| This dissertation is an account of a 27-month action research project that took place in an adult/dementia day center (ADC), which began as a modest architectural problem and ultimately evolved into a venture in organizational transformation. The basis for the change is the philosophical concept of "personhood in dementia" and theory of person-centered care proposed by Kitwood and Bredin, which was implemented in the ADC by means of Weisman's systemic Model of Place. The emergent project was guided by McNiff s generative model of the action research process, which also provided the basis for the project's process model. Where the purpose of the project was to facilitate change in the ADC through the development and adoption of a person-centered approach to care, the dual purpose of the dissertation was first, to measure the substantive effects of the change to person-centered care in the Skylight Room, and second, to describe the change process of the transition to person-centered care. There are three main contributions of the project: The first is substantive, relating to establishing a formative link between person-centered care and the physical setting. The second is concerned with practice, relating to the improved quality of care that ensures better days for the ADC's 50 program participants. The third is concerned with theory, relating to the development of the action research/place-based model of organizational change. These contributions were made possible through change activities in three broad areas that comprise the place: people, program and the physical setting. The full set of change activities of the project is associated with change at the level of place as assessed in terms of place experience. Findings of this study are reported in the four thematic areas of participant and staff behavior, relationships between behavior and environment, the change process associated with adopting the person-centered approach to care, and the generative action research process. An appendix of the document is comprised of 31 tactical "tools" for evaluation, facilitating, information gathering, and training materials that support the organizational transformation to a person-centered approach to care in an adult/dementia day center. |
