The purpose of this study was to examine Residential Care Aides’ (RCAs) experiences of good quality dementia care provision. Informed by a political economy perspective, I sought to understand how RCAs conceptualize quality dementia care, whether such conceptualizations are reflected in their daily care practice and how the organizational care context impedes or facilitates such care provision. Drawing on a focused ethnographic approach, I utilized in-depth interviews, participant observation and the review of selected documents to contextualize RCAs’ experiences within the organizational care environment. Over a 12-month period, in-depth interviews with 29 staff (21 RCAs, 3 LPNs and 5 managers) and 239 hours of participant observation were conducted in four small-scale dementia units in two nursing homes in British Columbia, Canada. In-depth interviews yielded information-rich data about RCAs’ care experiences and their relationships with residents, while participant observation afforded the opportunity to strategically link RCAs’ actions and interactions with what was said, a feature missing from much of the previous research examining staff perceptions of quality dementia care. A select review of facility documents and provincial licensing regulations provided additional insight regarding the relevance of the larger structural context for RCAs’ care experiences. In general, RCAs conceptualized, and exhibited in their daily physical care provision, quality dementia care as that which focused on tangible care outcomes (i.e., keeping residents clean, comfortable, calm and happy), on their care approach (i.e., delivering care in a compassionate, patient and affectionate manner) and was guided by family ideology (i.e., invoking of family metaphors). Inherent in their care provision was a sense of role tension, as they sought to incorporate social interaction with task completion and their co-workers’ conflicting expectations. Study findings also illustrated how, in the face of continued disempowerment and organizational constraints, RCAs sought to provide quality dementia care by negotiating their peer and supervisory relationships and selectively breaking formal and informal policies/procedures. Salient to RCAs’ experiences of personhood was the limited recognition and appreciation they received from management and the manner in which work-life balance, staffing coverage, human resource management practices and limited information sharing further devalued them and their work. Study findings draw attention to the importance of: acknowledging the role of structural constraints in the pervasiveness of a task-oriented work culture; attending to (and facilitating) staff personhood; facilitating supportive peer and supervisory relationships and; fostering effective management practices as a means of potentially improving care quality. As such, the study sheds important light on what RCAs require within their work environments to help facilitate resident well-being, reinforcing the assertion that residents’ care conditions are inextricably linked to RCAs’ care work conditions. / Graduate / 0351

published_or_final_version / Gerontology / Master / Master of Social Sciences

En vårdfilosofi kan fungera som en grund för hur man ska handla och en förklaring till varför man har handlat som man har. Studien syftar till att beskriva en personcentrerad vårdfilosofi och hur den kommer till uttryck i demensvård. I denna studie har kvalitativa studier av demensvård med ett personcentrerat perspektiv analyserats för att öka förståelsen för hur denna vård upplevs av patienterna och hur den uttrycks i vården.På grund av att patienter med demenssjukdom är extremt sårbara och beroende av andra för sitt välbefinnande är det speciellt viktigt att formulera en vårdfilosofi inom demensvård.Det som är återkommande i resultatet av studien är synen på patienten som en person. Att bli sedd som en person och inte som en sak eller diagnos ger mening åt livet och möjlighet till att uppleva välbefinnande.Personcentrerad vård inom demensvård innebär att bekräfta patienten, vara närvarande i mötet, lyssna till och försöka tolka patientens berättelse, ge patienten frihet och möjlighet att välja och bestämma över sin situation, hjälpa patienten att bevara sina relationer och underlätta eller kompensera för personens förlorade förmågor. / <p>Program: Fristående kurs</p><p>Uppsatsnivå: C</p>

<p><b>Aim:</b><b> </b>The overall aim of the present thesis was to describe and evaluate IT support in dementia care from the perspectives of staff and relatives. More specifically, it was to examine staff members’ satisfaction with work, life satisfaction and sense of coherence before and after increased IT support, to describe staff members’ opinions and perceptions of IT support during the process of implementation, to describe relatives’ opinions of IT support and to compare relatives’ perceptions of their irritations with care and life satisfaction before and after increased IT support. In addition, three questionnaires were further developed and tested among staff working in elderly care, and then used in the staff evaluation. <b>Methods:</b> A quasi-experimental design with baseline assessments and follow-ups and experimental and control groups was used in two studies to investigate the outcomes of IT support. A descriptive design was used to study staff views on IT support, and a correlative design was used in the methodological study. Participants were 33 staff members and 22 relatives in the evaluation, 14 staff members in the descriptive study and 299 staff members in the methodological study. Data collection methods were questionnaires and group interviews. The IT support consisted of passive passage alarms, fall detectors, sensor-activated night-time illumination of the lavatory, movement detectors, email communication, an Internet website and additional computers. <b>Findings and conclusions:</b> Staff job satisfaction and perceived quality of care increased in the experimental group. The relatives were generally positive about the IT support, and the experimental group showed a decrease in practical/logistical irritations. Staff described ‘moving from fear of losing control to perceived increase in control and security’ and ‘constant struggling with insufficient/deficient systems’. Conclusions are that IT support can be a resource in dementia care as perceived by caregivers if IT support is incorporated into the care system.</p>

The overall aim of the study was to gain some understanding of the lived experience of the care-giving spouses regarding their experiences of the manifestations of the disease, perception of their own health, the possibility of influencing the interpretation of the past, the present and future, outlook on life, surrounding contacts and intimate relationships with their sick partners. The spouses (n=13) of Alzheimer victims were followed with the help of personal interviews, diaries and telephone interviews during a two-years period. The texts was analysed according to a phenomenological-hermeneutic method. The main findings in the study showed that the spouses own health remained quite stable over time. Their perception of the development of their own health seemed to be influenced by how they saw their power to influence their situation, which seemed to be determined by how they interpreted the cause of their health problems.The social network was another important factor for understanding the spouses' experiences. The findings imply that spouses' images of themselves in relation to others were important for their perception of the overall social network. The spouses mostly regarded their relationships positively and their social networks were described as quite stable over time. The spouse's marital relationships, in most cases, seemed to undergo changes with the progress of the disease. Some spouses could maintain feelings of love but mostly the relationships were transformed into ones of tenderness, pity and estrangement. The spouses' valuation of their demented partner was mostly in the form of one of two divergent perspectives. On the one hand, spouses who seemed to perceive their partner as a person separate from the disease, could function as complementary ego aids. On the other hand some spouses were unable to make a distinction between the spouse as a person and the disease.The spouses' experiences regarding their previous relationship with parents, value system, philosophy of life, competence and autonomy seemed to be critical in their experiences of their caring situation. It appears that there is a sub-group of vulnerable carers, as suggested by the concurrence of psychological, physical, and social morbidity, along with deterioration in their marital relationship.The findings are discussed in relation to searching for meaning, the importance of significant others, perceiving and valuing the other, and caring relationships within a life-span perspective. / digitalisering@umu

Bakgrund: Sveriges befolkning lever allt längre och därmed ökar antalet äldre. Då den största riskfaktorn för att utveckla demenssjukdom är hög ålder, beräknas även antalet personer med demens att öka. Professionell omvårdnad anses idag vara den bästa behandlingen. Demensdagvård bedrivs inom kommunal demensvård och syftar till att erbjuda besökare social samvaro, struktur och meningsinnehåll. Reflektion möjliggör för omvårdnadspersonal att utbyta erfarenheter och utvecklas i sin yrkesroll. Syfte: Att beskriva och analysera ett reflekterande arbetssätt hos omvårdnadspersonal i demensdagvård. Metod: Kvalitativ intervjustudie, analyserad med stöd i kvalitativ innehållsanalys. Resultat: Det reflekterande arbetssättet är konstruktivt och sker genom en regelbunden och öppen kommunikation, vilket leder till ett medvetet förhållningssätt till besökaren och sina egna handlingar. Ett reflekterande arbetsrätt bidrar till sammanhållning i arbetsgruppen och professionell utveckling inom omvårdnadsarbetet samt en mer individanpassad och följsam vård för besökarna. Genom det reflekterande arbetssättet bygger omvårdnadspersonalen goda vårdrelationer till besökarna. Slutsats: Det reflekterande arbetssättet är konstruktivt och sker genom en öppen kommunikation, vilket leder till att omvårdnadspersonalen kan förbättra vården och utvecklas i sin profession och därmed också utveckla innehållet i omvårdnaden. / Background: The Swedish population is living longer and this will increase the number of elderly. Since the greatest risk factor for developing dementia are old age, the number of persons with dementia will increase. Professional nursing is currently considered as the best treatment. Day Care for persons with dementia is conducted within municipal dementia care and aims at offering visitors social interaction, structure and meaningful content. Reflection enables health care staff to exchange experiences and developing their profession. Objective: To describe and analyze health care staffs´ reflective way of working within dementia day care. Method: Qualitative interview study, analyzed with support of qualitative content analysis. Results: Five categories were identified from analysis of the interviews; continuity, awareness, cohesion, professional development and ventilation. The result shows that the reflecting way of working isprovidedon a regular basis and has become a natural part of everyday work. The reflection creates a conscious attitude ofhealth care staff for their actions in different nursing situations. The reflective way of working strengthens the working group and contribute to cohesion. By reflection thehealth care staff is developing in their profession, through exchange of experiences. Conclusion: The reflective way of working contributes to unity in the working group and professional development within caring, and a more individual adapted accommodative care for the visitors. By the reflective way of working health care staff build good relations to the visitors.

published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

Personal knowledge was disclosed amongst a group of experienced registered nurses in relation to feeding severely ill patients with cancer and dementia (I,II,III), communicating with severely demented patients (IV,V), and receiving group supervision (VI). Principled ethics did not seem an adequate model for describing the ethical reasoning of experienced RNs. For the twenty RNs working in oncological care the question of whether or not to accept active euthanasia was the most urgent. The twenty RNs working in dementia care emphasized the difficulty they had in understanding the meaning of communicative cues in severely demented patients. Both groups of nurses saw themselves as advocates for their patients and seemed to reason mainly in accordance with the Golden Rule. Through a phenomenological hermeneutic analysis of video recordings of two RNs' interaction with each of four severely demented patients, it was possible to interpret the patients' vague and unclear communicative cues. But observations based on an assessment of facial muscle movements showed that it was very difficult (the FACS). Group supervision based on a narrative framework was carried out in order to support nurses working in dementia care. Interviews with the fifteen RNs showed that they experienced recognition and reassurance of worth, an increased repertoire of actions, gained new perspectives, an increased awareness of their professional role, and interdependence. It is proposed that the care of severely ill patients can be improved by the use of a narrative approach both as regards understanding patients and encouraging RNs to develop their clinical knowledge through reflecting on their own and their coworkers' narrations about care. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 6 uppsatser.</p> / digitalisering@umu

Aim: The overall aim of the present thesis was to describe and evaluate IT support in dementia care from the perspectives of staff and relatives. More specifically, it was to examine staff members’ satisfaction with work, life satisfaction and sense of coherence before and after increased IT support, to describe staff members’ opinions and perceptions of IT support during the process of implementation, to describe relatives’ opinions of IT support and to compare relatives’ perceptions of their irritations with care and life satisfaction before and after increased IT support. In addition, three questionnaires were further developed and tested among staff working in elderly care, and then used in the staff evaluation. Methods: A quasi-experimental design with baseline assessments and follow-ups and experimental and control groups was used in two studies to investigate the outcomes of IT support. A descriptive design was used to study staff views on IT support, and a correlative design was used in the methodological study. Participants were 33 staff members and 22 relatives in the evaluation, 14 staff members in the descriptive study and 299 staff members in the methodological study. Data collection methods were questionnaires and group interviews. The IT support consisted of passive passage alarms, fall detectors, sensor-activated night-time illumination of the lavatory, movement detectors, email communication, an Internet website and additional computers. Findings and conclusions: Staff job satisfaction and perceived quality of care increased in the experimental group. The relatives were generally positive about the IT support, and the experimental group showed a decrease in practical/logistical irritations. Staff described ‘moving from fear of losing control to perceived increase in control and security’ and ‘constant struggling with insufficient/deficient systems’. Conclusions are that IT support can be a resource in dementia care as perceived by caregivers if IT support is incorporated into the care system.

This thesis considers the provision of person-centred care (PCC) in acute healthcare. In recent years it has been increasingly recognised that healthcare should be delivered in a person-centred manner and that staff should receive training and support in relation to this. There is a growing body of literature investigating the potential benefits of PCC in relation to both patient and service level outcomes. Paper one of this thesis is a systematic review of the literature examining staff training interventions for improving PCC in acute healthcare settings. The findings offer preliminary support for the positive impact of such training interventions on patient and service level outcomes in hospital environments. The research in this area is not of a uniformly high standard and this paper concludes that further research in this area is required. Paper two is an examination of a modified version of Dementia Care Mapping (Care Mapping – Neurorehabilitation: DCM-NR), an observational tool for measuring and improving PCC. Results provide evidence of the feasibility and validity of DCM-NR in a range of Clinical Neuroscience settings. Future research should examine the impact of DCM-NR on person-centred practices over time.The critical reflection paper considers both the systematic review and the empirical study. It aims to consider both the strengths and limitations of the research, challenges encountered, clinical implications and highlights areas for future research.