Generic placeholder image

Current Alzheimer Research


ISSN (Print): 1567-2050
ISSN (Online): 1875-5828

Research Article

Social Network Analysis of Dementia Wards in Psychiatric Hospitals to Explore the Advancement of Personhood in Patients with Alzheimer’s Disease

Author(s): Carlo Lazzari*, Yasuhiro Kotera and Hywel Thomas

Volume 16, Issue 6, 2019

Page: [505 - 517] Pages: 13

DOI: 10.2174/1567205016666190612160955

open access plus


Background: Little is known on investigating how healthcare teams in dementia wards act for promoting personhood in persons with Alzheimer’s disease (PWA).

Objective: The current research aimed to identify the social networks of dementia health carers promoting the personhood of PWA in acute or long-term dementia wards in public and private psychiatric hospitals.

Methods: We used a mixed-method research approach. Ethnographic observations and two-mode Social Network Analysis (SNA) captured the role and social networks of healthcare professionals promoting PWA personhood, using SocNetv version 2.4. The social network graphs illustrated how professionals participated in PWA care by computing the degree of centrality (%DC) for each professional; higher values indicated more statistical significance of a professional role compared to others in the provision of personhood care. The categories of personhood were biological, individual, and sociologic. Nurses, doctors, ward managers, hospital managers, clinical psychologists, occupational therapists, care coordinators, physiotherapists, healthcare assistants, and family members were observed if they were promoting PWA personhood.

Results: The highest %DC in SNA in biological personhood was held by the ward nurses (36%), followed by the ward doctors (20%) and ward managers (20%). All professional roles were involved in 16% of cases in the promotion of individual personhood, while the hospital managers had the highest %DC (33%) followed by the ward managers and nurses (27%) in the sociologic personhood.

Conclusion: All professional roles were deemed to promote PWA personhood in dementia wards, although some limitation exists according to the context of the assessment.

Keywords: Alzheimer, personhood, social network analysis, ethnography, dementia ward, mixed methods research.

Alzheimer Society. Fix dementia care and hospitals – the statistics (2018) (accessed on June 10, 2018). Available from:
Department of Health Dementia: a state of the nation report on dementia care and support in England 2013.
Lakey L. Counting the cost: caring for people with dementia on hospital wards Alzheimer’s Society (2009) available at: (accessed January 6, 2019). .
David Cameron, Prime Minister. Prime Minister Challenge on dementia 2020. Cabinet Office, Department of Health & Social Care, Prime Minister Office 10 Downing Street (2019), available at: (accessed: January 6, 2019) .
Department of Health. Dementia: A state of the nation report on dementia care and support in England (2013), available at: (accessed: January 6, 2019) .
Kitwood T. Dementia reconsidered. New York: Open University Press 1997; p. 25.
Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer’s disease and vascular dementia. (review). Cochrane Database of Systematic Reviews 2013; (Issue 6): Art. No.: CD003260.
National Institute for Health and care Excellence (NICE). Dementia: assessment, management and support for people living with dementia and their carers. NICE Guidelines [NG 97] (2018). [Online] Available at:
Mars RB, Neubert FX, Noonan MAP, Sallet J, Toni I, Rushworth MFS. On the relationship between the “default mode network” and the “social brain”. Front Hum Neurosci 6: 189. 2012
De Marco M, Meneghello F, Pilosio C, Rigon J, Venneri A. Up-regulation of DMN connectivity in mild cognitive impairment via network based cognitive training. Curr Alzheimer Res 15(6): 578-89. 2018
De Marco M, Meneghello F, Duzzia D, Rigona J, Pilosio C, Venneri A. Cognitive stimulation of the default-mode network modulates functional connectivity in healthy aging. Brain Res Bull 121: 26-41. 2016
Schapmire TJ, Head BA, Nash WA, Yankeelov PA, Furman CD, Wright B, et al. Overcoming barriers to interprofessional education in gerontology: the interprofessional curriculum for the care of Older Adults. Adv Med Educ Pract 9: 109-18. 2018
Hughes JC. How we think about dementia: personhood, rights, ethics, the arts, and what they mean for care. London, Philadelphia: Jessika Kingsley Publishers 2014.
Oxford Online Dictionary. Personhood (2019), available at: (accessed: January 6, 2019) .
Olson ET. Personal Identity In: Zalta EN (ed), The Stanford Encyclopedia of Philosophy (2017), available at: (accessed: January 4, 2019). .
Hughes JC. Thinking through dementia. Oxford: Oxford University press 2011.
Kitwood T. Dementia reconsidered. Berkshire: Open University Press-McGraw-Hill Education 1997.
Buron B. Levels of personhood: a model for dementia sare. Geriatr Nurs 29(5): 324-32. 2008
Farinde A. The interprofessional management of dementia-related behavioral and psychological disturbances. Health Interprofessional Prac 2(2): eP1064: 1-5. 2014
Hogan DB, Bailey P, Black S, Carswell AC, Chertkow H, Clarke B, et al. Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia. CMAJ 179(8): 787-93. 2008
Health Professions Networks Nursing & Midwifery Human Resources for Health Framework for action on interprofessional education & collaborative practice. World Health Organization Geneva (2010) available at: framework_action/en/ (accessed: January 6, 2019) .
Douglas NF, McDonald K. Interprofessional care in the management of alzheimer’s dementia: leaving our silos. Persp ASHA Special Interest Groups SIG 2 Vol. 1(Part 3): 129-37. 2016
Carson S, McDonagh MPH, Peterson K. A systematic review of the efficacy and safety of atypical antipsychotics in patients with psychological and behavioral symptoms of dementia. J Am Geriatr Soc 54: 354-61. 2006
National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers. [NICE guideline: NG97] (2018). Available at URL: (accessed: January 6, 2019) .
Dupuis S, McAiney C, Fortune D, Ploeg J, Witt L. Theoretical foundations guiding culture change: the work of the Partnerships in Dementia Care Alliance. Dementia 15(1): 85-105. 2016
Glasby J, Dickinson H. Partnership: working in health and social care. 2nd ed. Bristol: Policy Press 2014.
Sinclair P. ASK: dementia outcome measure Health Innovation Network, South London, (2017) available at: (accessed: June 8, 2018)..
Topp SM, Chipukuma JM. A qualitative study of the role of workplace and interpersonal trust in shaping service quality and responsiveness in Zambian primary health centres. Health Policy Plan 31: 192-204. 2016
Miller C, Freeman M, Ross N. Interprofessional practice in health and social care: challenging the shared learning agenda. London: Arnold 2001.
Rokstad AMM, Vatnern S, Engedalmd K, Selbæ KG. The role of leadership in the implementation of person-centred care using dementia care. J Nurs Manag 23: 15-26. 2015
Loveday B. Leadership for person-centred dementia care. London, and Philadelphia: Jessica Kingsley 2013.
School of Dementia Studies at the University of Bradford Dementia care mapping 2018 available at: (accessed: July 7, 2018) .
Brooker D. Person-centred dementia care. London, and Philadelphia: Jessika Kingsley 2007.
McCormack B. Person-centeredness in gerontological nursing: an overview of the literature. Intern J Older People Nurs Assoc J Clin Nurs 13(3a): 31-8. 2004
Cook K, Clayton B. Chapter 3: Where are people cared for and who is involved? In: Sadler, C A Practical guide to end of life care Berkshire, England: McGraw-Hill Education. 30-47. 2015
Hughes JC, Bamford C, May C. Types of centredness in health care: themes and concepts. Med Health Care Philos 11(4): 455-63. 2008
Prell C. (2012) Social network Analysis: History, Theory and Methodology London: SAGE; p. 99.
Crossley N, Bellotti E, Edwards G, Everette MG, Koskinen J, Tranmer M. Social Network Analysis for Ego-Nets. London, Thousand Oaks, New Delhi, Singapore: SAGE 2015.
Cross R, Parker A. The hidden power of social networks: Understanding how work really gets done in organizations. Boston, MA: Harvard Business School Press 2004.
Lockhart NC. Social network analysis as an analytic tool for task group research: a case study of an interdisciplinary community of practice. J Spec Group Work 42(2): 152-75. 2017
Lubbers MJ, Molina JL, Valenzuela-García H. When networks speak volumes: Variation in the size of broader acquaintanceship networks. Soc Networks 56: 55-69. 2019
De Brún A, McAuliffe E. Social Network Analysis as a methodological approach to explore health systems: a case study exploring support among senior managers/executives in a hospital network. Int J Env Res Pub He 15(511): 1-11. 2018
Bae S-H, Nikolaev A, Seo JY, Castner J. healthcare provider social network analysis: a systematic review. Nurs Outlook 63: 566-84. 2015
Borgatti S, Everett MG, Johnson JC. Analyzing Social Networks. 2nd Edition. London, Thousand Oaks, New Delhi, Singapore: SAGE 2018.
Palazzolo M, Grippa F, Booth A, Rechner S, Bucuvalas Jm Gloor P. Measuring social network structure of clinical teams caring for patients with complex conditions. Procedia Soc Behav Sci 26: 17-29. 2011
Chambers D, Wilson P, Thompson C, Harden M. Social network analysis in healthcare Settings: a systematic scoping review. Plus ONE 7(8)e41911 2012
Leung CK-S, Carmichael CL. Exploring social networks: a frequent pattern visualization approach. 2010 IEEE International Conference on Social Computing / IEEE International Conference on Privacy, Security: 419-24. 2010
Lazzari C. Participant ethnographic research approach in the healthcare system: creating policies in dementia care. CPQ Medicine 1(6): 1-4. 2018
Willis EM. The problem of time in ethnographic health care research. Qual Health Res 20(4): 556-64. 2010
Montreuil M, Carnevale FA. Participatory hermeneutic ethnography: a methodological framework for health ethics research with children. Qual Health Res 28(7): 1135-44. 2018
Uhrenfeldt L, Martinsen B, Jørgensen LB, Sørensen EE. The state of Danish nursing ethnographic research: flowering, nurtured or malnurtured - a critical review. Scand J Caring Sci 32: 56-75. 2018
Gibbs G. Analyzing qualitative data. London, Thousand Oaks, New Delhi, Singapore: SAGE 2007.
Miles BM, Huberman AM. Qualitative Data Analysis. Thousand Oaks, CA: Sage Publications 1994.
Medcalc. Test for one proportion calculator. (2019) available at: (accessed: 1 February 2019).
Social Network Visualizer. SocNetV version 2.4. (2018) available at (accessed: December 4, 2018).
Creswick N, Westbrook J. Social network analysis of medication advice-seeking interactions among staff in an Australian hospital. Int J Med Inform 79: e116-25. 2010
Blanchet K, James P. How to do (or not to do) a social network analysis in health system research. Health Policy Plan 27: 438-46. 2012
Krueger RA, Casey MA. Focus Groups A Practical Guide for Applied Research. 3rd Edition. Thousand Oaks, CA: Sage Publications 2000.
Iliffe SJ, De Lepeleire J, Van Hout H, Kenny G, Lewis A, Vernooij-Dassen M. & The Diadem Group Understanding obstacles to the recognition of and response to dementia in different European countries: A modified focus group approach using multinational, multi-disciplinary expert groups. Aging Ment Health 9(1): 1-6. 2005
Pinheiro Landim FL, Morais Fernandes A, Barreto de Mesquita R, Costa Collares PM, Albuquerque Frota M. Interpersonal Network Analysis: application to the reality of a nursing team working in a haematology unit. Saúde Soc São Paulo 19(4): 828-37. 2010
Gillieatt S, Fernandes C, Fielding A, Hendrick A, Martin R, Matthews S. Social network analysis and social work inquiry 68(3): 338-51. 2015
Sabot K, Wickremasinghe D, Blanchet K, Avan B, Schellenberg J. Use of social network analysis methods to study professional advice and performance among healthcare providers: a systematic review. Syst Rev 6: 1-23. 2017
Zhang S, de la Haye K, Ji M, An R. Application of social network analysis to obesity: a systematic review. Obes Rev 19: 976-88. 2018
Johnson JJ, Honnold JA, Stevens FP. Using Social Network Analysis to enhance Nonprofit organizational research capacity: a case study. J Comm Prac 18(4): 493-512. 2010
Giovagnoli AR, Manfredi V, Parente A, Schifano L, Olivieri S, Avanzini G. Cognitive training in Alzheimer’s disease: a controlled randomized study. Neurol Sci 38: 1485-93. 2017

© 2022 Bentham Science Publishers | Privacy Policy