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- Edberg, Anna-Karin
(författare)
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The nurse-patient encounter and the patients' state: Effects of individual care and clinical group supervision in dementia care.
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of thesis was to investigate the nurse-patient encounter in dementia care (n=9 patients), functional and cognitive ability, behaviours and mood of the patients as well as the reliability of the instruments used (n=75 nursing home patients). A further aim was to investigate the effects on the aspects mentioned above of a one-year controlled intervention (individually planned care and clinical group supervision) on one ward (EW) in comparison to a control ward (CW), each housing 11 patients. The nurse-patient encounter was studied by means of tape recorded interaction episodes including patients' regarded as vocally demanding. The inter-rater reliability of the Patient Mood Assessment Scale (PMAS), the General Behaviour Assessment Scale (GBAS), the Gottfries-Bråne-Steen Scale and the patients' state were investigated using nurses' assessments of the patients. The intervention effects were investigated at baseline and throughout the year, for the patients' state using PMAS, GBAS, Organic Brain Syndrome scale, Multi Dimensional Dementia Assessment Scale, Demanding Behaviour Assessment Scale and Mini Mental State Examination, and for the nurse-patient encounter using non-participant observations during morning care and analysis of notes from clinical supervision sessions. Patients actively seeking contact and nurses mediating "caring about", i.e. mutuality and confirming actions, characterised high quality encounters. Nurses' or patients' withdrawal, nurses being inattentive i.e. unilaterality and disconfirming actions, characterised poor quality encounters. The inter-rater reliability of the nurses' assessments of patients' state was acceptable for ADL and intellectual functions but low for emotional dimensions. Significant improvements were seen on the EW for nurse-patient encounters, patients' sensitivity and demanding behaviours while significant detoriations were seen on CW in nurse-patient encounters, patients' functional performance and orientation in the ward, speech performance and strength. Thus the nurse-patient encounters and the patients' state developed in opposite directions on the two wards, positively on the EW and seemingly the intervention supported the nurses in their encounters with the patients, which in turn was reflected in the patients' state.
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| 2. |
- Holst, Göran
(författare)
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Bridging the communicative gap between a person with dementia and caregivers. A nursing perspective
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim was to explore possible areas and sources that could inform the care for people with dementia. These were the people with dementia themselves, nurses reflective discussions about caring, nurse-patient interaction together with information from close family members, and the previous personality and sense of coherence of people with dementia in relation to behaviour during the disease as related by themselves and/or a family member and the experiences of everyday life for people with dementia still able to talk about their experiences and living as a couple when one of the partners has a dementia disease. The results are based on open-ended personal interview data from the person with dementia (n=11) and their spouses (n=6) regarding experiences of having a dementia disease. A number of 111 direct observations of the interaction between nurse and patient (n=22) during morning care and analysis of notes from clinical supervision sessions, personal interviews with a next of kin (n=40) were collected to study the relation between previous personality and reactions during the dementia disease. The agreement between an elderly persons? (n=77) self-assessment of personality (EPI) and sense of coherence (SOC) and that of a next of kin was also studied (n=77). The life of the people with dementia changed during the course of the dementia and in various ways they struggled to preserve a sense of self in relation to themselves and to others and recreated meaning and identity in their lives. Responsibilities were redistributed with the healthy spouse taking over mutual activities. The nurse-patient encounters demonstrated mutuality and acting at the same pace and unilaterality and acting out of pace with each other. In the reflective discussions nurses spoke about either confirming or threatening the nurse's and/or patient's identity and integrity. Patients experienced as vocally disruptive were more often described as introverted, rigid and with a tendency to control emotions prior to the disease as remembered by a next of kin than those not vocally active. The agreement between self-rating scores and the ratings made by a next of kin in measuring personality and sense of coherence was high or moderate. However information given by a spouse about the meaning of having a dementia disease did not fully agree with the sick partners understanding of it. The findings in the thesis may form a basis for the development of models with various kinds of knowledge framing the foundation for care for people with a dementia disease.
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