Eraslan, Semanur
(2024)
Understanding effects of reality disjunction in communication between people living with dementia and their carers - care home study.
PhD thesis, University of Nottingham.
Abstract
Reality disjunction refers to a phenomenon characterised by a mismatch between two individuals' perceptions on the events or conditions surrounding them. Reality disjunction often gives rise to behaviours, statements, or beliefs that diverge from those of others. Reality disjunction is common in dementia care, leading to difficulties in communication and the occurrence of challenging behaviour. Previous research on reality disjunction in dementia care has primarily focused on management strategies employed by carers. These studies have examined the strategies and discussed their applicability and acceptability in dementia care. However, there is limited research that investigate experiences of reality disjunction and factors, beyond carer strategies, that influence the management of reality disjunction.
To address this gap, an ethnographic study was conducted. Six-month observation of two care homes and 13 semi-structured interviews with care home staff and relatives of residents were carried out. The observations explored the communication and relationship between care home staff and residents living with dementia experiencing reality disjunction. They described how reality disjunction manifests in interactions and behaviours with individuals living with dementia, the apparent motivation that contribute to it, and the responses of care home staff. The interviews explored the rationale and factors that impact the management of reality disjunction.
The findings identified seven distinct reality disjunction types: (1) desire to go home, (2) desire to be with relatives and friends, (3) desire to have old lifestyle and habits, (4) desire to be responsible, (5) desire to be independent, (6) desire to be free and safe, and (7) not being able to recognise the current state of themselves. Additionally, the study revealed that care home staff employ different techniques to manage reality disjunction, with five specific management strategies identified: validation, reorientation, diversion, reassurance, and ignoring.
Facilitators and challenges of managing reality disjunction were identified. The main challenge reported by care home staff was difficulty in preventing negative emotions. However, several facilitators were also identified, including: (1) getting know the person, (2) memory boxes, (3) training and experience, (4) peer and family support.
Considering that this research was conducted during the COVID-19 pandemic, the pandemic restrictions affected the research, dementia care in care homes and reality disjunction experiences. During the study period, COVID-19 measures were strictly implemented in care homes, leading to residents with dementia facing unfamiliar practices that were incomprehensible to them. This created reality disjunction between residents living with dementia unaware of the COVID-19 pandemic and care home staff who were well-informed and had to take precautions for the pandemic. The effects of the COVID-19 pandemic on care home residents living with dementia, care home staff, and relatives of the residents were discussed individually.
This ethnographic study offers an in-depth exploration of the occurrence and management of reality disjunction within care home settings. By examining the experiences of care home staff and relatives of care home residents living with dementia, the study sheds light on the influential factors that either facilitate or challenge the management of reality disjunction. The implications of these findings are encompassing care home staff, policy, and future research. For care home staff, the research findings provide insights into the nature of reality disjunction and offer a range of management strategies that can be employed. This knowledge equips carers with a deeper understanding of the condition and enhances their ability to provide effective care and support to individuals experiencing reality disjunction.
From a policy perspective, implementing measures that enhance the facilitators identified in this study can benefit dementia care. Policies that prioritise training and support for carers, as well as the utilization of memory boxes can contribute to improved outcomes for individuals experiencing reality disjunction.
Furthermore, this research addresses a significant gap in the existing literature on reality disjunction, including taxonomies of reality disjunction types and management approaches, providing a foundation for future studies to build upon. By expanding our understanding of this phenomenon, future research can further refine management strategies and explore additional factors that influence the occurrence and management of reality disjunction.
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