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Through the Montessori Looking-Glass: Barriers to Implementing a Montessori-Based Intervention

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Abstract

Montessori methods are used with individuals with dementia to create meaningful, inclusive, failure-free activities that enhance quality of life. This research qualitatively explored the barriers to implementing a Montessori-based intervention for people living with dementia in a 24-hr memory care setting. A lens comprised of key Montessori values and principles guided a content analysis of field note data to create an overall framework for understanding implementation barriers, which are rarely addressed in the literature. Interestingly, the four themes that emerged as barriers—the absence of respect, interdependence, meaningful activity, and structure—permeated implementation efforts and represent the opposite of Montessori principles. These findings confirm literature that identifies similar barriers across diverse interventions. Findings underscore the need for formal documentation of implementation barriers and extensive pre-implementation work to accomplish culture change in long-term care.

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... These are only a few of many instances scattered throughout the literature emphasizing the adaptability of the approach in culturally diverse settings-others include Tibetan refugee schools in India and Nepal, and Himalayan boarding schools (Debs, 2019b;Wilson, 1987), successful public-school applications in Puerto Rico (Bryan-Silva & Sanders-Smith, 2021), urban and rural settings throughout India (Tschurenev, 2021;Wilson, 1987), and public and private school settings across the globe (e.g., Brunold-Conesa, 2010;Debs, 2019a;Dudnyk & Sviontyk, 2019;Freeman et al., 2016;Owen & Davies, 2020;Petersen, 1970;Prochner, 2002). Also reflecting the findings on nonconventional application, other studies have demonstrated its application outside of typical education settings-such as elderly care (e.g., Dreher, 1997;Giroux et al., 2010;Janssen et al., 2021), intergenerational programs with school-aged and elderly individuals impacted by learning and/or cognitive challenges (Isaki & Harmon, 2015), environmental education for middle-and high-school students (Misheva, 2020), religious education for children (O'Shea, 2018), digital curriculum programs (Pérez-Pérez et al., 2021), and a proposal for revitalizing American law school programs and curricula (Grant, 2015). Other, nonacademic, examples also demonstrate that Montessori is practiced all over the world in a variety of ways-using whatever training or instruction can be acquired and making it work with locally available resources (e.g., Stephenson, 2019 A. S. Lillard, 2017;A. ...
... As noted in the findings, sociocultural norms and expectations compete and contrast with Montessori methods, principles, and practices-inhibiting its growth in many different contexts. This impediment is a broad theme in the Montessori literature as well, where Montessori environments have been challenged across time and space by regulations and policies that inadvertently preclude its practices, contrasting ideas about freedom in education and academic emphasis, misinterpretations and misperceptions related to variations in application, and lack of buy-in from individuals (e.g., Debs, 2019a;Golann et al., 2019;Howlett, 2017;Janssen et al., 2021;A. S. Lillard, 2019;Owen & Davies, 2020;Prochner, 2002;Sisson, 2018;Whitescarver & Cossentino, 2008;Zieher & Armstrong, 2016). ...
Article
Providing education for children residing in remote or difficult-to-access locations, including children in refugee and displacement camps, is a staggering global challenge. In addition to logistical challenges (such as access, infrastructure, teaching professionals and resources), differences in language, culture, environment, and values render conventional (i.e., Western-based, traditional) modes of education unfeasible and frequently ineffective. However, a strengths-based lens reminds us that communities have the capacity to initiate solutions when they have access to the right tools. Historically underrepresented in the literature, Montessori education has been used for over a century by communities all over the world to prepare children through academic and developmental growth to contribute to their local and global societies. Using constructivist grounded theory methodology (Charmaz, 2014) this study explored the application of Montessori philosophy and methods in diverse settings around the world. Analyses were informed by more than two years of fieldwork (including ethnographic inquiry) and conducted from 34 interviews with practitioners (N = 31) in 14 countries to understand where (contexts), why (purposes), and how (processes) the Montessori approach was applied. Final theoretical models were derived from the findings, depicting the ways in which the Montessori approach was applied in diverse settings, including the strengths and challenges involved in that process. Final models illustrated both processes of implementation across settings and the spectrum of application initiated by Montessori philosophy, methodology, and praxis. This study contributes to the literature on global education and Montessori education by informing policy makers, leaders, trainers, practitioners, and communities how Montessori theories of human development may be applied through principles, practices, and methods in diverse and under-resourced locations to serve the academic and holistic development of children via community-based initiatives. Advisor: Rochelle L. Dalla
... These interventions, with elements of person-centred care, are designed to address several needs, including social inclusion and engaging interactions [4], and can delay the decline or improve a person's cognitive abilities [5]. In addition to enhancing cognitive abilities, the Montessori method for older adults addresses their physical, spiritual, social and emotional needs [6] by introducing meaningful activities and roles [5,7] into their daily activities, which encourages active engagement in decision making related to daily living [8]. The activities of daily living collectively describe fundamental skills required to independently care for oneself, such as eating, bathing, and mobility and is used as an indicator of a person's functional status [9]. ...
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Aim. Montessori activities were implemented in nursing care of older adults in the home environment with the aim of creating meaningful, inclusive, and failure-free daily activities that improve their quality of life. Material and methods. In-depth comparative case studies with exploratory methods were used based on structured interviews and observation of four purposely selected older adults with and without dementia in the home environment. The data was collected using the Montessori methodology, which was divided into five phases. Results. Diff erent types of activities and roles were developed based on the individual’s abilities and interests. The participants felt more independent and self-confident in the performance of planned activities and satisfied that they are busy during the day and engaged in activities that contribute to their better mobility and health. Conclusions. Implemented activities can facilitate the inclusion of older adults in the daily routine of family life, increase the quality of life and the possibility of self-care in the home environment.
... 1 Namaste care is an approach designed to provide sensory stimulation, emotional connection and physical comfort to people living with advanced dementia in care homes, using activities such as hand massage, calming music and aromatherapy. Originally developed in the United States, Namaste care is widely used in UK care homes (Bray et al., 2021) 2 Montessori activities have been used widely across care settings in recent decades to support people with dementia (Janssen et al., 2021). Selection and organisation of specialised materials in the environment provide structure to enable independent engagement in naturalistic and purposeful tasks. ...
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Background Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. Aims To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents’ communication needs. Methods and Procedures Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID‐19. Results were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%–87%) provided some level of communication intervention and considered management of residents’ communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents’ communication. Most (79%–89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. Conclusions and Implications SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. WHAT THIS PAPER ADDS What is already known on the subject There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents’ communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles.
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Chapter
Dementia—or major neurocognitive disorder (DSM-V)—encompasses a group of diseases that affect several, if not all, cognitive functions. The diseases invariably have a fatal ending, and, as of now, there is no cure for any of them.
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Montessori-based activities use a person-centred approach to benefit persons living with dementia by increasing their participation in, and enjoyment of, daily life. This study investigated recreation staff and multidisciplinary consultants' perceptions of factors that affected implementing Montessori Methods for Dementia™ in long-term care homes in Ontario, Canada. Qualitative data were obtained during semi-structured telephone interviews with 17 participants who worked in these homes. A political economy of aging perspective guided thematic data analysis. Barriers such as insufficient funding and negative attitudes towards activities reinforced a task-oriented biomedical model of care. Various forms of support and understanding helped put Montessori Methods for Dementia™ into practice as a person-centred care program, thus reportedly improving the quality of life of residents living with dementia, staff and family members. These results demonstrate that when Montessori Methods for Dementia™ approaches are learned and understood by staff they can be used as practical interventions for long-term care residents living with dementia.
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Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. Copyright © 2014 Elsevier Inc. All rights reserved.
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This article describes Montessori-based activities for use with persons with dementia in long-term care settings. An overview of the Montessori method of education is presented, with emphasis on its application to geriatric populations. Individual and group activities are detailed, along with techniques for adapting Montessori materials and procedures for use in long-term care settings. A description is provided of training procedures used with activities staff to allow them to implement such activities within their regular programming schedules. In addition, activities staff relate examples of the effects of implementing such programming on residents.
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The "culture change" movement represents a fundamental shift in thinking about nursing homes. Facilities are viewed not as health care institutions, but as person-centered homes offering long-term care services. Culture-change principles and practices have been shaped by shared concerns among consumers, policy makers, and providers regarding the value and quality of care offered in traditional nursing homes. They have shown promise in improving quality of life as well as quality of care, while alleviating such problems as high staff turnover. Policy makers can encourage culture change and capitalize on its transformational power through regulation, reimbursement, public reporting, and other mechanisms.
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Background. Observation is used in research in two ways – structured and unstructured. Which of these methods to choose depends on the research question but will be defined predominantly by the paradigm underlying each study. Positivistic research generally uses structured observation and interpretist/naturalistic paradigms use unstructured observation. This paper is concerned with unstructured observation. Aim. To discuss the importance of unstructured observation as a research method and to examine critically the problems associated with both access and field notes. Application to nursing. Although unstructured observation has been used in nursing research, it is less favoured than the interview. Furthermore, although some of the dilemmas concerned with observation such as the role of the researcher, covert research and informed consent have received attention in the nursing literature, other aspects remain relatively unexplored. In particular little has been written concerning access to the field and field notes. Both of these aspects have practical and theoretical considerations that require the attention of the researcher. This omission may partly explain nurses' apparent reluctance to use unstructured observation in their studies. This paper seeks to redress this situation.
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This paper is a description of inductive and deductive content analysis. Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method. When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge. Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.
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