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Namaste care in the home setting: developing initial realist explanatory theories and uncovering unintended outcomes.

ABSTRACT: INTRODUCTION:The End-of-Life Namaste Care Program for People with Dementia, challenges the misconception that people with dementia are a 'shell'; it provides a holistic approach using the five senses, which can provide positive ways of communicating and emotional responses. It is proposed Namaste Care can improve communication and the relationships families and friends have with the person with dementia. Previously used in care homes, this study is the first to explore the pioneering use of Namaste Care in people's own homes. OBJECTIVE:To develop initial programme theories detailing if, how and under which circumstances Namaste Care works when implemented at home. DESIGN:A qualitative realist approach following the RAMESES II guidelines was employed to understand not only whether Namaste Care has positive outcomes, but also how these are generated, for whom they happen and in which circumstances. SETTING:A hospice in the North East of England, operating in the community, through volunteers. PARTICIPANTS:Programme theories were developed from three focus groups with volunteers implementing Namaste Care (n=8; n=8; n=11) and eight interviews with family carers (n=8). RESULTS:Four refined explanatory theories are presented: increasing engagement, respite for family carers, importance of matched volunteers and increasing social interaction. It was identified that while Namaste Care achieved some of the same goals in the home setting as it does in the care home setting, it could also function in a different way that promoted socialisation. CONCLUSIONS:Namaste Care provides holistic and personalised care to people with both moderate and advanced dementia, improving engagement and reducing social isolation. In the present study carers often chose to use Namaste Care sessions as respite. This was often linked to their frustration of the unavoidable dominance of task-focussed care in daily life. Individualised Namaste Care activities thus led to positive outcomes for both those with dementia and their carers.

SUBMITTER: Dalkin SM

PROVIDER: S-EPMC7045233 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Namaste care in the home setting: developing initial realist explanatory theories and uncovering unintended outcomes.

Dalkin Sonia Michelle SM Lhussier Monique M Kendall Nicola N Atkinson Joanne J Tolman Sharron S

BMJ open 20200122 1

<h4>Introduction</h4>The End-of-Life Namaste Care Program for People with Dementia, challenges the misconception that people with dementia are a 'shell'; it provides a holistic approach using the five senses, which can provide positive ways of communicating and emotional responses. It is proposed Namaste Care can improve communication and the relationships families and friends have with the person with dementia. Previously used in care homes, this study is the first to explore the pioneering use ...[more]

PMID: 31974087

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Project description:A productive, informative three decades of correlates of phenomenal consciousness (P-Consciousness) have delivered valuable knowledge while simultaneously locating us in a unique and unprecedented explanatory cul-de-sac. Observational correlates are demonstrated to be intrinsically very unlikely to explain or lead to a fundamental principle underlying the strongly emergent 1st-person-perspective (1PP) invisibly stowed away inside them. That lack is now solidly evidenced in practice. To escape our explanatory impasse, this article focuses on fundamental physics (the standard model of particle physics), which brings to light a foundational argument for how the brain is an essentially electromagnetic (EM) field object from the atomic level up. That is, our multitude of correlates of P-Consciousness are actually descriptions of specific EM field behaviors that are posed (hypothesized) as "the right" correlate by a particular theory of consciousness. Because of this, our 30 years of empirical progress can be reinterpreted as, in effect, the delivery of a large body of evidence that the standard model's EM quadrant can deliver a 1PP. That is, all theories of consciousness are, in the end, merely recipes that select a particular subset of the totality of EM field expression that is brain tissue. With a universal convergence on EM, the science of P-Consciousness becomes a collaborative effort between neuroscience and physics. The collaboration acts in pursuit of a unified explanation applicable to all theories of consciousness while remaining mindful that the process still contains no real explanation as to why or how EM fields deliver a 1PP. The apparent continued lack of explanation is, however, different: this time, the way forward is opened through its direct connection to fundamental physics. This is the first result (Part I). Part II posits, in general terms, a structural (epistemic) add-on/upgrade to the standard model that has the potential to deliver the missing route to an explanation of how subjectivity is delivered through EM fields. The revised standard model, under the neuroscience/physics collaboration, intimately integrates with the existing "correlates of-" paradigm, which acts as its source of empirical evidence. No existing theory of consciousness is lost or invalidated.

Project description:BackgroundSeventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances.MethodsThis is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops.ResultsWe included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. We identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia.ConclusionsThis realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection.Study registrationThis study is registered as PROSPERO CRD42016047512.

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Namaste care in the home setting: developing initial realist explanatory theories and uncovering unintended outcomes.

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Namaste care in the home setting: developing initial realist explanatory theories and uncovering unintended outcomes.

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