Deborah O'Connor

What are the state and society’s collective responsibilities towards supporting children and their families? How does this interface with patriarchy, violence, parenting, and social work? This study addresses these questions by exploring mothers’ work of navigating social and legal systems for the safety and care of their children, while facing inequity-based interpersonal and structural violence. The goal of this research was to provide contextualized understandings of the day-to-day practices of mothers and professionals, and explicate how their practices are institutionally and socially organized. The method of inquiry in this study was institutional ethnography. The purpose of institutional ethnographic research is to uncover how the social is constructed, experienced, and understood. Institutional ethnography goes beyond personal narratives and uses texts to map the accounts of what people do at the local level, while investigating these experiences in connection to the sociopolitical context. Data sources included six individual interviews with women with experiential knowledges, one group interview with two professionals working at a women’s legal centre, legislation, policies, a risk assessment model, and case law from 220 child protection and 262 family law judgements. What emerged was the significance of the legal principle “best interests of the child” in women’s lives, as it structures decision-making about the safety and care of their children. This study illuminates how “best interests of the child” operates as an ideological code, activated through people’s material practices. Ideological codes import representational order through shared lexicon in social, political, and professional discourses, which become conceptually entangled with ideas that are widely accepted and often unquestioned. The “best interests of the child” ideological code serves as a modality of status quo regulation, producing and reproducing intersecting inequity-based violence through ruling relations of class, race, and gender. Analysis of “best interests of the child” reveals how social work practices can conceal and alter what is known, which can reinforce violence, despite the profession’s purported values of social justice and human rights. However, this study also highlights how texts can be social workers’ tools of resistance, rather than complicity.

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Since 2001, British Columbia has seen an expansion in the assisted living (AL) segment of supportive housing for older adults. Values associated with AL typically include independence, choice, self-direction, and autonomy, which position it as an attractive alternative to traditional residential care models or ‘nursing homes.’ Yet, there have been few studies that critically examine AL in the Canadian context. Such investigations are important because of the variation in AL facilities internationally. Also, there is lack of research generally on the significance of the transition to AL for older adults or what their experiences are once they have arrived. The purpose of this study was therefore to explore older adults’ narratives of moving to AL, in order to learn about their relocation experiences and how they fit with the overarching goals and values of AL. To do this, the study employed thematic content analysis of 18 provincially-focused, publicly available documents about AL. Collectively, the documents addressed both service users and providers and spoke to expectations and regulations for service delivery. The study also employed multi-level narrative analysis of four older adults' relocation stories, gathered over the period of a year. Findings from the study indicate that there are tensions between the foundational values and purposes of AL, how these are operationalized at the facility level, and how they are experienced by those moving in. While participants were generally pleased with the supportive and health care services they accessed by relocating, their accounts also highlighted a lack of social connection within AL and restrictions to choice in a variety of areas including dining and recreational pursuits. However, the findings also illuminate positive and innovative practices that can ease the transition to AL. Recommendations include: 1) finding avenues for residents to express their choices in meaningful ways, such as increasing resident input at an organizational level and expanding the type of activities offered; and 2) offering more deliberate facilitation of social and place connections in AL through an increased role for social workers in AL, peer support programs, and stronger community ties.

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To address shortcomings in traditional long-term residential care (LTRC), facilities are increasingly adopting person-centred care (PCC) approaches. Despite the proliferation of PCC models and discourses, there is limited understanding in gerontology of how such approaches are experienced on the ground. This dissertation addresses this gap through an ethnographic study of Cedar Grove, a large facility located in an urban centre in Western Canada that is undergoing culture change. During 12 months of fieldwork, I explored the range of issues this organization encountered as it endeavours to maintain the “person” at the centre of care. The purpose of this study is to contribute empirical data on how this orientation shapes daily life for residents, families, staff and administrators.This study is informed by the literatures of PCC and personhood theory, and it draws on a conceptual framework integrating critical, feminist and Foucauldian gerontology. It analyzes care across personal, interpersonal, and organizational levels, and considers the broader social-political-economic context of LTRC. Data generation employs multiple methods: participant observation, Dementia Care Mapping (DCM), group meetings, individual interviews, researcher-produced photographs, and a review of relevant organizational and policy documents. Findings reveal organizational tensions between ideals of safety and PCC, multifaceted challenges to relational care, and the importance of everyday activity toward social inclusion. Data suggest five key implications: 1) Intersectionality highlights residents’ disparate access to social inclusion and ways to support more heterogeneous populations, 2) Increased access to unstructured, everyday activity might address boredom and foster meaning in residents’ lives, 3) Job descriptions might better prioritize social care and flexibility in work roles to better address issues of time constraints, workload, and resident acuity, all of which challenge PCC, 4) Organizational support for narrative-based biography is vital to overcoming systemic barriers to its use in practice. Finally, 5) A methodological implication of this study relates to how DCM facilitated insight into residents’ non-verbal expressions of personhood and bodily, affective communications. The mobilization of this research to practice during fieldwork highlights DCM’s ability to convey positive practice skills in a way that supports uptake, positively impacting residents’ quality of life.

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Three aspects of dementia caring in the everyday life of Chinese immigrant families are not well understood: First, the notion of Chinese family or filial norm, in particular the key component of love and affection largely missing from the literature; second, the pathways between cultural beliefs and the actual caring practices of partners in care; and third, the Chinese person with dementia and the relationship with her or his carer, and their relationship within larger care contexts and structures. Borrowing notions from Buber, Bourdieu and Liang, the purpose of the study was to explore these gaps and uncover the connections between culture, emotions, and practice in Chinese families. Using the case study method and guided by principles of hermeneutical interpretation, four families comprising two or more family members and/or a service provider participated in in-depth interviews and observation sessions. Data were analyzed using ATLAS.ti to develop a holistic picture of each case situated in the particular and complex person-circumstance-time contexts of each family. Whereas the ‘story’ of each case, in its rich in-depth and contextualized details, was different and unique, cross-case analysis showed several themes that cut across all cases. First, routine caring practices are a culturally adaptive device as the routine practices embody the history, preferences and emotional investment of individuals. Second, the families draw on the cultural value of a Chinese relational self as reference for understanding family or filial obligation. Within the obligation are two aspects of responsibility and affection that co-exist and co-constitute each other. Third, in practice, participants draw on different cultures from their family, social, religious, and other life experiences in fluid and non-thinking ways that often introduce contradictions and tension between their thoughts and their actions. These non-thinking ways in between cultural spaces and dualities suggest alternative ways of knowing and being, such as emotional rationality or intelligence. Study findings on dementia care practices of Chinese immigrant families have important research and practice implications.

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Long-term care facilities are becoming more representative of the diverse ethno-cultural demographics of Canadian society in the make-up of residents, family and staff that live and work there. Therefore, it is entirely likely that care given and received in these facilities will be intercultural in nature. That is, the people caring for them may be from different ethno-cultural, racial and religious backgrounds than the people they are caring for. The impacts of this phenomenon on care provision within elder care settings, such as long-term care have not been adequately explored in the research literature, especially in a Canadian context. The purpose of this qualitative, ethnographic research study was to explore the impact of these intercultural dynamics on care for people with advanced dementia. This study took place over 9 months on a care unit based in a Jewish long-term care facility. The choice of an ethno-culturally specific facility allowed for an exploration of the culture concept in a setting in which culture and cultural identity are deeply embedded within daily life. Field work included approximately 210 hours of participant observation, 21 interviews with a diverse mix of staff and family members, 20 Dementia Care Mapping sessions with residents, and document analysis including resident care charts, and facility-based and systemic policies and procedures. The findings from this study illustrate the ways in which individuals and groups utilize the culture concept in a myriad of strategic and resourceful ways. They include: helping to secure scarce resources; to make sense of the differences that exist within the health care interactions and dementia care; to help position and locate oneself within the context of an overtly ethno-cultural and medical setting; and to challenge more dominant Western, medical paradigms about dementia, personhood and care that are specific to the end of the dementia process. Dementia care acted as a discursive space through which intercultural dynamics and negotiations were played out that represent and reflect the world outside of the facility. While this study was specific to a Jewish facility, the intercultural dynamic is applicable to a myriad of elder care settings which have different cultural configurations, inferring that the findings could be of benefit to recognizing and further exploring this topic.

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Trends in Canadian demographics reflect a growing multicultural population with diverse perspectives on health and illness. This phenomenon brings unique challenges and opportunities to health care professionals to provide excellence in Hospice Palliative Care (HPC). Cross-cultural care can be complex and cultural differences may result in poor health outcomes for minority persons at end-of-life. The purpose of this study was to explore the lived experience of health care for culturally diverse persons who had been diagnosed with a life-limiting illness. Guided by the principles of hermeneutic phenomenology, it aimed to identify what culturally diverse persons considered important to their health care and to understand how mainstream and minority cultural approaches to care were enacted in their experiences. Data were generated through in-depth interviews with ten participants with various palliative diagnoses. Data analysis included the contextual development of four paradigm cases to uncover primary themes related to the participants’ experience of health care. These cases were categorically compared and contrasted with the other cases to further develop the themes. A conceptual picture of whole-person care that included the key dimensions of holistic care, integration of multiple care knowledges, and prioritization of collaborative care emerged through this process. The findings revealed that the participants addressed gaps in whole-person care by drawing on both mainstream and minority cultural beliefs and practices to meet their physical, mental, emotional and spiritual needs. This study points to the need for social workers and other health care professionals to re-conceptualize biomedicine as one cultural approach to health and illness alongside others of HPC and culturally diverse persons.

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