Dementia is a degenerative disease which appears to take away personhood and identity and calls into question how we understand what it means to be a person. My argument is that how people with dementia are seen and imagined is key both to the understanding of their value and the care that is offered. The aim of this study is to determine how the Christian ethos of Methodist Homes (MHA) influences the care of people with dementia in order to develop a general theology of care from within practical theology. The thesis explores the ways in which the Methodist emphases of social justice and prevenient grace offer a basis for dementia care, and how MHA has drawn on its origins within the Methodist Church to develop an ethos of care that places respect for the person with dementia at the centre. This concern for those with dementia is then surveyed and the themes of respect and relationality emerge offering the potential for human becoming. Within MHA the care offered is based on a person-centred model. In order to discover how the Christian ethos of the organisation influences care this thesis explores patterns of delivering care in three homes of each of three types; well-established, recently-acquired and new-build. In each home the views of the staff were surveyed. Three in-depth interviews were conducted when questions were asked in order to understand their perception of the person with dementia. The interviews uncovered what carers regarded as good care and when care did not meet the needs, and why they believed that happened. Browning’s ‘strategic practical theology’ was used to evaluate these findings from within a Christian context to examine the influence of MHA’s ethos on the care offered. The core value chosen as the most important for care was ‘respect’; and while the care offered across all types was ‘person-centred’ the way it was delivered varied. The culture of MHA that gave rise to the values is investigated, along with the challenge of retaining ‘mutuality’ as an ideal as the needs of older people changed. The themes that emerged were those around quality of life and the things that enable the change in thinking from basic ‘caring’ to ‘caring for the person’ as the person is seen in a different way. Dementia is sometimes called the ‘theological disease’, and this understanding of dementia and the person is explored to discern what can be offered from theology to the best ideals of care in order to provide true person-centred care that is respectful of the person. I argue from within practical theology that a new way of seeing the person with dementia is needed in order to anticipate the possibility for human flourishing that is possible in a person, even in dementia. And that, offered with respect, good person-centred dementia-care can be a sign of the Kingdom. Part 1 of the D.Prof. comprises four sections in which I explore dementia from within practical theology; how it impacts on personhood, how I, as a practitioner within Methodist Homes (MHA), could enable others to offer care of the whole person; and how the carers’ understanding of the person makes a difference. In the first section, the literature was surveyed in order to discover the historical development of the term dementia. Until the middle of the twentieth century, there was little care as the condition was not named. But then drugs were discovered that could control unsocial behaviour, and the medical model of care developed. However, a new culture of care developed (person-centred care), because of the better understanding of the social nature of the disease. From within the context of theology, I explored how personhood can be understood within dementia and how, even in dementia, it might be possible to grow into the fullness of Christ as spirituality is enhanced. The second section was in the form of a publishable article which explored how it might be possible to evaluate spiritual care within a dementia-care setting. This took the form of a case study in which I worked with staff in a home that had difficulty evidencing spiritual care. It raised issues about the nature of care and assessment of spiritual care, as well as the rationale behind, and the delivery of, that care. What developed used the biblical concept of ‘fruits of the spirit’ as a way of recognising spiritual dis-ease as it is these qualities which enable inspiration, reverence, awe, meaning and purpose even in those who have no religious beliefs. The model used to offer this care was through the 3 R’s of reflection, relationship and restoration. Section three, reflective-practice section, emerged out of my practice as a chaplaincy adviser for MHA, in which I reflected critically on the contexts and understanding of the manager and chaplain, and how a chaplaincy manual was developed. The ability of the chaplain to work effectively and enable good spiritual care in the home, depended on the relationship between the manager and chaplain. By exploring the culture of both manager and chaplain, a way to enable good communication was discovered. The role of pastoral care and how it is seen within an organisation, that must have a professional management, was investigated and ways suggested for mutual understanding using the chaplaincy manual. The last section examined whether the Christian ethos of MHA encouraged a model of person-centred care. I suggested that a way of making sense of the data is by using types to describe personhood and how that can be made visible by their care. Considering the way that therapeutic interventions (reminiscence therapy, reality orientation, validation therapy, drug therapy) were used offered a way to enable the ethos of the home to be seen more clearly. Central to theological anthropology is the concept of the person which includes an ethical dimension. MHA has the strap line, ‘care informed by Christian concern’, so the study investigated whether this Christian ethos is lived out in the care offered. These aspects of study have led me to begin this thesis to research how care is delivered and what carers understand to be appropriate care. An appreciation of the context in which this care takes place also highlighted a need to conduct a theological exploration of the nature of the person with dementia.

Made available in DSpace on 2016-03-15T19:48:52Z (GMT). No. of bitstreams: 1 Rita de Cassia Dias Moreira de Almeida.pdf: 484262 bytes, checksum: c60dcb5ada6840afd3546c51de2ea2b1 (MD5) Previous issue date: 2009-03-02 / Religion has influenced the development process of social groups in many aspects. In each historical moment of human being, religion has equally suffered transformation. As a social group achieves maturity, religion gets new tint: from the Twelve Table of Law, with its rigid punishments, until Christianity in the person of Jesus Christ, who scanned the intimate areas of human being, made innovative proposals for his time, led people to interpersonal relationship reflection, and proposed mutual respect among the group. Therefore, the history course of the discrimination toward woman was changed. A new view was triggered by Jesus' actions toward women around him. He did not see them as simple spectators of the historical scene made by men, but as leaders with men in the social relationship evolution. The principles of Christianity, although had been dormant in the Dark Era, it was rescued to be established in the modern world. The woman role was strongly changed due to significant conquests in the last millennium. The influence of the religious Christian ethos in the social group of such size influenced the Contemporary Law, resulting in strong modification in the legislation, by seeking extinction of woman discrimination and creating protective laws against domestic violence. Such laws do not intend to create a distinction between men and women, or creating privilege in the society, but specifically to inhibit the abuses made by men against women for the simple matter of gender. Even though we live in the Occidental World of Lay States, in which legislations contain distorted religious matters, we can observe Christian principles in the creation of protective laws against domestic violence. Even dedication of Human Rights as indispensable guarantees to human dignity has strong influence of the Christian ethos concerning equality among members of a social group. In the legal area, the Constitutional Law, nowadays, has the main function to promote juridical security to people so men and women, as the main objective of state action, have foundation in their lives of the historically recognized laws conquered in their adventure of living. However, written law is not enough for the principles of ethic and morality to be fulfilled in the juridical system of a country. Although legality principle is an instrument of fundamental importance for the Democratic State of Right, it is still necessary that the interpreter and the executor of the law to be permeated by the religious ethic, so well described by Weber, so that the literal text of the law may be effective in the social group by producing real objectives. For this reason, it is necessary that the Constitution, the Magna Carta of a country, which contains guarantees about Human Rights, to be effective among people to materialize fundamental rights, and to focus on social security, which is indispensable for the configuration of human dignity values. Conquered rights by men and woman in social disputes in times do not confront against each other, but amalgamate by composing a constitutional system lived by the new juridical system based on political participation of people, which directs its content and gives foundation the a new constitutional order formed in the process of the State Evolution. The Human Dignity, a constitutional guarantee, was not being properly interpretated in this country, so the creation of a new mechanism to make the protection doctrine effective was necessary. For this reason the Law 11.340/06, named as Maria da Penha Law, was created to deal with domestic violence against women in Brazil. / A religião tem influenciado o processo de desenvolvimento do grupo social em diversos aspectos. Em cada momento histórico da humanidade a religião igualmente sofreu transformações. Com a maturidade do grupo social, a religião ganhou novas nuanças. Do tempo da Lei das Doze Tábuas, rígidas em suas punições, passamos ao Cristianismo com a figura de Jesus Cristo perscrutando as regiões mais íntimas do ser humano, fazendo propostas inovadoras para a época, levando as pessoas a refletirem sobre as relações interpessoais, propondo um respeito mútuo entre os integrantes do grupo. Com isso alterou-se o curso da história com relação à discriminação da mulher. Um novo enfoque fora desencadeado pelas ações de Jesus Cristo com relação às mulheres que o cercavam. Ele não as via como meras expectadoras do cenário histórico traçado pelos homens, mas como protagonistas junto com eles da evolução das relações sociais. Os princípios do Cristianismo, embora tenham estado adormecidos na era das trevas, ressurgiu para se solidificar no mundo moderno. O papel da mulher foi fortemente alterado com conquistas significantes no último milênio. A influência do ethos religioso cristão no grupo social foi de tal monta que influenciou o direito contemporâneo, redundando em fortes modificações nas legislações para extinção da discriminação da mulher e criar normas protetivas contra a violência doméstica. Tais normas não visam criar uma desigualdade entre homens e mulheres, fazendo delas seres privilegiados dentro da sociedade, mas visam especificamente coibir os abusos praticados pelo homem contra a mulher pela questão de gênero. Ainda que vivamos no mundo ocidental em Estados laicos, nos quais as legislações estão dissociadas das questões religiosas, podemos observar os princípios do Cristianismo na elaboração das normas protetivas contra a violência doméstica. Até mesmo a consagração dos direitos humanos como garantias indispensáveis à dignidade da pessoa tem forte influência do ethos cristão de igualdade entre os membros do grupo social. O Direito Constitucional, modernamente, tem a função primordial de promover a segurança jurídica dos povos para que homem e mulher, principais objetivos da ação estatal, tenham alicerçados em sua vida o reconhecimento de direitos conquistados historicamente em sua aventura do viver. Todavia, não basta a lei escrita para que os princípios de ética e moralidade sejam cumpridos na ordem jurídica de um país. Não obstante ser o princípio da legalidade um instrumento de fundamental importância para o Estado Democrático de Direito, há ainda a necessidade de estar o intérprete e aplicador da lei imbuído da ética religiosa, tão bem delineada por Weber, para que o texto frio da lei ganhe relevo no cotidiano do grupo social a fim de produzir os seus verdadeiros objetivos. É necessário, portanto, que a Constituição, lei magna de um país, na qual são expressas as garantias sobre os direitos humanos, se faça viva entre os povos contribuindo, dessa forma, para a concretização dos direitos fundamentais, incluindo em seu bojo tal gama de direitos, preconizando a segurança social imprescindível para a configuração dos valores da dignidade humana. Os direitos conquistados tanto pelo homem como pela mulher nas lutas sociais ao longo dos tempos de maneira alguma se confrontam, antes se amalgamam compondo um sistema constitucional vivificado pelo novo sistema jurídico embasado na participação política dos povos, que balizam o seu conteúdo e dão sustentáculo ao novo constitucionalismo forjado no calor do processo de evolução do Estado. Foi assim com a criação da Lei nº 11.340/06, denominada comumente de Lei Maria da Penha, que trata no Brasil do combate à violência doméstica contra a mulher. A dignidade do ser humano, garantida constitucionalmente, não estava sendo interpretada da melhor forma, sendo necessária a criação de outros mecanismos para efetivação da doutrina de proteção.