Conceptualizing violence in nursing home policy: A citizenship perspective.

Violence is a pervasive, yet often hidden, issue within nursing homes, affecting residents, family members and care workers. Critical exploration of embedded understandings of violence within public policies can provide important insights into how violence is viewed and addressed in nursing home environments as well as the implications of violence for different groups and alternative ways of framing and addressing violence. To this end, this study explored how violence is conceptualized within 45 nursing home policy texts from two Canadian provinces - Manitoba and Nova Scotia. Using a critical policy analysis approach and a citizenship lens, we identified four dominant constructions of policy 'targets' associated with specific rights and conceptualizations of violence. Policy documents construct residents as either vulnerable and in need of protection or as challenging and requiring behavior management. Care workers are constructed as either clinical risk managers, responsible for mitigating violence, or as employees with rights and responsibilities. Overall, violence prevention policies governing nursing homes are fragmented and convey conflicting conceptualizations of violence, associated with divergent rights and responsibilities. Our findings highlight the need for comprehensive violence prevention policies that affirm the rights of nursing home residents and care workers alike.

Setting a lived experience agenda for rural suicidality research in Canada.

INTRODUCTION: The perspectives of rural communities, specifically people with lived experience of suicidality and suicide loss in rural places, are often neglected in suicide research. It is critical that rural and remote health researchers acquire a deeper understanding of suicidality in rural Canadian communities for generation of relevant knowledge to better inform the development of suicide prevention, intervention and postvention solutions. This article presents research findings of how rural residents understand their community values, what information gaps they identify in relation to current suicide research, and how research can be mobilized to reach rural communities. METHOD: Researchers conducted six virtual focus groups with 47 participants from the Canadian provinces of British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Newfoundland and Labrador between March and May 2021. All focus groups were transcribed verbatim and analyzed using thematic analysis. RESULTS: Focus group findings revealed the need for research that recognizes the significance of rural culture, the sense of community experienced and the ways in which they shape rural suicide experiences with associated impacts of suicide. Participatory, community-based action research methods are required to examine the interplay between rural residence, community, and suicide. In addition, the voices of rural people with lived experience of suicide are absent in the research literature. The need exists for qualitative research conducted for the purpose of investigating the lived experience of rural suicidality. CONCLUSION: Research participants asked that a lived experience agenda be prioritized to include the voices and stories of rural people, with consideration of rural culture, an aspect of rural suicidality currently not evident in Canadian research literature.

Rural older adults' resilience in the context of COVID-19.

Public health and media discourses have often portrayed older adults as a vulnerable group during the COVID-19 pandemic. Yet, some emerging research is showing that older adults are faring better in terms of their mental health when compared to their younger counterparts. Understanding older adults' mental well-being during the pandemic requires in-depth exploration of the different place-based resources and systems around them. In particular, rural older adults face distinct challenges and opportunities related to accessing valued resources to promote their well-being. Drawing together research on aging and multi-systemic resilience, we explored what strategies, resources, and processes rural older adults valued in the initial stages of the COVID-19 pandemic. A series of 51 semi-structured telephone interviews were conducted from May to August 2020 with 26 rural older adults in Manitoba, Canada. Despite adversities, participants drew on and developed resources at the individual, local, community, institutional, and societal level to support their well-being. Specifically, they identified individual strategies (e.g., positivity, acceptance, and gratitude), resources in their immediate environments (e.g., opportunities to keep busy, connect with friends, family and neighbours, and outdoor visits), and community organizations that contributed to their well-being. They also identified broader systems that shaped their resilience processes, such as access to health services, opportunities to volunteer and support others, media stories, reliable information, and public health policies and practices that value older adult lives. Importantly, some resources were less accessible to some participants, highlighting the need to develop strategies that address inequitable resources at different levels. By describing rural older adults' resilience we seek to advance the growing body of research in relation to social ecological resilience that moves beyond a focus on individual characteristics to include understanding of the role of material, social, and cultural contexts.

Dance Wherever You Are: The Evolution of Multimodal Delivery for Social Inclusion of Rural Older Adults.

BACKGROUND AND OBJECTIVES: Older adult social inclusion involves meaningful participation that is increasingly mediated by information communication technology and in rural areas requires an understanding of older adults' experiences in the context of the digital divide. This article examines how the multimodal streaming (live, prerecorded, blended in-person) of the Sharing Dance Older Adults program developed by Canada's National Ballet School and Baycrest influenced social inclusion processes and outcomes in rural settings. RESEARCH DESIGN AND METHODS: Data were collected from on-site observations of dance sessions, research team reflections, focus groups, and interviews with older adult participants and their carers in pilot studies in the Peterborough region of Ontario and the Westman region of Manitoba, Canada (2017-2019). There were 289 participants including older adults, people living with dementia, family carers, long-term care staff, community facilitators, and volunteers. Analytic themes were framed in the context of rural older adult social exclusion. RESULTS: Remote delivery addressed barriers of physical distance by providing access to the arts-based program and enhancing opportunities for participation. Constraints were introduced by the use of technology in rural areas and mitigated by in-person facilitators and different streaming options. Meaningful engagement in dynamic interactions in the dance was achieved by involving local staff and volunteers in facilitation of and feedback on the program and its delivery. Different streaming technologies influenced social inclusion in different ways: live-stream enhanced connectedness, but constrained technical challenges; prerecorded was reliable, but less social; blended delivery provided options, but personalization was unsustainable. DISCUSSION AND IMPLICATIONS: Understanding different participants' experiences of different technologies will contribute to more effective remote delivery of arts-based programs with options to use technology in various contexts depending on individual and organizational capacities.

Identifying places that foster mental health and well-being among rural men.

Drawing together research on therapeutic landscapes and rural men's mental health, this article explores where men living with mental health challenges feel well. Semi-structured interviews were conducted with 24 men experiencing mental health challenges to collect in-depth information about their experiences in rural places. Study participants identified strategies to promote their well-being, including using everyday places for relief, relaxation, and to escape judgement; finding spaces for social connection; and helping others. Despite facing some challenges accessing everyday therapeutic landscapes, men's narratives highlight hidden rural amenities, countering deficit framings of rural places and revealing place-based strategies for supporting rural men.

Conversations in Times of Isolation: Exploring Rural-Dwelling Older Adults' Experiences of Isolation and Loneliness during the COVID-19 Pandemic in Manitoba, Canada.

Older adults have been described as a vulnerable group in the current context of the COVID-19 pandemic. In Canada, where this study took place, older adults have been encouraged to self-isolate while the rest of the population has been cautioned against in-person contact with them. Prior to COVID-19, social isolation and loneliness among older adults was considered a serious public health concern. Using a series of semi-structured interviews with 26 community-dwelling older adults (65+) living in rural Manitoba, we explore older adults' experiences of isolation and loneliness in the initial stages of the pandemic between the months of May and July 2020. Participants identified a loss of autonomy, loss of activities and social spaces (e.g., having coffee or eating out, volunteering, and going to church), and lack of meaningful connection at home as factors influencing their sense of isolation and loneliness. Although these loses initially influenced participants' self-reported isolation and loneliness, the majority developed strategies to mitigate isolation and loneliness, such as drawing on past experiences of isolation, engaging in physically distanced visits, connecting remotely, and "keeping busy." Our findings call attention to the role of different environments and resources in supporting older adults social and emotional wellbeing, particularly as they adapt to changes in social contact over time.

Stories of violence and dementia in mainstream news media: Applying a citizenship perspective.

In this article, we analyze how mainstream news media frames violence in relation to dementia and the consequences of different frames for people living with dementia and their carers. Conceptually, the goal is to bring literature on citizenship and aggression into dialog with each other. Empirically, a total of 141 regional and national English-language mainstream Canadian news media articles (2008-2019) with a focus on dementia, violence, and aggression were analyzed. Analytically, we examine how different actors are portrayed as victims or perpetrators; how their histories (identities, belonging, and exclusion) are told; how dementia is used to explain events; and what types of expert knowledge and authorities are introduced to make sense of stories of violence in relationships of care. Our analysis points to the implications of media narratives for people with dementia as well as carers and researchers seeking to address stigma and call for change.

Aggression and Older Adults: News Media Coverage across Care Settings and Relationships.

Systematic, in-depth exploration of news media coverage of aggression and older adults remains sparse, with little attention to how and why particular frames manifest in coverage across differing settings and relationships. Frame analysis was used to analyze 141 English-language Canadian news media articles published between 2008 and 2019. Existing coverage tended towards stigmatizing, fear-inducing, and biomedical framings of aggression, yet also reflected and reinforced ambiguity, most notably around key differences between settings and relations of care. Mainstream news coverage reflects tensions in public understandings of aggression and older adults (e.g., as a medical or criminal issue), reinforced in particular ways because of the nature of news reporting. More nuanced coverage would advance understanding of differences among settings, relationships, and types of actions, and of the need for multifaceted prevention and policy responses based on these differences.

Dancing With Dementia: Exploring the Embodied Dimensions of Creativity and Social Engagement.

BACKGROUND AND OBJECTIVES: Dance is increasingly being implemented in residential long-term care to improve health and function. However, little research has explored the potential of dance to enhance social inclusion by supporting embodied self-expression, creativity, and social engagement of persons living with dementia and their families. RESEARCH DESIGN AND METHODS: This was a qualitative sequential multiphase study of Sharing Dance Seniors, a dance program that includes a suite of remotely streamed dance sessions that are delivered weekly to participants in long-term care and community settings. Our analysis focused on the participation of 67 persons living with dementia and 15 family carers in residential long-term care homes in Manitoba, Canada. Data included participant observation, video recordings, focus groups, and interviews; all data were analyzed thematically. RESULTS: We identified 2 themes: playfulness and sociability. Playfulness refers to the ways that the participants let go of what is "real" and became immersed in the narrative of a particular dance, often adding their own style. Sociability captures the ways in which the narrative approach of the Sharing Dance Seniors program encourages connectivity/intersubjectivity between participants and their community; participants co-constructed and collaboratively animated the narrative of the dances. DISCUSSION AND IMPLICATIONS: Our findings highlight the playful and imaginative nature of how persons living with dementia engage with dance and demonstrate how this has the potential to challenge the stigma associated with dementia and support social inclusion. This underscores the urgent need to make dance programs such as Sharing Dance Seniors more widely accessible to persons living with dementia everywhere.

Grounded in Culture: Reflections on Sitting Outside the Circle in Community-Based Research With Indigenous Men.

Research continues to be a dirty word for many Indigenous people. Community-based participatory research (CBPR) is a means to disrupt power dynamics by engaging community members within the research process. However, the majority of relationships between researcher and participants within CBPR are structured within Western research paradigms and they often reproduce imbalances of power. The purpose of this article is to reflect on the process of CBPR within a research project focused on Indigenous men's masculinity and mental health. In doing so, we aim to contribute to reflexive practice in CBPR and flatten research hierarchies to facilitate more equitable knowledge sharing. Our reflections highlight the importance of prioritizing healing, centering cultural protocols, negotiating language, and creating space for Indigenous research partners to lead. These critical lessons challenge Western researchers to ground their practices in Indigenous culture while they "sit outside the circle" to facilitate more equitable and engaged partnerships.

"Talk about it:" changing masculinities and mental health in rural places?

Rural men's mental health has been described by some scholars as a "silent crisis." Rural men report lower levels of stress and depression and, paradoxically, much higher rates of suicide and substance use. Research has linked rural men's silence to dominant forms of masculinity with limited consideration of how masculinities are changing within and across rural places. In this article, we draw together literature on changing masculinities, rural places, and rural men's mental health to explore how, where, and with whom rural men talk about mental health; as well as their perspectives of what it means to be a healthy man. To collect in-depth information about men's perceptions and experiences of mental health and masculinity, the study employed semi-structured interviews with 23 adult male participants (aged 20-79 years) in Manitoba, Canada. Men in the study described the complex dynamics of talking about mental health with spouses, other family members, friends, and in the community. Many men wanted to talk about their mental health and some men actively developed relationships to support "talking about it;" however, they also identified competition, gossip, and stigma in relation to talking about mental health in the community. Most men in the study resisted hegemonic masculinities and some men aspired to more balanced, relational, and caring ideals. Men in the study identified community and environmental challenges to talking about mental health and changing masculinities in rural places. We argue that addressing the so-called silent crisis of rural men's mental health requires greater attention to community change and rural development to support relationships and places to talk about mental health.

Responding the "Wrong Way": The Emotion Work of Caring for a Family Member With Dementia.

BACKGROUND AND OBJECTIVES: Although it is generally acknowledged that the changing behaviors of some people living with dementia can be emotionally exhausting for family members, there has been little research on how carers actually interpret and manage their emotional responses when interacting with persons with dementia in context and over time. Applying the concept of emotion work, this analysis examines when and where carers feel they are responding "the right way" to their kin and when and where they resist normative emotions around family care. RESEARCH DESIGN AND METHODS: Semi-structured qualitative interviews (N = 20) and diaries (N = 11) were conducted with, and collected from, family carers in Manitoba, Canada to explore how they negotiate their emotions and emotional displays when caring for a family member whose behaviors are changing. RESULTS: Carers expressed feelings of frustration, anger, and resentment and identified putting on a positive attitude, putting the person with dementia first, protecting the person with dementia, and avoiding conflict and arguing as the "right way" to respond to these feelings. They identified challenges responding the "right way," however, in relation to household chores, and situations that also involved isolation, fear, verbal aggression, and fatigue. DISCUSSION AND IMPLICATIONS: Programs and policies must recognize the complex emotion work of family carers. There is a need for more nuanced education materials, support with household tasks, inclusion of carers' emotional needs in transition planning, and support for carers to exit the caring role when necessary.

Responding to Aggression and Reactive Behaviours in the Home.

Behaviours such as hitting, spitting, swearing and kicking can be a common response to personal, social and environmental challenges experienced by people with dementia. Little attention, however, has been given to how partners in care experience and respond to these behaviours in the home. This paper examines the emerging theme of 'aggression,' in seven interviews with nine former partners in care of people with dementia in Ontario, Canada. We explore how partners in care talk about, interpret and respond to these behaviours drawing on recent conceptualizations of structural and interpersonal violence in health and social geography and contributing to the growing body of research on relational care. We discuss the responses to, and implications of, these behaviours at a range of spatial scales and identify important considerations for future research.

Fear, Defensive Strategies and Caring for Cognitively Impaired Family Members.

One topic rarely addressed in the literature on older adults and interpersonal violence is the violence that can be experienced by family carers in relationship with a person living with cognitive impairment. This violence tends to remain hidden and is rarely framed as intimate partner violence. We examine how situations of intimidation and violence invoked fear in family carers and how they interpreted and reacted to these circum- stances. Interview and diary data were collected from family members who had previously or were currently experiencing some form of aggression in caring for someone with cognitive impairment or dementia. Drawing on discussions of fear and applying the analytic lens of defensive strategies, we explore how these carers responded to situations of intimidation and violence.

Improving social inclusion for people with dementia and carers through sharing dance: a qualitative sequential continuum of care pilot study protocol.

INTRODUCTION: This study examines the potential of dance to improve social inclusion for people living with dementia and carers. Research suggests that arts-based programmes can improve the health of people living with dementia and carers; however, little is known about how these programmes might address barriers to social inclusion. Addressing barriers requires the development and evaluation of accessible, non-stigmatising and affordable programmes that facilitate social inclusion across the continuum of institutional, community and household care settings. METHODS AND ANALYSIS: The study involves a qualitative sequential pilot study of the innovative Baycrest NBS Sharing Dance Seniors programme underway in non-metropolitan regions of two Canadian provinces. It focuses on the remotely instructed delivery of the programme in care facilities, community centres and households. The study involves five phases of observations, diaries, focus groups and interviews with programme participants (people living with dementia), carers, coordinators, instructors and volunteers as well as critical reflections among research investigators and knowledge users. NVivo-based thematic and narrative analyses of the qualitative data will produce new knowledge about the experiences, effectiveness and challenges of the dance programme that will inform understanding of whether and in what ways it increases social inclusion and quality of life for older people living with dementia and carers. The findings will identify opportunities for programme expansion and support the further development of arts-based approaches. ETHICS AND DISSEMINATION: The study is approved by the Research Ethics Boards at Trent University and Brandon University, and by participating organisations according to their governance procedures. The perspectives of people living with dementia and carers are incorporated throughout the study (from design to dissemination) and the study adheres to the ethical considerations when including people with dementia. A series of publicly available reports, seminars and symposia will be undertaken in collaboration with knowledge user and collaborating organisation partners.

Using care ethics to enhance qualitative research on rural aging and care.

Qualitative research offers important insights into the subjectivity, complexity, and relationality of care. In this article, we examine the particular processes and relationships involved in doing qualitative research about care with older people in rural places. We draw on our experience completing two related qualitative studies of rural care in Canada to extend discussions about responsible research practice in relation to participant recruitment, interviews, and focus groups. By applying Hankivsky's principles of care ethics in our reflection on research practices, we make explicit the role of emotions in connecting with research participants, collecting and participating in narrative-based research, and negotiating identity. We conclude with a discussion of the distinct ways in which applying care ethics throughout the research process can augment reflexive practice and enhance the integrity and theoretical contributions of qualitative health research while developing more inclusive understandings of vulnerability in older rural populations.

The emotional overlay: older person and carer perspectives on negotiating aging and care in rural Ontario.

This paper extends the burgeoning interest in emotion, health and place by investigating the emotionally complex experiences of aging and care in rural settings. Featuring a thematic analysis of 44 semi-structured interviews and two focus groups with older people and their carers in rural Ontario (Canada) we examine the importance and implications of emotions within and across multiple scales at which care relationships, expectations and responsibilities are negotiated. With the aim of broadening the discussion surrounding geographical dimensions of ethical care, our approach draws on feminist care ethics to understand the multifaceted ways in which emotions shape and are shaped by experiences of aging and caring at the interpersonal, household and community scales. The findings reveal how emotions are central, yet often-overlooked and even hidden within care relationships among older rural people and their carers. We argue that ethical care is contingent on recognizing and valuing the situated emotions involved in doing care work, sustaining care relationships and asking for care. In doing so, we demonstrate how qualitative research on the emotional geographies of care can contribute to the development of informed policies that are contextually sensitive and, ultimately, have the potential to build more ethical rural conditions of care.