Practices for making residents’ wishes fit institutional constraints: a case of manipulation in dementia care

Abstract

Purpose: The study aims to show how practices of manipulation are used by a member of staff in a care situation where the member of staff has to perform two tasks at once.

Method: The study is an ethnomethodological conversation analytic single-case study of a care situation in residential dementia care. The analyses are based on video recordings and observations conducted during 9 months of fieldwork at a residential care facility for persons with dementia.

Results: The study details the methods by which a member of staff engages in manipulation by constructing her actions as responses to a resident's wish which has in fact never been stated.

Conclusion: The study discusses how manipulation may be understood as care staff practices for making a residents’ wishes fit the institutional constraints they are subjected to and for “doing what is best for the resident.”

Keywords:

• Dementia
• conversation analysis
• person-centered care
• manipulation

Note

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 The term manipulation, in this article, denotes methods for deliberately working to influence other people’s wishes and needs without letting them know that this is happening. The term is only meant to describe the interactional methods used, not the acceptability of the intentions of the person engaging in manipulation. Thus, we acknowledge that manipulation may be used as a means for helping someone or keeping them out of harm’s way by e.g. preventing residents from leaving the care facility or by making them take their medication.