Book Review
Demetia Care Nursing: Promoting well-being in people with dementia and their families
Trevor Adams (ed)
ISBN: 978-1-403916-51-8; 2008; xix+291 pages; Palgrave Macmillan, New York;
Bruce Barber
Research Fellow, National Ageing Research Institute, Parkville VIC
This book is a substantial contribution to the dementia care literature. The editor and major contributing author, Trevor Adams, writes from a strong practical and academic background in dementia care and nurse education. Consequently, the book is comprehensive in its scope, well referenced and clear in its essential argument. While it is, for the most part, written in the context of the United Kingdom experience, the content will have high relevance across national and cultural boundaries.
Adams' central thesis is that the person-centered care model and the subsequent relationship-centered care model were both necessary and significant advances from the neglectful institutionalization that dominated prior to the 1960s. However, he argues that both of these models, though necessary, are not sufficient in addressing the needs of those with dementia. Person-centered and relationship-centered care have a role in Adams' proposed model but they are adapted to, and contextualized in, what he calls the ‘whole systems' model.
The driving force behind this proposed approach is the recognition that dementia is everybody's business - the person with dementia, the family and friends, the medical and allied health professions, the nursing profession, the providers of residential care, legislators, administrative bodies and so on. A high level of communication between all these people, institutions and structures is essential and, furthermore, the communication pathways must be responsive to individual needs rather than to stereotypes or categories. Communication is founded upon the recognition and acceptance by all involved that insights and understandings, motivations, needs, experiences and interests vary according to role. Adequate care therefore demands that all the players, including the person with dementia, have a voice that is heard, acknowledged, accommodated, evaluated and included in decision-making, policy and practice. Does it sound utopian? Far from throwing their hands up and walking away from the concept, Adams and the other contributors construct an all-embracing theoretical framework for their model then, chapter by chapter, address the multiplicity of issues and challenges that emerge. Adams uses a philosophical model - Critical Realism - as the theoretical framework. However, the book does not dwell on the sometimes difficult language of philosophy.
The authors recognize that their proposal is complex so the language is clear and coherent. This is not to say that it is an easy read and access to an online dictionary may be useful. The book will ruffle some feathers and invite argument but it cannot be ignored.
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