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- Rahm Hallberg, Ingalill, 1944-
(författare)
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Vocally disruptive behaviour in severely demented patients in relation to institutional care provided
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Thirty-seven patients identified as vocally disruptive and a control group, selected from 264 patients at psychogeriatric wards were studied. Tape-recordings of their vocal behaviour, ratings of their functional performance and symptoms related to dementia, observations of their behaviour, activities and interaction with caregivers were performed. Seventeen plus sixteen caregivers were interviewed to give their interpretation of the experience behind the behaviour and describe their own experience of it. The severely demented vocally disruptive patients were found to be significantly more physically dependant, disorientated at the ward and prone to confusional reactions but they had a more preserved speech performance than the controls. The vocal activity expressed such as helplessness, pain, fear and protest. Some were emotionally indifferent and a few expressed positive emotions. Caregivers interpreted the behaviour as an expression of anxiety related to such as abandonment, dissolution and loss of autonomy. They also expressed a strong wish to comfort the patients but felt unable to do so. The patients' daily life was characterized by idleness and solitude. Caring activities and interactions were dominated by physical procedures performed in a fragmentary and rapid way. Two hypotheses are generated. 1. Vocally disruptive behaviour develops influenced by sensory deprivation and the brain damage. 2. The care provided is influenced by caregivers experiencing anxiety in the patients as well as experiencing a conflict between the care they would like to provide and the care they actually provide. This evokes anxiety in them which elicits defence mechanisms leading to emotional withdrawal from the patients and task oriented care. The results are discussed in a nursing perspective based on existential thoughts, psychoanalytic and psychosocial theory.
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| 2. |
- Åkerlund, Britt Mari, 1943-
(författare)
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Dementia care in an ethical perspective : an exploratory study of caregivers' experiences of ethical conflicts when feeding severely demented patients
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to explore how caregivers caring for severely demented patients experience ethical conflict situations. Feeding patients in a late state of dementia was chosen as focus. Special attention was paid to analyses of the caregivers' experiences with regard to their feelings, use of force, interpretations of the patients' behaviour and their ethical reasoning.The study was carried out in five separate parts, presented as five papers. A phenomenological - hermeneutic approach was consistent. Personal interviews, a projective defence mechanism test, the Meta Contrast Technique and an analysis of patient/caregiver behaviour as shown in video taped feeding sessions were the methods used.Study participants were forty-one caregivers in psychogeriatric care, registered nurses, licensed practical nurses and nurses' assistants.The result indicated that, when facing ethical decisions the caregivers were caught in a double bind conflict due to the contradicting ethical demands "Keep the patient alive!" and "Don't cause the patient suffering!". The difficulty to interpret what the patients experienced and the impossibility to know for sure what actions would be right or wrong were sources of anxiety. They defined force feeding individually, yet a pattern was found. Some caregivers defined force feeding according to the amount of persuasiveness or violence they had to perform. Some regarded force feeding from a patient wish perspective. A majority combined the two dimensions.The caregivers' ethical reasoning showed that their decision making was to be regarded as a process grounded on ethical rules. Interdependence in the relation caregiver/patient made them develop their reasoning in a direction of existential reasoning.
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| 3. |
- Åström, Sture, 1946-
(författare)
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Attitudes, empathy and burnout among staff in geriatric and psychogeriatric care
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study concerned assessments of attitudes towards demented patients among students and nursing staff as well as attitudes towards active euthanasia, wish to transfer to other jobs, ability of empathy and experience of burnout among nursing staff. The study aimed also to relate experience of burnout to attitudes towards demented patients, ability of empathy and experience of work with demented patients. The study was performed by use of questionnaires, scales measuring attitudes towards demented patients, experience of burnout and ability of empathy. Tape-recorded interviews were also included aiming to explore the staffs experience at work.The results showed that a majority of the students and staff held positive attitudes towards demented patients. A small proportion intended to work solely with demented patients. Staff working in psychogeriatric care and somatic long-term care held more positive attitudes than staff working in acute medical care. Proportions of staff with positive attitudes varied depending on age, duration of employment, education and place of work. A larger proportion of staff in geriatric care than in acute care reported a wish to transfer to another job. LPN’s in nursing homes to the largest proportion stated this wish to transfer.A majority of both students and staff expressed negative attitudes towards active euthanasia to severely demented patients in the finale stage of life. However, most favourable attitudes towards active euthanasia were found among students with shorter health care education and among nurse's aides and LPN’s.The staffs empathy was judged as moderately high and there were no differences found in relation to sex, staff category or place of work.Experience of burnout /tedium varied with the place of work and category of staff. Largest proportions at risk to develop burnout were found among those working in somatic long-term care and psychogeriatric care. RN’s showed lower burnout scores than nurse's aides and LPN’s.Experience of burnout was correlated to attitudes towards demented patients, indicating that the lower burnout score the staff have the more positive are the attitudes. Burnout was also related to the staffs ability of empathy i.e. the lower degree of burnout the higher is the empathie ability. Regression analysis showed that "Experience of feed-back at work” and "Time spent at present place of work" were the most important factors for the staffs experience of burnout.
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