Sunlight behind the curtains : experiencing self-advocacy in the nursing home through photovoice

Thesis (Ph. D.)--University of Rochester. Margaret Warner Graduate School of Education and Human Development, 2017.The likelihood that residents of a total institution may experience a degradation of identity was suggested theoretically by Goffman (1961). Goffman considered nursing homes to be environments where this might occur. Compatible with Goffman’s theory, prior research has found nursing home residents to be impacted negatively by institutional processes. For example, Baltes (1988) demonstrated that attitudes about age among nursing home staff contribute to residents’ passivity. These processes do not necessarily represent the intents of institutional employees; nor do they represent the goals of institutional organizations. Rather, they result from patterns of social influence and role-stratification within the institutional environment. Erikson’s (1950) theory of ego development further suggests that experiencing a degradation of identity in an institutional nursing home could undermine residents’ achievement of integrity; a felt continuity with their prior lived experiences. The alternative to integrity, per Erikson, is despair. Consequently, the potential disruption of residents’ developmental tasks in nursing home environments represents a salient concern for mental health counselors and others interested in late-life mental wellness. Photovoice (Wang & Burris, 1994) methods were chosen in order to overcome potential resident passivity as documented above. They also served as a systemic intervention. Participants photographed their daily life, explained what these images meant to them, shared their perceptions with each other, and presented public poster exhibits illustrating their life in a contemporary nursing home environment. Interpretive Phenomenological Analysis (IPA; Smith, Flowers, & Larkin, 2009) was used to explore the meanings of participants’ experiences. While Photovoice had been utilized recently as a systemic intervention in a long-term care facility (Janes, Cowie, Bell, Deratnay, & Fourie, 2015), this study is unique for focusing on the meanings older adult residents constructed of their experiences. This study found that older adult nursing home residents could meaningfully participate in research about quality of life and that participants’ experience of life in the nursing home mapped to their remembered life histories. Based on participants’ experiences, a concept of “Continuity in the Context of Senescence” was developed. Advocacy outcomes included interested others offering to change their existing practices to more greatly respect nursing home residents’ preference