, and person-centred care: using ethnography to examine the everyday practice of unregistered dementia care staff.
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 formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles 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, 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. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings.
authors.affiliation: Center for the Study of Aging and Human Development, Duke University, USA.|School of Nursing, Duke University, USA.
authors.forename: Kezia
authors.initials: K
authors.lastname: Scales
authors.affiliation: Alliance Manchester Business School, University of Manchester, Manchester, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Bailey
authors.affiliation: School of Health Sciences, University of Manchester, Manchester, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Middleton
authors.affiliation: School of Sociology & Social Policy, University of Nottingham, Nottingham, UK.
authors.forename: Justine
authors.initials: J
authors.lastname: Schneider
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000451:nursing*; D004739:England; D006801:Humans; D018802:Patient-Centered Care / Q000379:methods*; D011209:Power, Psychological; D012648:Self Care
keywords: Foucault; dementia; ethnography; person-centred care; power