https://www.um.edu.mt/library/oar/handle/123456789/23591 Sat, 04 Apr 2026 12:27:06 GMT 2026-04-04T12:27:06Z https://www.um.edu.mt/library/oar/handle/123456789/27015 Title: Implementing person-centred dementia care in a rehabilitation hospital through an appreciative inquiry approach Abstract: Background: The quality of care of persons with dementia in hospital settings is far from optimal and can be very challenging, partly because staff are untrained in person-centred dementia care. Training and staff development has been shown to positively influence staff and patient outcomes, although staff may not be empowered enough to translate what they have learned into practice. Methods: The aim of this study was to develop and evaluate using a pre-test-post-test design, a facilitation program on person-centred dementia care in two geriatric hospital wards through an appreciative inquiry approach. The attitudes and perceived self-efficacy of all staff in both wards and the quality of care of ten patients with dementia admitted in the two wards, was collected using Dementia Care Mapping, and compared with the data obtained immediately following the program and four months after. Positive care experiences/stories as obtained from the staff members and relatives of persons with dementia were collected and analysed. Open-ended questions were asked to encourage care workers to narrate positive care experiences when the care was perceived to be at its best and to identify what made these experiences possible. Interviews were audio-taped and transcribed whilst data was analysed thematically. Eventually staff working in the same wards attended six workshops during which they were guided to build an understanding of person-centred dementia care partly adapted from their own stories as derived from the interviews and how to develop action plans to implement this type of care. Findings: Based on the interviews with the hospital staff and family members of persons with dementia, positive care experiences were developed within five care processes namely; building a relationship between the ‘extended’ dementia care triad, providing ‘quality time’ and ‘care in time’, going the ‘extra mile’, attending to the psychosocial needs and attending to the physical needs with a ‘human touch’. Factors facilitating these positive care experiences included personal attributes of care workers; organisational, environmental and contextual factors. Hospital staff favourably commented about the AI approach used. Staff attitudes towards persons with dementia significantly improved following the workshops whilst the number of staff-patient interactions that enhanced the psychological need for comfort doubled and remained so after four months. Moreover, staff worked collaboratively to develop a strategic vision and action plans, some of which were implemented in practice. Conclusion: A facilitation program in person-centred dementia care using an appreciative inquiry approach improved staff attitudes towards persons with dementia and encouraged inter-professional collaboration to develop and implement dementia care practices in hospital wards. Exploring positive care experiences using the Discovery phase of appreciative inquiry helped in understanding the meaning of quality dementia care from the perspective of the stakeholders involved. Finally, the study showed that using an AI approach, learning about dementia care can be facilitated by combining person-centred dementia care theories and models with the practical knowledge obtained from the staff own stories. Description: PH.D.GERONTOLOGY Sun, 01 Jan 2017 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/27015 2017-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/24653 Title: The impact of admission of a spouse with dementia in a care home on spousal relationships Abstract: This research focuses on the experience of older married couples who placed their wives or husbands with dementia in a care home. This study seeks to understand how institutionalisation influences the marital relationship as perceived by the non-affected spouses. The life-course perspective and social exchange theory provided the theoretical background for this research. Fifteen husbands and wives, over the age of sixty-five years; who have been married for fifteen years or more and who had their dementia afflicted spouse residing in St. Vincent de Paul Long-term Facility for at least six months, were recruited. This study took a qualitative approach adopting Interpretative Phenomenological Analysis. Semi-structured, face-to-face interviews with open-ended questions resulted in thematically analysed transcripts. Emergent themes highlighted conflicting feelings for the spouses in which positive feelings were contrasted along uncertainty for the future. Participants reported there efforts for maintaining connection with their institutionalised loved ones through continued spousal caring, despite the challenges posed by the disease itself, physical separation and healthcare provision. Spouses portrayed a commitment towards their life-long partners and their religious beliefs of a sacramental marriage. Furthermore, they expressed how they derived meaning and coped with their current living situation both within and outside the care facility. In view of the absence of local research on marital relationships in later life vis-a-vis institutionalisation, this study provided an understanding on the experiences of this group of spouses with institutionalised partners suffering from dementia amidst the Maltese context. While this study replicates some findings elevated from previous gerontology research particularly from a psychosocial perspective in relation to institutionalisation, it also provides new directions for future research. Important recommendations stemming out of the research include the development and implementation of educational and clinical policies underpinned by relational-centred care frameworks and strategies that appreciate the uniqueness of every couple in order to promote their positive well-being. Description: M.GER. Sun, 01 Jan 2017 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/24653 2017-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/24651 Title: Visually connect : older adults’ reflections around a programme of visual art dialogues Abstract: The research was designed to address a lacuna in fourth age learning within the context of lifelong learning, outside of formal settings and within a residential home for older adults. The main goal of the research was to investigate older adult participation in a learning programme and to determine the kind of learning that occurs when they attend a weekly programme of visual art dialogues over a seven week period. It sought to investigate the effect these reproductions of visual art had on the kind of learning experienced: learning in terms of personal gains and identity capital, learning in terms of the social/peer interactions and in terms of the exposure to the projected images of the medium of visual arts shown. The mean age of participants was 81 years. At the end of the programme there was a focus group with the older adult participants themselves. The research tried to ensure that geragogical principles are followed and implemented. Furthermore the research provided a significant opportunity to advance the understanding of exposure of older adults, with limited cultural capital, to reproductions of visual art images and to capture their feelings of the learning involved through them. The research was carried out qualitatively, and took an action research approach because of the collaborative nature expected between the action researcher/practitioner and the participants. Analysis and discussion of the findings led to the emergence of six main identifiable themes: the importance of reminiscence, intergenerational and ‘intra’-generational learning, visual art dialogues as springboard for more contemporary issues, visual art dialogues encouraging art appreciation, visual art as a vehicle to dialogue and socialization, and stimulation of cognitive abilities. Learning occurring via these themes was also evidenced. The research concluded that although there were no actual measureable tangible outcomes, the other general aims of the programme were also achieved, that is, the provision of visual art enrichment and informal art appreciation, communication by encouragement of self-expression and consequent enhancement of social interaction, stimulation of creativity, increasing psychological wellbeing and ultimately improvement of quality of life. Motivations and benefits of fourth age learning emerged too. The research also threw up many questions in need of further investigation. Recommendations across different spheres ranged from practice to policy issues. Description: M.GER. Sun, 01 Jan 2017 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/24651 2017-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/24540 Title: Exploring the knowledge, explicit and implicit attitudes of health care professionals on sexuality amongst older persons Abstract: Sexuality is an integral aspect of every human being and has significance throughout the lifespan. Interest in sexuality and intimacy do not cease with age; however, sexual expression and intimacy may be overlooked or discouraged by healthcare professionals (HCPs). The primary aim of this study was to explore the knowledge, and explicit and implicit attitudes of HCPs on sexuality in later life. A further aim was to examine the relationship between explicit ratings of attitudes obtained by the Ageing Sexual Knowledge and Attitude Scale (ASKAS) and implicit ratings obtained by the Implicit Relational Assessment Procedure (IRAP). The ASKAS is a questionnaire consisting of two subscales that address knowledge and attitudes related to sexuality in later life. The IRAP, is a computer-based task that requires the participant to directly deny or confirm a specific attitude or belief, by responding rapidly and accurately to different stimuli. The participants recruited in the current study were all HCPs from different disciplines and working with older adults. The findings indicated that knowledge among HCPs regarding sexuality in later life was average; however, findings indicated that males had more knowledge about sexuality in later life than females. Moreover, the higher the level of education, the greater the knowledge HCPs possessed. HCPs with longer years of service showed higher knowledge than those with less years of service. Explicit attitudes measured by the ASKAS were permissive; the higher the level of education, the more permissive the attitude. Furthermore, people working in the private sector held more permissive attitudes than those who worked in the public service. The study identified a strong negative implicit bias measured by the IRAP. There was no association between explicit attitudes measured by the ASKAS and implicit attitudes measured by the IRAP. Hence, HCPs implicit beliefs did not correspond to their explicit ones. A negative implicit bias held by HCPs towards sexuality in later life was identified in the study. Further research, knowledge and continuous education programmes are recommended to provide care that transcends stereotypes and negative attitudes of sexuality in later life. The need for the implementation of institutional policies were highlighted in order to assist older adults in maintaining their sense of identity, wellbeing, quality of life and autonomy, irrelevant of their living arrangements. Description: M.GER. Sun, 01 Jan 2017 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/24540 2017-01-01T00:00:00Z