Taking risks with dementia : Exploring practitioner accounts of risks and decision-making.

In contemporary health and social care, stories of risk and risk management pervade practice discourse. This study explores practitioner accounts of risk management and decision-making in dementia care, with a particular focus on wellbeing and quality of life.Interviews were undertaken with 11 practitioners working within NHS dementia care services in the north of England, during 2008. These were used to examine how practitioners talked about risk management, and their constructed and represented understandings of risk and decision-making.My analysis of practitioners' stories was undertaken alongside considerations of key policy and practice guidelines.Practitioners portrayed complex, contextual, reflexive approaches to risk management decision-making. Some discourses were so useful or strong they were represented as if they were the truth, whilst other discourses were questioned and reconstructed. Practitioners represented decision-making along continuums, such as subjective-objective and emotional-cognitive. Their accounts included stories of home, practice cultures, risk-taking, wellbeing, resources and discrimination. Some risk management strategies were portrayed as hazardous, in particular living 'in care', and practitioners consistently portrayed risk management decision-making as full of dilemmas and uncertainty.Unlike some dementia care research and policy, practitioners' stories did not prioritise physical wellbeing over psychological wellbeing. Some practitioners proposed a reconsideration of risk management decision-making that takes more account of the benefits and values of risk-taking.This research contributes to understandings of practitioners' decision-making and dilemmas in risk management with people living with a dementia. By positioning some dissemination within daily practice and discourse, I hope my study will trigger discussion, ideas, and action.