Combining ethnography and conversation analysis to explore interaction in dementia care settings

Background It is well established that the actions and behaviour of care home workers are fundamental to the well-being of the people they care for. They not only deliver basic care but through their day-to-day presence provide an underlying continuity for residents, many of whom will have dementia or other cognitive problems. This can have many positive psychological and social benefits. A variety of ethnographic approaches have been used to explore the broader social and cultural dimensions of dementia care work. Similarly, there is a growing body of work applying micro-level approaches such as conversation analysis (CA) to describe the interactional mechanics of specific care skills. Strategy We outline what ethnography and CA are, how they work as stand-alone methodologies and how they have been used in care work and dementia care settings. A working illustration is given of how the two approaches may be integrated. Discussion Dementia care workers occupy a uniquely tenuous sociopolitical and professional position within healthcare. If they are to progress to a more professional status there is a pressing need for standardized systems of training to be developed. As has been common practice in most other fully professionalized sectors of healthcare, this training needs to be backed up by an understanding of how effective care work is undertaken at the micro-level. For it to be practically relevant to care workers it also needs to have been informed by the wider social context in which it occurs. Conclusion We argue that elements of ethnography and CA can be usefully combined to provide the fully contextualized micro-level descriptions of care work practice that will be needed if current moves towards the greater professionalization of care work are to continue. Patient or Public Contribution The authors undertake a significant amount of Patient and Public Involvement and Engagement and study codesign with members of the public, care workers and people living with dementia. Our engagement work with care staff and family carers undertaken as part of a current National Institute for Health Research study exploring naturalistic care worker skills (see acknowledgements) has been particularly relevant in shaping this article.

Automated summary

This article discusses the application of ethnography and conversation analysis in care work and dementia care settings, and proposes the possibility of integrating the two methods. The authors argue that in order to further promote the professionalization of care work, a comprehensive understanding of the micro-level descriptions of care work practice is needed, while considering the wider social context. The importance of engaging with the public, care workers, and people living with dementia in research and design is also emphasized.