Becoming intersubjective 'in medias res' of behaviours that challenge in dementia : A layered autoethnography

Hodge, Gary and Froggatt, Katherine and Limmer, Mark and Bingley, Amanda (2020) Becoming intersubjective 'in medias res' of behaviours that challenge in dementia : A layered autoethnography. PhD thesis, Lancaster University.

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Abstract

Behaviours that challenge in dementia, often described and diagnosed as behavioural psychological symptoms in dementia (BPSD) are experienced by over 90% of people living with dementia, and 75% of those admitted to hospital, with 43% of nurses reporting these behaviours as severely distressing to them. During behaviours that challenge moments in dementia there is an intersubjective relationship between the person living with dementia and the nurse. This can lead to both the nurse and the person living with dementia experiencing a variety of emotions. I suggest that much of the emotion that exists is created by interactions between our lived stories, which also have the potential of influencing the intersubjective experiential outcome. The study aims to make sense of my (first-person) experiences of intersubjectivity in medias res (Latin for in the midst) of behaviours that challenge in dementia, and also consider how I as a nurse can manage that intersubjective moment to achieve a positive outcome. I used layered autoethnography as my study’s methodology to gather retrospective personal and professional experiential data in moments where ‘I’ as a nurse have faced personal and professional challenges, and in doing so made relational connections between the two. To explore these connections my study was framed within a Deleuzian theory of time, where the pure past, meets the living present, creating a transient becoming future synthesis. Data was managed and analysed through rhizoanalytical methods, including Deleuzian-Guattarian rhizomatic mapping. The study established that although the ability to remain intersubjective remains for people living with dementia, interactions are often on an emotional level and not always based in the living present. It is therefore my role as a nurse to consider the story of other, whilst also evaluating self during moments of challenge by engaging in metacognitive and empathically curious nursing practice.