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

Abstract

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.

Keywords: conversation analysis; dementia care; ethnography; video-ethnography.

Figure 1

Tom asks about the time (corresponding to Lines 2–5 in Extract 1).

Figure 2

Sarah leads Tom to the chair (corresponding to Lines 19–20 in Extract 1).

Figure 3

Sarah and Tom sit down (corresponding to Lines 27‐32 in Extract 1).