Deb Hearle, Dr Val Rees & Dr Jane Prince

Plan Present overview of the context of methodologies Explain Narrative in more depth Explore methods of narrative analysis

Stage 1: Using a narrative methodology, explored the differences and reasons for the differences in occupations between older adults in the community and in Residential Care.

Methodology Opportunity sample of 22 older adults, Mean age = 83 years 4 males and 18 females (reflects the imbalance of men and women in this age group) 10 living independently in own homes, of which 3 regularly attend a local day centre 6 living at home in receipt of a full community care package 6 living in residential homes Those receiving care matched for health status. In both groups, they had sensory, motor, respiratory and circulatory problems

Methodology ctd… A design was employed eliciting life narratives, a relaxed and non-intrusive approach, to illuminate individual change over a lifespan. Tell me about your life from as early as you can remember

Stage 2: Using observation, explored the participation of older adults in residential care in occupations and their relationship to their environment.

Methodology & Data Analysis Stage 2 Single Case Study – 1 residential care home (23 residents, mean age 83 years) Tools of data collection: Observation schedule Field notes Analysed using descriptive statistics and presented in graphs. Field notes supported the discussion.

Stage 3 & 4: Using narrative and Interpretive phenomenological analysis, explored the experiences of transition of older adults into residential care. Future: Exploring possible selves in older adults: Facilitators and barriers

If you want to know me you must know my story for my story defines who I am. And if I want to know myself, to gain insight into the meaning of my own life, I, too, must come to know my own story. I must come to see, in all its particulars, the narrative of the self - the personal myth that I have tactically, even unconsciously, composed over the course of my years. It is a story I continue to revise and tell to myself (and sometimes to others) as I go on living (McAdams 1993 p 11).

What is a narrative? Human beings have personal, unique stories A series of logically and chronologically related events Gripping drama and believable history Narrator + plot or theme with moral point Meaningful stories which aim to understand social processes Identifies large units of discourse (codes) with little direction from researcher (prompt questions only)

Narrative A complex process - the plot is used to contextualise and clarify life events. Polkinghorne (1991) The individual is provided with a means of expressing past and present experiences and future aspirations from a unique perspective (Clouston 2003) The use of narrative encapsulates the holistic and humanistic practice of occupational therapy (Rees and Hearle 2004)

Advantages allows narrator to tell their story as they see it and conceptualises stories as a whole – holistic captures the richness, complexity and historical depth provides a way of understanding human experience allows a person a sense of self-worth in the present and confidence in the future allows people with health problems to construct new maps and new perceptions of their relationships to the world. lays disclosure at the feet of the narrator (lets them choose) Utilises strategies synonymous with older adults such as reminiscence and validation, in an attempt to understand the life events which have shaped each individual.

Limitations Ambiguity can mean unscientific and unconvincing Time consuming to transcribe and analyse data Not useful for data collection from large numbers Methods of analysis can be subjective

Analysing the Data Thematic Analysis Patterns across narratives Content analysis Frequencies (only part of content analysis) Interpretative Phenomenological analysis (IPA) Meaning behind the stories

ThemesCategoriesCodes FeelingsFearAnxious about future Worried what staff would be like What happens if doesnt suit MoodFelt that it was the end of life Waiting for God Felt happier now safe AcceptanceThese things happen couldnt manage on own Others influence Environment

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Transition to residential care appears to be associated with closure. Those participants in care retreated into the past, adopted passive, compliant roles and conformed with the organisation and procedures of the institution. 15

A role exists for occupational therapists within residential care The ecology of residential homes should be examined and changed to empower individuals Individual choice should be recognised Balance of care is essential (holistic) Residents should have a voice (advocacy) Preparation for transition to care is essential More research examining needs of older adults 17

Clouston, T. (2003) Narrative Methods. BJOT. 66 (4) pp Polkinghorne, D (1991) Narrative and Self Concept. J Narrative & Life history 1 pp Rees, V. Hearle D. (2004) Im not just sitting Im thinking OTN March 2004 p30.

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