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A Response to S. Hoskins, M. Coleman & D. McNeely (2005) Stress In Carers of Individuals With Dementia and Community Mental Health Teams: An Uncontrolled …

A Response to S. Hoskins, M. Coleman & D. McNeely (2005) Stress In Carers of Individuals With Dementia and Community Mental Health Teams: An Uncontrolled …
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  Your views and letters A response to S. Hoskins, M. Coleman & D. McNeely (2005) Stress in carers of individuals withdementia and Community Mental Health Teams: an uncontrolled evaluation study.  Journal of Advanced Nursing   50 (3), 325–333. It is widely acknowledged that supporting relatives with differentforms of dementia at home is often very stressful. Over the last20 years this problem has been addressed by developments insocial policy, the provision of services and the development of various interventions. The  Journal of Advanced Nursing   (  JAN  )paper by Hoskins  et al.  (2005) supports this approach towardsdementia care, an approach that has been called ‘the care for thecarer approach’ (Adams & Bartlett 2003).Recently, however, this approach has come under substantialcriticism (Stalker 2003). There are difficulties with approachesthat focus on the family carer when based on studies driven byanecdotal accounts that contain little theorizing; do not differ-entiate between types of carers; that focus on the ‘burden’ of care; and fail to acknowledge ‘hidden carers’. The ‘care for thecarer’ approach presents ‘only half the picture’ (Lloyd 2000) andfails to fully represent the interests of the person with dementia.The problematic nature of this approach has stimulated anumber of alternative approaches towards dementia care (Adams& Gardiner 2005).These recognize the ‘family politics’ of dementia care andacknowledge the importance and contribution of each person oragency involved as well as the person with dementia, their familycarers and paid-for carers. With this dual focus, the voice of theperson with dementia and that of their family carer(s) isacknowledged. To do otherwise marginalizes or excludes eitherthe person with dementia or their carer.In this context, Hoskins  et al  .’s paper may be seen to highlightthe family carer at the expense of the person with dementia.Little attention is given to the perspective of the person withdementia and is simply seen as the cause of the carer’s stress. Thepaper’s theoretical basis and substantive content is based on anapproach that is now outmoded. Furthermore, there are recentdevelopments in early diagnosis and treatment of dementia thatdefy earlier stereotypical ideas of people with dementia and,instead, give them a voice.This ‘care for the carer’ approach is no longer a sound basis fornursing care and relationship-centred care must be seen asapproach of choice for dementia care. Indeed, early accounts of community psychiatric nursing for people with dementia didhave a dual focus that related to the person with dementia andtheir carer (Barker & Black 1971). Subsequent ideological andsocio-political changes associated with neo-liberal thinkingencouraged the ‘care for the carer’ approach. But more recentdevelopments in ‘person-centred care’ (Kitwood 1997) and‘hearing the voice of the person with dementia’ (Goldsmith1996) have restored the visibility of the person receivingdementia care from community mental health nurses.These developments should have been recognized much morefully by Hoskins  et al.  (2005). It is certainly my view thatfocusing on the carer alone dichotomises dementia care nursing,privileges the carer and leads to the marginalization of the personwith dementia. The only way forward I believe is to adopt amuch wider perspective that include all members of the family,and centrally include the person with dementia. Trevor Adams  MSc PhD RN Cert Ed CPN Cent Lecturer in Mental Health, European Institute of Health and Medical Sciences, University of Surrey, UKE-mail: T.Adams@surrey.ac.uk References Adams T. & Bartlett R. (2003) Constructing dementia. In  DermentiaCare  (Adams T. & Manthorpe J., eds), Arnold, London, pp. 3–21.Adams T. & Gardiner P. (2005) Communication and interactionwithin dementia care triads: Developing a theory for relationship-centred care.  Dementia  4 , 185–205.Barker C. & Black S. (1971) An experiment in integratedpsychogeriatric care.  Nursing Times  67 (45), 1395–1399.Goldsmith M. (1996)  Hearing the Voices of People with Dementia . Jessica Kingsley Publications,  London. Hoskins S. Coleman M. & McNeely D. (2005) Stress in carers of individuals with dementia and Community Mental Health Teams:an uncontrolled evaluation study.  Journal of Advanced Nursing  50 (3), 325–333(9).Kitwood T. (1997)  Dementia Reconsidered: The Person Comes First  .Open University Press,  Buckingham. Lloyd L. (2000) Caring about carers: only half the picture?.  Critical Social Policy  62 ,  20 (1), 136–150.Stalker K. (2003)  Reconceptualising Work With ‘Carers’: NewDirections for Policy and Practice . Jessica Kingsley Publishers,London. FORUM  JAN   2005 Blackwell Publishing Ltd  539
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