How can autonomy be maintained and informal care improved for people with dementia living in residential care facilities: A systematic literature review

Background and objectives: For people with dementia living in residential care facilities, maintaining autonomy and receiving informal care are important. The objective of this review is to understand how caregiving approaches and physical environment, including technologies contribute to the maintenance of autonomy and informal care provision for this population. Research design and method: A literature review of peer-reviewed articles published between January 1995 and July 2017 was performed. Realist logic of analysis was used, involving context, mechanism and outcome configurations. Results: Forty-nine articles were included. The improvement of the relationship between residents and formal/informal caregivers is important. This increases the knowledge (sharing) about the resident and contributes to their autonomy. A social, flexible, and welcoming attitude of the formal caregiver improves the provision of informal care. Specially designed spaces, for instance, therapeutic gardens, create activities for residents that remind them of themselves and contribute to their autonomy. Use of technologies reduces caregiver's time for primary tasks and therefore enables secondary tasks such as interaction with the residents. Discussion and implications: The results revealed how residential care facilities could maintain autonomy of their residents and improve informal care delivery using caregiving approaches and the physical environment including technologies. The results are supporting toward each other in maintaining autonomy and also helped in enhancing informal care provision. For residential care facilities that want to maintain the autonomy of their residents and improve informal care delivery, it is important to pay attention to all aspects of living in a residential care facility

Embracing the social nature of recovery:A longitudinal, qualitative, multi-perspective study on the resource group method for people with severe mental illness

Objective: The resource group method for people with severe mental illness might provide a useful framework to facilitate patient's empowerment and systematically engage significant others. However, no research has explored the perspectives and experiences of patients and their significant others. This is crucial for better adjustment to the needs of the people using the method. The aim of this study was to develop a useful framework for a deeper understanding of the resource group method and its outcomes. Method: The study used a longitudinal, qualitative multiple case-study design based on grounded theory methodology. During a period of 2 years, the developments and processes in eight resource groups were explored by conducting a total of 74 interviews (e.g., with patients, significant others, and mental health professionals) and 26 observations of resource group meetings. Results: Analysis showed that a well-functioning resource group set the stage for five processes to unfold: (i) experience of support; (ii) acknowledgment of significant others; (iii) activation; (iv) openness; and (v) integration. These processes facilitated recovery both in terms of an arousing curiosity within the patient as well as increasing reciprocity and equality in their social relations. In addition, the method emphasized the uniqueness of each recovery journey, thereby providing a framework to shape recovery-oriented care. The analysis also revealed three hindering factors: (i) embedding and implementation issues; (ii) predominant network; and (iii) tensions inherent in the resource group setting. Conclusion: Working according to the resource group method involves that the person's recovery work becomes a social process that takes place in relation to the social environment and everyday life in which it is important to acknowledge and integrate the needs of significant others in treatment and care. This study provides a first step toward a multidimensional comprehension of the resource group method, the working mechanisms and its influence on recovery for people with severe mental illness

Interpersonal relations within the context of resource groups for people with severe mental illness:A narrative approach

Objective: The resource group method intends to promote patients' agency and self-management and to organize meaningful partnerships between patients and their informal and formal support systems. The aim of this study was to enhance the understanding of interpersonal dynamics that arise within resource groups for people with severe mental illness. Insight into these unfolding processes would enable improved implementation of the resource group method so that it contributes to establishing a positive social environment, which can lead to more enduring recovery. Methodology: We performed a narrative analysis of transcripts and field notes obtained in a longitudinal, qualitative study on the resource group method. The stories of four different resource groups were reconstructed and analyzed in depth. Data included a total of 36 interviews (with patients, significant others, and mental health professionals) and 18 observations of resource group meetings. Results: The degree to which the resource group method actually contributes to recovery was based on the extent to which the existing roles of and patterns between the patient and his/her resource group members were altered. Breaking through old patterns of inequality and the joint search for a new balance in relationships proved to be crucial processes for establishing an empowering resource group. The four cases showed that it takes time, patience, and small steps back and forth to overcome the struggles and fears related to finding new ways of relating to each other. An honest and reflective atmosphere in which all participants are encouraged to participate and be curious about themselves and each other is essential for changes in interpersonal dynamics to emerge. Such changes pave the way for individuals with SMI to find their own voices and pursue their unique recovery journeys. Conclusions: The functioning of the resource group and the ability of the involved members to respond in new ways are important when working toward the patient's recovery goals. The resource group method should therefore not be considered an intervention to organize informal support for the patient, but a platform to expose and adjust the functioning of the patient's social network as a whole

Maïs beperkt nitraatverlies van gras

Maïs staat bekend als een gewas dat veel nitraat naar het grondwater lekt. Maar maïs heeft ook goeie kanten. Nieuw in dit rijtje is dat maïs, in vruchtwisseling met gras, ook het nitraatverlies van grasland beperkt. Dit blijkt uit de metingen van het RIVM op De Marke