An exploration of the quality of life in nursing homes: the use of single case and organisational observation in a research project

Abstract

The present article provides a brief introduction to the research project, ‘Quality of Life in Nursing Homes’ funded by the University of Vienna. Within the scope of this project, single case observation and organisational observation techniques based on the Tavistock/Bick approach were employed as research methods in an effort to explore the subjective wellbeing experienced by residents of nursing homes suffering from dementia. Further subjects of the investigation were aspects of the organisational dynamics which influence the evocation of such feelings of wellbeing. The main emphasis of the article is on the presentation and discussion of excerpts from the observation accounts which were carried out in one particular nursing home. The article outlines just how intensely inmates of nursing homes themselves, but also caregivers and members of other professional groups involved with them, are continually confronted with the experience of cognitive and physical decline, loss and loneliness, helplessness and dependency, and also with the theme of the unrelenting approach of death. The article also describes the ways in which these experiences evoked strong and overwhelming emotions in staff members and residents as well as in members of the research team. In addition, the article outlines the psychosocial processes within the organisation, which might possibly help members of the organisation better tolerate and allay such feelings, and the influence that these processes have on the dynamics of everyday relationships within the home, and, as a further consequence, upon the wellbeing of the residents.

One particular aspect highlighted is the fact that there is no mental or social space at the nursing home specifically set aside to enable the residents and the staff to exchange thoughts about these experiences and to understand their emotional impact. The article concludes with remarks on the difficulties involved in observing in nursing homes where people suffering from dementia live.

Keywords:

• Tavistock/Bick observation method
• Tavistock/Bick approach
• single case observation
• organisational observation
• dementia
• nursing home
• quality of life
• observation as a research method
• qualitative research methods

A first version of this paper was presented in a workshop chaired by Branca Pecotic at the conference ‘From Baby to Boardroom: the Tavistock–Bick method of Infant Observation and its application to organisations and in consultancy’, 17–18 October 2008, Tavistock Centre, London.

A first version of this paper was presented in a workshop chaired by Branca Pecotic at the conference ‘From Baby to Boardroom: the Tavistock–Bick method of Infant Observation and its application to organisations and in consultancy’, 17–18 October 2008, Tavistock Centre, London.

Acknowledgements

This paper is based on the research project ‘An empirical investigation into the life world and the life quality in nursing homes’ financed by the University of Vienna and run by Prof. Dr. Anton Amann of the Department of Sociology, Prof. Dr. Elisabeth Seidl of the Department of Nursing Science, and Prof. Dr. Wilfried Datler of the Department of Education.

The single case observations were done by Alexandra Bisanz, Ursula Bog, Vanessa Cerha, Xenia Cerha, Gabriele Heußler, Tanja Meindorfer, Stephanie Pfarr and Klaudia Schneider, all of whom we want to thank for their hard work and their commitment to this project. Kathrin Trunkenpolz carried out the organisational observations. Wilfried Datler and Kathrin Trunkenpolz also want to thank Ross A. Lazar for his continuous work with our research group on the observational material and on the general research project agendas.

Notes

A first version of this paper was presented in a workshop chaired by Branca Pecotic at the conference ‘From Baby to Boardroom: the Tavistock–Bick method of Infant Observation and its application to organisations and in consultancy’, 17–18 October 2008, Tavistock Centre, London.

1. The first number indicates the number of the observation from which the quotation is derived. The number after the slash refers to the page of the report from which the passage has been excepted.

2. Homepage of the research project ‘Toddlers’ adjustment to out-of-home care’: http://www.univie.ac.at/bildungswissenschaft/papaed/seiten/forschungseinheit/forschungsprojekte/x1_FWF%20Eingewoehnungsphase%20in%20KinderKrippe.htm

3. The first Viennese scientist to employ young child observation techniques as an extension of infant observation and application to a research project was Gertraud Diem-Wille (1997). She initiated the first infant observation seminar held in Vienna under the expert direction of Isca Salzberger-Wittenberg and Anne Alvarez as the seminar leaders. Beginning in 1994, members of that seminar set out, with supervisory support from Isca Salzberger-Wittenberg and Ross A. Lazar, to conduct infant observation seminars, which have since become a core part of the curriculum for some post-graduate courses being offered in various institutes in Vienna (Diem-Wille, Steinhardt, & Reiter, 2006). To a somewhat lesser degree, this is equally true of the young child observation and organisational observation seminars offering methodologies pioneered and first taught in Vienna by Anton Obholzer and Ross A. Lazar. The Infant Observation Study Group Vienna (IOSGV) today is comprised of 11 individuals, who regularly lecture on infant observation and its applications in Vienna.

4. ‘Social Space’: ‘Hetherington et al. (1997) emphasise the place of professional judgement in a thoughtful ‘space’. The social space is one in which the professional is permitted—and empowered—to work in a climate in which psychological and social factors are taken into account and then considered in a problem-solving activity’. (Briggs, 1999, p. 149)