RESUMEN
This article offers a glimpse into the lives and activities of some of the patients, volunteers and staff in the Saskatchewan mental health system during the period of deinstitutionalization. Drawing on her own experience as a patient in psychiatric wards as well as ongoing research in the history of mental health, it features the role of Regina Volunteer Visitors in Saskatchewan Hospital, Weyburn and examines the importance of occupational and recreational therapies and activities in improving the lives of the patients in that institution. It emphasizes the perspectives of patients and volunteers who actively worked to develop recreational activities, with the intention of helping individuals connect with the surrounding communities. The views and perspectives presented here are drawn from a variety of historical and oral interview sources, including views from visitors to the asylum and patients who lived within its walls. The author has also been a consumer of mental health services, and spent time in the Provincial Mental Hospital in North Battleford. The article therefore makes an important contribution to enhancing our understanding of the social history of deinstitutionalization, not only for its unique source base, but also because those sources have been examined and explained to readers through the perspectives of a former patient herself. This article draws significant attention to the changing opportunities for patients as they interacted with the women's volunteer groups, as well as to how the changes brought about by the encroaching deinstitutionalization, care in the community, and decisions from "above" affected the individuals on the ground.
Asunto(s)
Desinstitucionalización , Hospitales Psiquiátricos , Cuerpo Médico de Hospitales , Servicios de Salud Mental , Pacientes , Visitas a Pacientes , Desinstitucionalización/economía , Desinstitucionalización/historia , Desinstitucionalización/legislación & jurisprudencia , Historia del Siglo XX , Hospitales Psiquiátricos/economía , Hospitales Psiquiátricos/historia , Hospitales Psiquiátricos/legislación & jurisprudencia , Entrevistas como Asunto , Cuerpo Médico de Hospitales/economía , Cuerpo Médico de Hospitales/educación , Cuerpo Médico de Hospitales/historia , Cuerpo Médico de Hospitales/legislación & jurisprudencia , Cuerpo Médico de Hospitales/psicología , Servicios de Salud Mental/economía , Servicios de Salud Mental/historia , Servicios de Salud Mental/legislación & jurisprudencia , Terapia Ocupacional/economía , Terapia Ocupacional/educación , Terapia Ocupacional/historia , Terapia Ocupacional/legislación & jurisprudencia , Terapia Ocupacional/psicología , Pacientes/historia , Pacientes/legislación & jurisprudencia , Pacientes/psicología , Terapia Recreativa/economía , Terapia Recreativa/educación , Terapia Recreativa/historia , Terapia Recreativa/legislación & jurisprudencia , Terapia Recreativa/psicología , Saskatchewan/etnología , Visitas a Pacientes/educación , Visitas a Pacientes/historia , Visitas a Pacientes/legislación & jurisprudencia , Visitas a Pacientes/psicología , Voluntarios/educación , Voluntarios/historia , Voluntarios/legislación & jurisprudencia , Voluntarios/psicologíaRESUMEN
PURPOSE: To provide a stronger evidence base for cultural change in the nursing home, this study elicited nursing, recreational therapy, and medical staff perceptions of barriers to the implementation of nonpharmacological interventions for the behavioral and psychological symptoms of dementia (BPSD). DESIGN: Thirty-five staff members (registered nurses, licensed practical nurses, nurses' aides, recreational therapists, activity personnel, and medical directors) from six nursing homes located in Pennsylvania and North Carolina participated in the qualitative study. METHODS: A focus group methodology was used to capture discussions that were audio-recorded and transcribed verbatim. Data were analyzed using standard methods of content and thematic analysis. FINDINGS: Four broad themes were identified: the changing landscape; resident behaviors; reaching out to the person with dementia; and the educational needs of staff. The concept of time emerged as a key barrier to the use of nonpharmacological interventions for BPSD. CONCLUSIONS: Successful use of nonpharmacological interventions requires the right staff with the right education at the right time. The Vulnerability Framework is a model that helped organize these findings into a meaningful perspective. CLINICAL RELEVANCE: To effect change in the nursing home, the findings indicate a need for: implementation of staffing patterns that allow staff the time to make a difference in the care of residents with BPSD; development of educational programs that promote staff understanding versus control; and design of research studies that answer questions about the influence of time on the selection of interventions for BPSD.