well-being in the therapeutic garden for patients with dementia
TRANSCRIPT
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WELL-BEING IN THE THERAPEUTIC GARDEN
FOR PATIENTS WITH DEMENTIA
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Stokkeprosjektet
• The Vestfold University college collaborated with the local municipality of Stokke
• The aim was to develop good public health services with high accessibility
• A therapeutic garden for 21 patients with dementia at the nursing home, was one practical answer
• The participatory action research was chosen to balance action and research
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Action research as practical approach
• To fulfil the local action purpose, an interdisciplinary team was established.
• Action research is experience-based, participant-and action-orientated
• The interdisciplinary team aimed to develop and explore an accessible therapeutic garden to improve the patients well-being
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Disharmony
• The interdisciplinary team reported that the situation outdoors wasmeaningless, unmanageable and incomprehensible for the patients
• At the same time, the situations were occasionally were unmangeablefor the nurses.
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This disharmony is interpreted
according to disability in the Gap
model.
The gap between demands of the
outdoor environment,
and the patients capabilities
in the immediate environment,
is not harmonized
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GMT v. reversed time
• Patients with dementia re-experience their former life, in bygone times
• At the time, in relation to dementia, they experience a reversed axis of time
• Since their capabilities connected to time, among others, are declining successively …
• the gap between demands of the environment,
• and the person with dementia capabilities declines as time passes …
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From disharmony to well-being
• To synthesize resources and risk factors, the Soc construct was adapted to achieve well-being
• The therapeutic garden and universal design principles were activated in the planning process
• The principles served as Generalized Resistance Resources in the immediate outdoor environment
• The aim of GRR scaffolding, in the outdoor environment, was to facilitate well-being outdoors, for this vulnerable group
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Universal design: a paradox?http://www.design.ncsu.edu/cud
• Universal design: The design of products and environments to be usable by all people, to the greatest extent possible, without adaptation or specialized design.
• Universal design guides a wide range of design disciplines including environments, products and communications.
• As a project leader I applied the principles as a guide, in the design process to strengthen comprehensibility and manageability in theoutdoor area
• This is contradictory, because the design should be for everyone, which I consider is valid in theory , but not often performed in practice
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Universal design principles:
Presentation of principles 1,2,3 and 4
• 1 EQUITABLE USE
• The design is useful and marketable to people with diverse abilities.
• 2 FLEXIBILITY IN USE
• The design accommodates a wide range of individual preferences and abilities.
• 3 SIMPLE AND INTUITIVE USE
• Use of the design is easy to understand, regardless of the user’s experience, knowledge, language skills, or current concentration level.
• 4 PERCEPTIBLE INFORMATION
• The design communicates necessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities.
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Presentation of universal design
principles 5,6 and 7.
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5 TOLERANCE FOR ERROR
The design minimises hazards and the adverse
consequences of accidental or unintended actions.
6 LOW PHYSICAL EFFORT
The design may be used efficiently and comfortably
and with minimum fatigue.
7 SIZE AND SPACE FOR APPROACH AND USE
Appropriate size and space is provided for
approach, reach, manipulation and use,
regardless of user’s body size, posture, or mobility.
Printed 9/06 by J . Woodar
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A therapeutic approach in the garden
• Throughout history the garden has contributed to holistic healing: body, mind and spirit
• The most important principle will be presented:
• Utilise plants and other elements that stimulate the memory , conversation and activity ( meaning )
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FROM ACTION TO RESEARCHThe interdsiciplinary team were focus group interviewed 1, 2 and 3 years after the garden had been
opened, and the interviews served as a fruitful unit of analysis in the hermeneutic-
phenomenological analytic process
• A main result was that when the patients were upset indoors, it was like they were transformed when entering the therapeutic garden
• They slowed down and relaxed, like in an intermediate stage and…
• They transformed from this initial stage and then activated their senses in the therapeutic garden
• They were more satisfied with being outdoors than indoors
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INTERPRETATION
• In Phenomenoligie de la peception, 1945, Maurice Merleau Ponty, attributed to Heidegger, presentsan existensial theory where, among others:
• The lived body is essential for accessing the world
• Each bodily change, changes the world
• The term Merleau Ponty uses is «etre-au –monde» , which expressesfacing the world
• I have interpreted the transformation entering the outdoor area, to..
• A perceptual field opens to the patient , attributed to the pre-objective phenomena like wind, weather, light, noises and temperature
• Then they perceive objects by hearing the birds singing , taste thestrawberries, smell the thyme, stroke the dog and look at the flowers
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Results
• A salutogenesic framework, combined withaction research as a method, therapeuticaland universal design principles in theplanning process, resulted in an appropriatedesign with high accessibility for the patientswith dementia.
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Conclusion
• Well-being was the result, attributed to the possibility of patients to comprehend, manage and experience meaning outdoors
• Thank you for your attention
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