| 51. |
- Skovdahl, Kirsti
(författare)
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Krävande beteenden i samband med demens : förekomst och olika förhållningssätt
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis based on five studies conducted within community care sought to I) study demanding symptoms and behaviour in persons > 65 years in home care or sheltered housing and work load from a staff perspective over a decade, II) study caregiver reflections when dealing with Behavioural and Psychiatric Symptoms of Dementia (BPSD), III) illuminate interactions between individuals with BPSD and caregivers who reported problems dealing with such behaviour and caregivers who did not, IV) obtain insight into their reasoning from their respective interactions with the residents. A further aim was to discuss their reasoning in relation to each other and V) describe documented experiences from giving tactile stimulation to five randomly selected residents with BPSD and changes seen in these persons during the intervention period. Demanding symptoms and behaviours of older adults > 65 years in home care or sheltered housing were assessed from a staff perspective together with workloads in 1993 (= 1187 older adults) and 2002 (= 1017 older adults). Data for the qualitative studies were obtained by interviewing 15 formal caregivers at three care units, one unit where caregivers (n=5) (group 1) felt they were able to deal with aggressive behaviour and two units where an unexpected high level of aggressive behaviour had been reported (study I) and the caregivers felt the BPSD was problematic (n=10) (group 2). Videotaping of caregivers at a unit who felt they were able to interact in a positive way (group 1) respectively recordings from a unit where the caregivers had experienced aggressiveness as difficult to handle (group 2) were conducted during morning care sessions (=6 video recordings). One resident and three caregivers (group 1), and one resident and six caregivers (group 2) participated. The interviews and the videotapes were transcribed and analysed using a phenomenological-hermeneutic approach. Individual 'stimulated recall' interviews were carried out with all the caregivers who had been videotaped (n=9). Thematic content analysis was used to analyse the interviews. Study V followed the caregivers' documentations from five randomly selected residents living in a sheltered housing facility for persons with BPSD that received tactile stimulation for 28 weeks. The documentations were analysed by qualitative content analysis. Findings indicated that demanding symptoms had in general increased from 1993 to 2002, as well as the physical and the psychological workloads (I). The interviews indicated the importance of balance between demands and competence for the residents as well as for the caregivers if a positive relationship is to develop. Support was crucial, not only for the residents but also for caregivers if they were expected to deal with demanding situations (II). The interactions indicated as either being in a positive (group 1) or a negative spiral (group 2). Group 2 caregivers focused on accomplishing the task, which was the goal itself, while group 1 caregivers focused on how they could reach their goal in the best way, based on the resident's demands and wishes. Power in different ways was central, either in a positive way, as a way to involve the other (group 1) or in a more negative way, making decisions over the other (group 2) (III). Group 2 focused on their duties and seemed unwittingly to prevent positive interactions with the resident. Group 1 seemed to be accustomed to being able to reflect and sustain positive interactions with the residents (IV). Residents displayed signs of positive feelings and relaxation and fell asleep almost every time they received tactile stimulation. The caregivers felt they were able to interact with the residents in a more positive way and that they had a warmer relationship with them (V). Indicators are that caregivers who strive to understand the meanings behind behaviours, who master the necessary care-giving skills, and can implement them, will be much more successful at curbing distressing behaviour, than caregivers who merely act in a task oriented fashion. The caregivers are, however, also dependent on effective organisational, managerial and collegial support if the are to be able to achieve positive relationships and a high quality of nursing care that is also experienced as positive by the persons with dementia.
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| 52. |
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| 53. |
- Skovdahl, Kirsti, 1964-, et al.
(författare)
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Tactile stimulation associated with nursing care to individuals with dementia showing aggressive or restless tendencies : an intervention study in dementia care
- 2007
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Ingår i: International Journal of Older People Nursing. - Oxford : Blackwell Publishing. - 1748-3735 .- 1748-3743. ; 2, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This study aimed to describe from documentation both the caregivers' experiences of giving tactile stimulation to five people with moderate-to-severe dementia and who showed aggressive or restless tendencies, and the changes seen in them. Background. Clinical experiences indicate that tactile stimulation can contribute to a feeling of trust and confirmation as well as to improving communication, promoting relaxation and easing pain. There is, however, very little scientific documentation of the effects of touch massage for people with dementia. Design. From caregivers' documentation (28 weeks) of experiences, the giving of tactile stimulation to five randomly selected people with dementia showing aggressive or restless tendencies and the subsequent changes noticed. Method. The documentation was analysed by using qualitative content analysis. Results. All residents displayed signs of positive feelings and relaxation. The caregivers stated that they felt able to interact with the residents in a more positive way and that they felt they had a warmer relationship with them. Conclusion. Tactile stimulation can be seen as a valuable way to communicating non-verbally, of giving feedback, confirmation, consolation or a feeling of being valuable and taken care of. Relevance to clinical practice. Tactile stimulation has to be administered with respect and care, and given from a relational ethics perspective. Otherwise, there is a risk that tactile stimulation will be used merely as a technique instead of as a part of an effort to achieve optimal good, warm nursing care.
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| 54. |
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| 55. |
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| 56. |
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| 57. |
- Tyrrell, Marie, et al.
(författare)
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Embarking on a memory assessment voices of older persons living with memory impairment
- 2021
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Ingår i: Dementia. - : Sage Publications. - 1471-3012 .- 1741-2684. ; 20:2, s. 717-733
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Tidskriftsartikel (refereegranskat)abstract
- AimTo describe older persons who had commenced a memory assessment, experiences of living with memory impairment and related symptoms.BackgroundPersons with subjective memory impairment are two times more likely to develop dementia over the years than their peers. Older persons seldom seek help from primary health care clinics solely for subjective memory impairment. Of those who seek help, it can take up to 35 months from the person experiencing initial symptoms to referral to a memory clinic. Further research is needed regarding how older persons live with memory impairment with related symptoms before they receive a memory diagnosis.MethodA qualitative study with 23 participants who had commenced a memory assessment in primary care. Semi-structured interviews were held. During the interviews, the Neuropsychiatric Inventory was completed and discussed with the participants. Interview data were analysed using Interpretive Description.ResultsThe results are presented under four themes: Conflicting views about the situation, Unveiling the presence of neuropsychiatric symptoms, Compensating with external and internal strategies to recall and Worrying about self and future. Persons with memory impairment were encouraged by family members or others to seek a memory assessment. Few persons were self-referred as memory impairment was often seen as a part of aging. Polarised viewpoints existed within the families regarding the impact of memory impairment on daily life. The presence of neuropsychiatric symptoms appeared unexplored in the participants seeking a memory assessment. In this study, the majority of participants experienced neuropsychiatric symptoms at the time of contact for a memory assessment.ConclusionsMemory problems experienced were often viewed by the person as being part of an aging process. The presence of neuropsychiatric symptoms was not acknowledged as being connected to memory impairment. Contextualising ‘memory impairment’ as a part of a ‘cognitive process’ may help the person in identifying the presence of neuropsychiatric symptoms.
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| 58. |
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| 59. |
- Tyrrell, Marie, et al.
(författare)
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Feeling valued versus abandoned : Voices of persons who have completed a cognitive assessment
- 2021
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Ingår i: International Journal of Older People Nursing. - : John Wiley & Sons. - 1748-3735 .- 1748-3743. ; 16:6
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe older persons' experiences of a cognitive assessment and possible neuropsychiatric symptoms [NPS] related to a neurocognitive diagnosis.BACKGROUND: A cognitive assessment in primary care is offered to persons with suspected dementia with subsequent referral to a specialist clinic if required. The assessment process, with the likelihood of receiving a dementia diagnosis, is surrounded by uncertainty with long waiting times. Although NPS are common among persons with cognitive impairment persons are not routinely asked about these symptoms during a cognitive assessment.METHOD: Interviews were held with 18 participants who had completed a cognitive assessment. The Neuropsychiatric Inventory [NPI] was incorporated into one of the interview questions enabling participants to self-report NPS, if present. Interview data were analysed using Interpretive Description.RESULTS: Two main themes were identified: a matter of trust and making sense of a cognitive diagnosis. Experiences of the assessment process ranged from feeling valued to abandoned with variations of trust in the process. A diagnosis of mild cognitive impairment was experienced as an abstract diagnosis devoid of follow-up support. A lack of preparedness for the assessment existed among participants. Some experienced the process as standardised. One half of participants self-reported the presence of one to four NPS, regardless of neurocognitive diagnosis. Irritability and depression were most common NPS identified.CONCLUSIONS: Experiences of a cognitive assessment varied from feeling valued by society to abandoned in the absence of follow-up support. The assessment was viewed as a standardised procedure failing to see the person behind the testing. Diagnosis disclosure conversations were experienced as diffuse with participants unprepared for a dementia diagnosis. The NPI enabled participants to identify and report the presence of NPS which otherwise could go undetected during the cognitive assessment, impacting on the person's well-being and daily life.
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| 60. |
- Tyrrell, Marie, et al.
(författare)
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Living with a well-known stranger : Voices of family members to older persons with frontotemporal dementia
- 2020
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Ingår i: International Journal of Older People Nursing. - : Wiley. - 1748-3735 .- 1748-3743. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe family members' experiences of living with persons with neuropsychiatric symptoms (NPS) related to frontotemporal dementia (FTD).BACKGROUND: The majority of persons with dementia during the disease trajectory develop NPS. Persons with FTD are likely to develop greater levels of NPS than persons with other types of dementias. Research-based knowledge regarding family members' experiences of living with persons with FTD and NPS is limited.METHODS: Nine family members of persons with FTD were interviewed. Interviews commenced with completion of the Neuropsychiatric Inventory (NPI). Upon completion of the NPI, questions were posed from an interview guide where study participants provided in-depth information about NPS identified. Interview data were analysed using qualitative content analysis.RESULTS: Interviewed family members highlighted that persons with FTD had developed between four and eight co-existing NPS. Irritability and disinhibition were the most common NPS, with variations in severity, frequency and distress. From the interview data, two themes emerged: Living with a well-known stranger and Coping and overstepping social norms.CONCLUSIONS: Living with a well-known stranger depicted a new co-existence with a loved one with changes in personality and behaviour, which were not inherent to the person or predictable any more. The presence of NPS can threaten the safety of the person with FTD and their family in real world and on social media. Support offered should focus on the person's physical and psychological needs, not on a diagnosis.IMPLICATIONS FOR PRACTICE: From a health care perspective it is important to see the person with FTD and their family as unique individuals with specific needs.
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