IDENTIFYING AND UNDERSTANDING THE NOTION OF QUALITY WITHIN AN APPLIED THEATRE PROJECT DESIGNED TO PLAYFULLY ENGAGE PEOPLE LIVING WITH DEMENTIA
In this chapter, we examine notions of quality and quality of life (QoL) as they relate to applied theatre work conducted in dementia care contexts. To do this, we draw upon a framework created by researchers from the health sector (O’Rourke et al., 2015) to analyse and thus better understand data collected within a research project entitled Playful Engagement. Focused specifically on individuals with mid to advanced dementia, this mixed methods, multidisciplinary project was funded through an Australian Research Council Linkage Project grant that saw Wesley Mission Brisbane (WMB), one of Queensland’s largest aged care service providers, partner with a team of Griffith University researchers, including those with expertise in nursing, applied theatre and ethnography.1 Conducted across six WMB sites and involving 60 participants, the project generated 340 visits, totalling 85 hours of practice.
The O’Rourke et al. framework describes QoL from the perspective of individuals living with dementia, and we apply it here to help us understand a series of visits between an elderly woman we have called Heather and two Playful Engagement applied theatre artists named Clark Crystal and Anna Yen. At the time of the visits, Heather, originally from Scotland, was living in a WMB care home on the Southside of the city. Clark and Anna were a pair of relational clowns who called themselves the “Lamingtons”. Specifically trained in working with people living with dementia, within their work Clark and Anna’s approach is spontaneous and responsive, designed to affirm and celebrate each individual’s personal identity and life experience. Each wears a red nose and they dress in clothing from the 1950s.Their story is that they are identical twins who live together out of town, with the very tall Clark becoming “Tiny” Lamington and Anna his sister becoming “Dumpling” Lamington. As out-of-town visitors, they carry suitcases which are home to their props. Like most clowns, they adopt low status roles and as such are constantly lost, tangled, confused, hopeless and late. However, unlike “traditional” clowns that seek laughter in response to this status lowering, within their work Tiny and Dumpling use their low status roles to empower individuals who are not normally provided with opportunities to be the experts or the ones “who know”.
For the WMB residents, involvement in the research component of the project required formal consent from their families, whilst assent from the individuals themselves was confirmed on a continuous basis via a simple question, “Can we visit with you today?” To support these processes, families were provided with information packages and also invited to attend workshops where they had the opportunity to meet the team and have their specific questions addressed. Consent options included participation with video documentation or observation only.
In previous publications, we have drawn on data from across the project to explore and understand the vocabularies of practice used by the Playful Engagement artists (Balfour et al., 2017) and more recently to question the value of employing quantitative QoL measures to understand the effectiveness of applied theatre projects in dementia contexts (Dunn, Balfour and Moyle, 2019). In each of these works, we have focused on the importance of the “moment”, and in the latter work have suggested that when attempting to understand the impact of applied theatre in dementia settings, it might be more appropriate for researchers to focus on “quality moments of life” rather than the broader notion of QoL.This idea emerged as a way of reconciling the contrasting findings between the qualitative and quantitative data sets within this mixed-methods study. These findings revealed that while the majority of participants demonstrated positive responses within the visits, including displays of pleasure, engagement and an improved level of alertness, the quantitative measures employed were unable to identify any significant shifts in QoL.
In developing the notion of“quality moments of life”, we took the lead from nursing professionals like Pringle (2003) who has argued that when working with people living with dementia, emphasis should be placed on “improving the quality of the moment”. Of course, as Pringle also notes (2003, 9), this emphasis leads to the inevitable question: What constitutes a quality moment? This is clearly a challenging question. Applied theatre work with people moving towards the end of their life is unlike similar work in any other setting. Participants are living with declining linguistic and cognitive capabilities, they have fragmented perceptions of past and present, and feel disconnected from themselves and others.Their short-term memories are particularly fragile and, as such, they usually do not remember interactions that have occurred just a minute or two previously. As a result, some of the common intentions of applied theatre and the approaches used to gauge their effectiveness are problematic, leading McCormick (2017, 8) to argue that the efficacy of relational applied theatre with older adults is best understood in terms of the kinds of affects that are both individually and communally experienced in moments of interaction. In offering this view, McCormick contributes to the ongoing debate within applied theatre around the relationship between affect and effect (Thompson, 2009), specifically in relation to participants living with dementia. But what are these affects and how do we understand them in the context of creating high-quality moments?