OBJECTIVE--To assess if and how demented patients' living conditions affect their level of functioning. DESIGN--A prospective concurrent control-study. SETTING--Sundsvall, an industrial community in the middle of Sweden. PARTICIPANTS--Forty-six demented patients in group-living (GL-group) and 62 controls (C-group). MAIN OUTCOME MEASURE--Cognitive function, ADL-capacity and behaviour were measured every third month during one year. RESULTS--Both groups deteriorated, but the decline was significantly slower in the GL-group regarding some ADL-functions, e.g. dressing and motor functions, whereas some behavioural disturbances were significantly more frequent in the GL-group. No differences were observed regarding the level of cognitive function. CONCLUSION--The living condition has small effects on cognitive function and ADL-capacity. The behavioural disturbances observed in GL should be the focus of future research.
The total number of people with dementia symptoms is expected to double every 20 years and there will also be an increase in the number of older immigrants in several countries. There are considerable deficiencies in the present knowledge of how to conduct well-functioning health care for immigrants with dementia symptoms. The aim of this study was to explore caring and uncaring encounters between assistant nurses and immigrants in two group homes for persons with dementia symptoms in Sweden: a Finnish-speaking as well as a Swedish-speaking context. In addition, this study aims to describe how caring and uncaring encounters are manifested in these two contexts according to Halldórsdóttir's theory of "Caring and Uncaring encounters".
Descriptive field notes from 30 separate observations were analyzed using qualitative deductive content analysis.
The main category "caring encounters" focused on reaching out to initiate connection through communication, removing masks of anonymity by acknowledging the unique person, acknowledgment of connection by being personal. Reaching a level of truthfulness by being present and showing respect, raising the level of solidarity by equality and true negotiation of care, based on the residents' needs. The main category, uncaring encounters, focused on disinterest in and insensitivity towards the other, coldness in the connection and lack of humanity in care situations. The observations showed that caring encounters occurred more in the Finnish-speaking context and uncaring encounters more often in the Swedish context.
Encounters could be caring, uncaring, and carried out using a person-centered approach. Communication and relationships could be facilitated using the same language but also through learning to interpret residents' needs and desires.
Physical restraints are commonly used on older persons living in geriatric care settings. The aim of this study was to investigate the influence of environmental and organizational variations and resident and staff characteristics on restraint prevalence. In this cross-sectional study of 33 nursing home wards and 12 group living units for old persons with dementia in two municipalities in northern Sweden, 540 residents (mean age 82) and 529 staff members were evaluated for resident and staff characteristics and organizational and environmental variables. The proportion of residents with impaired mobility function, the number of behavioral disturbances, and nursing staff's attitudes towards use of restraints were the strongest discriminators between restraint-free wards and wards that used restraints. A classification function analysis showed that these three variables could correctly classify the wards as restraint-free, low-use, and high-use wards in 63.6% of the cases, with the highest figures for restraint-free wards (91%). This study has shown that the use of physical restraints is strongly connected with residents' functional status and nursing staffs' attitudes toward their use.
The Hamilton Psychiatric Hospital schizophrenia psychosocial rehabilitation program developed a supported housing project to meet the goals of patients severely disabled with schizophrenia. An evaluation was conducted to assess whether the project had been implemented according to the original proposal. The assessment allowed adjustments to be made to the project, provided lessons for future undertakings, and demonstrated the value of clearly specifying the elements underlying any pilot project.
One seldom-discussed issue is the factors that influence nurses' decisions about the time they spend with residents in psychiatric care. This study uses a qualitative naturalistic approach and consists of an analysis of focus-group interviews with nurses, which aimed to identify factors affecting nurses' decisions about being with or being nonattendant in their relationship with their residents. Two series of focus-group interviews were conducted, interpreted and analysed through content analysis. The study included all the staff (n=32) at two municipal psychiatric group dwellings housing residents mainly with a diagnosis of long-term schizophrenia. This study revealed that the main factor that determined nurses' nurse/resident time together or nonattendance time was whether they liked or disliked the individual resident. One possible explanation is the carers' change from a perspective in which the nursing care was given on the basis of each resident's needs and rights, based on the individual nurse's professional judgement, to a consumer perspective, which leads to a change in responsibility from themselves to the individual residents.
The aim of this article is to describe the relationship between activities, social network and the possibility of influencing daily lives for about 24 people with intellectual disabilities. The study is based on data collected through interviews with staff at day centres and in group homes and with one relative. The results indicated that several of the people with intellectual disabilities had little or no opportunity to exert influence on choice of activities or social contacts. The study also suggests that if the environment makes it possible for people with intellectual disabilities to make choices, learn social competence and technical know-how and to communicate, it will support the opportunity for choosing activities, participating and influencing. Increased possibilities for communication are one way of changing the balance of power. An important factor for the participants was relatives and contact people, those participants who have these had more variation in their activities and in more different environments. The study shows that it is important to offer different experiences to people with intellectual disabilities in order that they learn to take initiatives and try new things.
The aim of this study was to illuminate the meaning of the physicians' expectations regarding registered nurses who are responsible for the care of older people living in sheltered housing, retirement homes and group dwellings. A phenomenological-hermeneutic method was used for the analysis. Twelve physicians from two municipalities in Sweden were interviewed. The naive reading of the interviews characterizes the physicians' expressed views of nurses by using metaphors such as "the extended arm", "gatekeeper" and "belonging to a no-man's land". In the structural analysis, explanations of the metaphors are given. The new understanding was that the physicians also expect registered nurses to be able to switch between keeping a distance and being close to older people. When registered nurses have this skill, the physicians have a "we" feeling towards the nurse. The paper provides insights into the physician-nurse relationship, in the context of residential care in Sweden.
BACKGROUND: Family caregivers of relatives with dementia report higher level of psychological distress than other caregivers and report their self-related health as poorer than that of comparison groups. AIMS AND OBJECTIVES: The purpose of the study was to examine characteristics of family caregivers and to assess whether income, subjective health, age and relationship were associated with the burden of care they experienced. SETTING: Group living units in southern Sweden. PARTICIPANTS: Fifty caregivers who served as informal caregivers of relatives with dementia in group living care. DESIGN: Interviews regarding economic and social conditions and well-evaluated scales for health and caregiver burden (CB) were used. RESULTS: The majority of the family caregivers were adult children, and twice as many were female than were males. The investigation showed that total burden, strain and disappointment, adjusted for health and age, were related to income. Disappointment showed a relation to subjective health. The adult children showed a significantly higher degree of total burden, irrespective of age, compared to other family caregivers. Low income was associated with a higher degree of burden among adult children. However, elderly participants experienced less of burden than younger ones. CONCLUSION: Our findings indicate that caregivers with low health profile and low income, especially adult children, are associated with higher CB. RELEVANCE TO CLINICAL PRACTICE: People with coexisting risk factors (low income, low perceived health) are the ones who may benefit most from health-oriented interventions.
As part of a larger study, we offered Everyday Life Rehabilitation (ELR) as a model for integrated occupational therapy in sheltered or supported housing facilities, to enable meaningful daily occupations for people with psychiatric disabilities. Our aim with this study was to understand how participants made sense of their occupational transformations in the context of their everyday life and life history. We carried out qualitative interviews and field observations with 16 participants with psychosis-related disorders. We used narrative analysis and disclosed stories of "rediscovering agency," referring to occupational and identity transformations. A parallel outcome study has shown positive results for participants, and by using narrative inquiry we contribute with a deeper understanding of the meaning making of their transformations and mechanisms of the intervention; i.e., hope, extended value of reaching goals, reentering the majority world, transparency of process, and attunement to the individual. The findings support the use of the ELR intervention.