Healthcare Support Workers Working With People With Dementia on Mental Health Wards: A Practice Model Informed by Care Aesthetics

This study explores the practice of healthcare support workers (HCSWs) working with people with dementia on mental health wards for older people within the National Health Service in the United Kingdom. People with dementia in these settings have complex physical and mental health needs with significant behaviors that challenge and therefore require high levels of staff expertise to meet their needs. Underpinned by the theory of care aesthetics, our primary aim was to raise the visibility of HCSWs' everyday practice in this under-researched area of dementia. Working with three mental health wards over two sites, we used an exploratory, participatory action research methodology with qualitative and ethnographic methods to refine and clarify our understanding of care aesthetics in this practice setting. Over the course of the study, and through a series of collaborative learning groups in each site, we developed an explanatory practice model applying constant comparative analysis to the data to ensure that each stage of the model was iteratively developed and refined with the participating HCSWs. The model demonstrates how HCSWs use sensory, embodied, and relational practice to effectively "tune in" to the person with dementia, to the ward and their colleagues, to themselves and their values, to their craft, and to ward visitors. Being co-present was a resulting linking schema that demonstrated high-quality in-the-moment person-centered care. The model illustrates the range of everyday practices delivered by HCSWs and how care aesthetics has the potential to inform and develop the language of person-centered dementia care.