Taking a shower
Managing a potentially imposing activity in dementia care
DOI:
https://doi.org/10.1558/jircd.v5i1.27Keywords:
Conversation Analysis, dementia care, management strategies, nursing homes, oppositional behavior, politeness theory, the shower taskAbstract
This article focuses on an activity routinely carried out in elderly care: taking a shower. The care setting is two nursing homes in Sweden hosting elderly people with dementia. The data consist of transcriptions of three caregivers’ interaction with their residents prior to, and during the performance of the shower task. While the shower routinely is rejected by the care recipient in these settings, the article demonstrates alternative ways of performing the task that are less imposing for the elderly person and that may maintain the care recipient’s dignity and sense of autonomy. The way opposition occurs during the course of the activity depends on how the care worker frames the performance of the task. When physical action is embedded and aligned with the care recipient’s concerns, the washing of the body progresses more smoothly. The article highlights the importance of allowing the care recipient to feel that her priorities form the basis for how the activity should proceed. The implications of this study for the care system are discussed in terms of providing opportunities for caregivers and elderly persons to build relationships of mutual trust and support.
References
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Anward, J. (2004) Lexeme recycled. How categories emerge from interaction. Logos and Language 5 (2): 31–46.
Backhaus, P. (2009) Politeness in institutional elderly care in Japanese care facility. Health Communication: Journal of Korean Academy on Communication in Healthcare 3 (2): 102–108.
Bidewell, J. W. and Chang, E. (2010) Managing dementia agitation in residential aged care. Dementia 10 (3): 299–315. http://dx.doi.org/10.1177/1471301211407789
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Brown, P. and Levinson, S. (1987) Politeness. Some Universals in Language Usage. Cambridge: Cambridge University Press.
Caporael, L. R. (1981) The paralanguage of caregiving: Baby talk to the institutionalized aged. Journal of Personality and Social Psychology 40 (5): 876–884. http://dx.doi.org/10.1037/0022-3514.40.5.876
Carpiac-Claver, M. L. and Levy-Storms, L. (2007) In a manner of speaking: Communication between nurse aides and older adults in long-term care settings. Health Communication 22 (1): 59–67. http://dx.doi.org/10.1080/10410230701310307
Chen, Y-L., Ryden, M. B., Feldt, K. and Savik, K. (2000) The relationship between social interaction and characteristics of aggressive, cognitively impaired nursing home residents. American Journal of Alzheimer’s Disease 15 (1): 10–17. http://dx.doi.org/10.1177/153331750001500108
De Bot, K. and Makoni, S. (2005) Language and Aging in Multilingual Contexts. Clevedon: Multilingual Matters Ltd.
Goffman, E. (1967) Interaction Ritual: Essays on Face to Face Behavior. New York: Pantheon.
Goffman, E. (1974) Frame Analysis. New York: Harper & Row. Goodwin, C. (2006) Retrospective and prospective orientation in the construction of argumentative moves. Text and Talk 26 (4/5): 443–461. http://dx.doi.org/10.1515/TEXT.2006.018
Goodwin, M. H. (2006) Participation, affect, and trajectory in family directive/response sequences. Text and Talk 26 (4/5): 515–543. http://dx.doi.org/10.1515/TEXT.2006.021
Goodwin, M. H. and Goodwin, C. (1987) Children’s arguing. In S. Philips, S. Steele and C. Tanz (eds) Language, Gender and Sex in Comparative Perspective, 200–262. Cambridge: Cambridge University Press.
Grainger, K. (1990) Care and control: Interactional management in nursing the elderly. In R. Clark., N. Fairclough, R. Ivanic, N. McLeod and P. Meara (eds) Language and Power. 147–157. London: Centre for Information on Language Teaching and Research.
Grainger, K. (1993) ‘That’s a lovely bath dear’: Reality construction in the discourse of elderly care. Journal of Aging Studies 7 (3): 247–262. http://dx.doi.org/10.1016/0890-4065(93)90014-B
Grainger, K. (1995) Communication and the institutionalized elderly. In J. F. Nussbaum and J. Coupland (eds) Handbook of Communication and Aging Research, 417–436. Mahwah, NJ: Lawrence Erlbaum Associates. Publishers.
Grainger, K. (2004) Verbal play on the hospital ward. Solidarity or power? Multilingua 23 (1–2): 39–59. http://dx.doi.org/10.1515/mult.2004.007
Grainger, K., Atkinson, K. and N. Coupland (1990) Responding to the elderly: troubles-talk in the caring context. In H. Giles, N. Coupland and J. M. Wiemann (eds) Communication, Health and the Elderly, 192–212. Manchester: Manchester University Press.
Hakulinen, A. (1993) Inandningen som kulturellt interaktionsfenomen. [Inbreath as a cultural interactional phenomen.] In A.-M. Ivars et al. (eds), Språk och social context. [Language and social context], 49–67. (Meddelanden från Institutionen för nordiska språk och nordisk litteratur vid Helsingfors universitet, Serie B:15). Helsingfors.
Heinemann, T. (2006) ‘Will you or can’t you’? Displaying entitlement in interrogative requests. Journal of Pragmatics 38 (7): 1081–1104. http://dx.doi.org/10.1016/j.pragma.2005.09.013
Heinemann, T. (2009) Managing unavoidable conflicts in caretaking of the elderly: Humor as a mitigating resource. International Journal of the Sociology of Language 200: 103–127.
Heritage, J. (2002) The limits of questioning: negative interrogatives and hostile question content. Journal of Pragmatics 34 (10–11): 1427–1446. http://dx.doi.org/10.1016/S0378-2166(02)00072-3
Jansson, G. and Nikolaidou, Z. (2013) Work-identity in ethnographic research: Developing field roles in a demanding workplace setting. International Journal of Qualitative Methods 12: 152–167.
Jefferson, G. (1984) On the organization of laughter in talks about troubles. In J. M. Atkinson and J. Heritage (eds) Structures of Social Action. Studies in Conversation Analysis, 346–369. Cambridge: Cambridge University Press.
Kitwood, T. (1997) The experience of dementia. Aging and Mental Health 1 (1):13–22. http://dx.doi.org/10.1080/13607869757344
Kitwood, T. and Bredin, K. (1992) Towards a theory of dementia care: Personhood and well-being. Aging and Society 12: 269–287. http://dx.doi.org/10.1017/S0144686X0000502X
Makoni, S. and Grainger, K. (2002) Comparative gerontolinguistics: Characterizing discourses in caring institutions in South Africa and the United Kingdom. Journal of Social Issues 58 (4): 805–824. http://dx.doi.org/10.1111/1540-4560.00291
Maynard, D. W. (1985) How children start arguments. Language in Society 14 (1): 1–30. http://dx.doi.org/10.1017/S0047404500010915
Ochs, E., Schegloff, E. A. and Thompson, S. A. (eds) (1996) Interaction and Grammar. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511620874
Pomerantz, A. (1984) Agreeing and disagreeing with assessments: some features of preferred/dispreferred turn shapes. In J. M. Atkinson and J. Heritage (eds) Structures of Social Action. Studies in Conversation Analysis, 57–101. Cambridge: Cambridge University Press.
Ragan, S. L. (1990) Verbal play and multiple goals in the gynaecological exam interaction. In K. Tracy and N. Coupland (eds), Multiple Goals in Discourse, 67–84. Clevedon and Philadelphia, PA: Multilingual Matters Ltd.
Sacks, H. (1992) Lectures on Conversation II. Cambridge: Blackwell Publishers.
Sacks, H., Schegloff, E. A. and Jefferson, G. (1974) A simplest systematics for the organization of turn-taking in conversation. Language 50 (3/4): 696–735. http://dx.doi.org/10.2307/412243
Saunders, P. A. (1998) ‘You’re out of your mind!’: Humor as a face-saving strategy during neuropsychological examinations. Health Communication 10 (4): 357–372. http://dx.doi.org/10.1207/s15327027hc1004_4
Saunders, P.A., de Medeiros, K and Bartell, A. (2011) ‘Oh he was forgettable’: Construction of self identity through use of communicative coping behaviors in the discourse of persons with cognitive impairment. Dementia 10 (3): 341–359. http://dx.doi.org/10.1177/1471301211407805 #
Schegloff, E. A. (2007) Sequence Organization in Interaction: A Primer in Conversation Analysis. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511791208
Socialstyrelsen [The Swedish National Board of Health and Welfare] (2010) Nationella riktlinjer för vård och omsorg vid demenssjukdom 2010. Stöd för styrning och ledning [National guidelines for health care in dementia 2010. Support for governance and management]. No:2010-5-1. ISBN 978-91-86585-18-1.
Twigg, J. (2000) Bathing. The Body and Community Care. New York and London: Routledge. http://dx.doi.org/10.4324/9780203190876
Vasse, E., Vernooij-Dassen, M., Spijker, A., Olde Rikkert, M. and Koopmans, R. (2010) A systematic review of communication strategies for people with dementia in residential and nursing homes. International Psychogeriatrics 22 (2): 189–200. http://dx.doi.org/10.1017/S1041610209990615
Williams, K. N. (2011) Elderspeak in institutional care for older adults. In P. Backhaus (ed.) Communication in Elderly Care. Cross-cultural Perspectives, 1–19. London and New York: Continuum.
Williams, K. and Herman, R. E. (2011) Linking resident behavior to dementia care communication: Effects of emotional tone. Behavior Therapy 42 (1): 42–46. http://dx.doi.org/10.1016/j.beth.2010.03.003
Williams, K., Kemper, S. and Hummert, M. L. (2003) Improving nursing home communication: An intervention to reduce elderspeak. The Gerontologist 43 (2): 242–247. http://dx.doi.org/10.1093/geront/43.2.242
Anward, J. (2004) Lexeme recycled. How categories emerge from interaction. Logos and Language 5 (2): 31–46.
Backhaus, P. (2009) Politeness in institutional elderly care in Japanese care facility. Health Communication: Journal of Korean Academy on Communication in Healthcare 3 (2): 102–108.
Bidewell, J. W. and Chang, E. (2010) Managing dementia agitation in residential aged care. Dementia 10 (3): 299–315. http://dx.doi.org/10.1177/1471301211407789
Brown, P. and Levinson, S. (1978) Universals in language usage: Politeness phenomena. In E. N. Goody (ed.) Questions and Politeness. Strategies in Social Interaction, 56–289. Cambridge: Cambridge University Press.
Brown, P. and Levinson, S. (1987) Politeness. Some Universals in Language Usage. Cambridge: Cambridge University Press.
Caporael, L. R. (1981) The paralanguage of caregiving: Baby talk to the institutionalized aged. Journal of Personality and Social Psychology 40 (5): 876–884. http://dx.doi.org/10.1037/0022-3514.40.5.876
Carpiac-Claver, M. L. and Levy-Storms, L. (2007) In a manner of speaking: Communication between nurse aides and older adults in long-term care settings. Health Communication 22 (1): 59–67. http://dx.doi.org/10.1080/10410230701310307
Chen, Y-L., Ryden, M. B., Feldt, K. and Savik, K. (2000) The relationship between social interaction and characteristics of aggressive, cognitively impaired nursing home residents. American Journal of Alzheimer’s Disease 15 (1): 10–17. http://dx.doi.org/10.1177/153331750001500108
De Bot, K. and Makoni, S. (2005) Language and Aging in Multilingual Contexts. Clevedon: Multilingual Matters Ltd.
Goffman, E. (1967) Interaction Ritual: Essays on Face to Face Behavior. New York: Pantheon.
Goffman, E. (1974) Frame Analysis. New York: Harper & Row. Goodwin, C. (2006) Retrospective and prospective orientation in the construction of argumentative moves. Text and Talk 26 (4/5): 443–461. http://dx.doi.org/10.1515/TEXT.2006.018
Goodwin, M. H. (2006) Participation, affect, and trajectory in family directive/response sequences. Text and Talk 26 (4/5): 515–543. http://dx.doi.org/10.1515/TEXT.2006.021
Goodwin, M. H. and Goodwin, C. (1987) Children’s arguing. In S. Philips, S. Steele and C. Tanz (eds) Language, Gender and Sex in Comparative Perspective, 200–262. Cambridge: Cambridge University Press.
Grainger, K. (1990) Care and control: Interactional management in nursing the elderly. In R. Clark., N. Fairclough, R. Ivanic, N. McLeod and P. Meara (eds) Language and Power. 147–157. London: Centre for Information on Language Teaching and Research.
Grainger, K. (1993) ‘That’s a lovely bath dear’: Reality construction in the discourse of elderly care. Journal of Aging Studies 7 (3): 247–262. http://dx.doi.org/10.1016/0890-4065(93)90014-B
Grainger, K. (1995) Communication and the institutionalized elderly. In J. F. Nussbaum and J. Coupland (eds) Handbook of Communication and Aging Research, 417–436. Mahwah, NJ: Lawrence Erlbaum Associates. Publishers.
Grainger, K. (2004) Verbal play on the hospital ward. Solidarity or power? Multilingua 23 (1–2): 39–59. http://dx.doi.org/10.1515/mult.2004.007
Grainger, K., Atkinson, K. and N. Coupland (1990) Responding to the elderly: troubles-talk in the caring context. In H. Giles, N. Coupland and J. M. Wiemann (eds) Communication, Health and the Elderly, 192–212. Manchester: Manchester University Press.
Hakulinen, A. (1993) Inandningen som kulturellt interaktionsfenomen. [Inbreath as a cultural interactional phenomen.] In A.-M. Ivars et al. (eds), Språk och social context. [Language and social context], 49–67. (Meddelanden från Institutionen för nordiska språk och nordisk litteratur vid Helsingfors universitet, Serie B:15). Helsingfors.
Heinemann, T. (2006) ‘Will you or can’t you’? Displaying entitlement in interrogative requests. Journal of Pragmatics 38 (7): 1081–1104. http://dx.doi.org/10.1016/j.pragma.2005.09.013
Heinemann, T. (2009) Managing unavoidable conflicts in caretaking of the elderly: Humor as a mitigating resource. International Journal of the Sociology of Language 200: 103–127.
Heritage, J. (2002) The limits of questioning: negative interrogatives and hostile question content. Journal of Pragmatics 34 (10–11): 1427–1446. http://dx.doi.org/10.1016/S0378-2166(02)00072-3
Jansson, G. and Nikolaidou, Z. (2013) Work-identity in ethnographic research: Developing field roles in a demanding workplace setting. International Journal of Qualitative Methods 12: 152–167.
Jefferson, G. (1984) On the organization of laughter in talks about troubles. In J. M. Atkinson and J. Heritage (eds) Structures of Social Action. Studies in Conversation Analysis, 346–369. Cambridge: Cambridge University Press.
Kitwood, T. (1997) The experience of dementia. Aging and Mental Health 1 (1):13–22. http://dx.doi.org/10.1080/13607869757344
Kitwood, T. and Bredin, K. (1992) Towards a theory of dementia care: Personhood and well-being. Aging and Society 12: 269–287. http://dx.doi.org/10.1017/S0144686X0000502X
Makoni, S. and Grainger, K. (2002) Comparative gerontolinguistics: Characterizing discourses in caring institutions in South Africa and the United Kingdom. Journal of Social Issues 58 (4): 805–824. http://dx.doi.org/10.1111/1540-4560.00291
Maynard, D. W. (1985) How children start arguments. Language in Society 14 (1): 1–30. http://dx.doi.org/10.1017/S0047404500010915
Ochs, E., Schegloff, E. A. and Thompson, S. A. (eds) (1996) Interaction and Grammar. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511620874
Pomerantz, A. (1984) Agreeing and disagreeing with assessments: some features of preferred/dispreferred turn shapes. In J. M. Atkinson and J. Heritage (eds) Structures of Social Action. Studies in Conversation Analysis, 57–101. Cambridge: Cambridge University Press.
Ragan, S. L. (1990) Verbal play and multiple goals in the gynaecological exam interaction. In K. Tracy and N. Coupland (eds), Multiple Goals in Discourse, 67–84. Clevedon and Philadelphia, PA: Multilingual Matters Ltd.
Sacks, H. (1992) Lectures on Conversation II. Cambridge: Blackwell Publishers.
Sacks, H., Schegloff, E. A. and Jefferson, G. (1974) A simplest systematics for the organization of turn-taking in conversation. Language 50 (3/4): 696–735. http://dx.doi.org/10.2307/412243
Saunders, P. A. (1998) ‘You’re out of your mind!’: Humor as a face-saving strategy during neuropsychological examinations. Health Communication 10 (4): 357–372. http://dx.doi.org/10.1207/s15327027hc1004_4
Saunders, P.A., de Medeiros, K and Bartell, A. (2011) ‘Oh he was forgettable’: Construction of self identity through use of communicative coping behaviors in the discourse of persons with cognitive impairment. Dementia 10 (3): 341–359. http://dx.doi.org/10.1177/1471301211407805 #
Schegloff, E. A. (2007) Sequence Organization in Interaction: A Primer in Conversation Analysis. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511791208
Socialstyrelsen [The Swedish National Board of Health and Welfare] (2010) Nationella riktlinjer för vård och omsorg vid demenssjukdom 2010. Stöd för styrning och ledning [National guidelines for health care in dementia 2010. Support for governance and management]. No:2010-5-1. ISBN 978-91-86585-18-1.
Twigg, J. (2000) Bathing. The Body and Community Care. New York and London: Routledge. http://dx.doi.org/10.4324/9780203190876
Vasse, E., Vernooij-Dassen, M., Spijker, A., Olde Rikkert, M. and Koopmans, R. (2010) A systematic review of communication strategies for people with dementia in residential and nursing homes. International Psychogeriatrics 22 (2): 189–200. http://dx.doi.org/10.1017/S1041610209990615
Williams, K. N. (2011) Elderspeak in institutional care for older adults. In P. Backhaus (ed.) Communication in Elderly Care. Cross-cultural Perspectives, 1–19. London and New York: Continuum.
Williams, K. and Herman, R. E. (2011) Linking resident behavior to dementia care communication: Effects of emotional tone. Behavior Therapy 42 (1): 42–46. http://dx.doi.org/10.1016/j.beth.2010.03.003
Williams, K., Kemper, S. and Hummert, M. L. (2003) Improving nursing home communication: An intervention to reduce elderspeak. The Gerontologist 43 (2): 242–247. http://dx.doi.org/10.1093/geront/43.2.242
Published
2014-03-29
Issue
Section
Articles
How to Cite
Jansson, G., & Plejert, C. (2014). Taking a shower: Managing a potentially imposing activity in dementia care. Journal of Interactional Research in Communication Disorders, 5(1), 27-62. https://doi.org/10.1558/jircd.v5i1.27
