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Bakgrunn: Mulighet for kontakt mellom pårørende og beboere i sykehjem kan være begrenset på grunn av avstander og beboernes begrensede evne til å anvende telefon. Videokommunikasjon er vanlig ellers i samfunnet, og dette kan også være en mulighet for beboere i sykehjem. Hensikten med studien var å få kunnskap om pårørende og ansatte sine erfaringer med bruk av videokommunikasjon i en sykehjemsavdeling. Data ble innhentet gjennom kvalitative intervju med seks pårørende og to ansatte, og det ble foretatt en kvalitativ innholdsanalyse. Tre hovedtema ble analysert fram: 1) styrket kontakt mellom beboer og pårørende, 2) videokommunikasjon gir kognitiv støtte og økt forståelse, og 3) nært samarbeid mellom personalet og pårørende er avgjørende. Videokommunikasjon kan være et viktig kommunikasjonshjelpemiddel mellom pårørende og beboere i sykehjem, da det kan styrke fellesskapet og gi flere muligheter for samtaler og kontakt. For at disse samtalene skal kunne gjennomføres, må ansatte ha mulighet til å legge til rette for videokommunikasjon. Det er behov for videre forskning på hva som kan fremme tilretteleggingen av samvær mellom beboere på sykehjem og deres pårørende gjennom nye teknologiske løsninger som videokommunikasjon.måsjekke

Improving everyday life of people with dementia living at home: Health care professionals' experiences.

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Coping with everyday life for home-dwelling persons with dementia : A qualitative study

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Informal caregivers and persons with dementia's everyday life coping

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How volunteers contribute to persons with dementia coping in everyday life

Introduction: The society needs volunteers to fulfill its duty to ensure that people with dementia have active and meaningful everyday lives. Volunteers seem to experience their work as positive and meaningful for their own part, but we know less about what motivates volunteers to start working in home-dwelling dementia care and what motivates them to continue their engagement. This study seeks to close some of the knowledge gaps that exist regarding volunteers’ engagement in activities for persons with dementia. Aim: The aim of this study was to explore what motivates volunteers to start engaging in volunteer work in home-dwelling dementia care and what motivates them to continue their engagement. Methods: The study design was qualitative, using focus group interviews. Three focus group interviews (n=16) took place between May and June 2018. The text was analyzed using content analysis. Results: Findings in this study indicate that the volunteers were motivated by the feeling of doing an important job for the persons with dementia and their relatives, and that they contribute to their coping with everyday life. Other motivating factors included feeling important to someone, gaining friendship, and sharing common interests. They also believed that they do an important job for the community to fulfill society’s goal that people with dementia should stay home longer. However, the volunteers were confused about their role and ask for knowledge, peer support, and clarification of roles. Conclusion: To maintain motivation volunteers need to know what his/her role is. A volunteer can and shall not act as a substitute for a professional, only as a supplement, and the expectations must be addressed to all stakeholders: the health care service, the volunteer, the person with dementia, and their relatives, as we believe that this will contribute to diminishing misunderstandings.publishedVersio

Dementia and interaction A qualitative exploratory study of Marte Meo counselling for staff in dementia-specific care units

Approximately 70–80% of all persons who live in nursing homes have dementia. Enhancing communication and interactions that promote mutuality, dignity, and respect can be challenging because of the residents’ decreased abilities to understand and interact and the staff’s difficulties in understanding and interpreting vague communication from the residents. Positive interactions between persons with dementia and nurses are essential to promote dignity and avoid undesirable and conflicting situations. The manner in which nurses act in encounters with residents appears to greatly impact the well-being and behaviour of the residents. The main aims of this dissertation were to explore whether Marte Meo counselling (MMC) may contribute to positive changes in the daily interactions between persons with dementia and staff in dementia-specific care units (DSCUs) and to explore the nurses’ experiences of MMC. MMC is a video-supported counselling method that has been adopted in recent years to enable staff to recognise and improve communication and interactions when working with persons with dementia. It is based on the assumption that a heightened awareness of what comprises effective communication can facilitate greater contact and mutuality in interpersonal interactions between persons with dementia and their caregivers. This dissertation was based on three studies: Study I aimed to investigate whether changes could be identified in the interactions between persons with dementia and their nurses during morning care following MMC. An intervention study based on video recordings before and after MMC intervention was used. Thirteen nurses and 10 residents from six DSCUs at six different institutions in Norway participated. Data were collected through the video recording of six pairs (nurse and resident) during interactions before and after the staff received MMC. Four pairs were included in the comparison group. The findings suggest that nurses who received MMC succeeded, to a greater degree compared with the comparison nurses, in providing care consistent with promoting positive interactions. We identified clearer indications of increased positive interactions and a reduction in inappropriate interactions in the intervention group. In the comparison group, the variation was greater, with both good and poor interactions present in a given case. This study indicated that MMC can facilitate positive interactions and reduce inappropriate interactions. Study II sought to explore the staff members’ experiences of participating in MMC with a particular focus on their learning experiences in four DSCUs. This was a qualitative descriptive study. Data were collected through 12 individual and four focus group interviews (N=24). Findings emerged through manifest and latent content analyses. The nurses acquired new knowledge regarding the residents through MMC, which resulted in an improved capability to interpret the residents’ expressions and an increased awareness of the residents’ competence. New knowledge concerning themselves as nurses also emerged; they recognised how their actions affected the interactions, which consequently made them aware of the usefulness of taking time, pacing their interactions, maintaining eye contact, and describing the situation in words during interactions. This increased knowledge appeared to increase the resident’s perception of being able to cope. This study indicated that MMC helped nurses to learn how to improve interactions with residents with moderate and severe dementia. Study III sought to identify factors that affected the learning outcomes from MMC. Twelve individual interviews and four focus group interviews (N=24) with staff who had participated in MMC were analysed through a qualitative content analysis. The study found that the learning climate had significantly influenced the experienced advantages of MMC and indicated that the learning climate depended on three conditions: establishing a common understanding of the content and form of MMC, ensuring the staff’s willingness and opportunity to participate, and securing an arena in the unit for discussion and interactions. Clear leadership was essential to ensure a good learning climate. This dissertation suggests that MMC may contribute to positive changes in the daily interactions between persons with dementia and the staff of DSCUs. Further research is necessary to evaluate the effects of MMC

Sporing av personar med kognitiv svikt med hjelp av GPS

Prosjektet er eit del-prosjekt av det Midt-norske Velferdsteknologiprosjektet der hovudmålet er at brukarar og deira pårørande skal oppleve ein trygg kvardag gjennom bruk av individuelt tilpassa velferdsteknologiske løysningar. Føremålet med prosjektet var å samle erfaringar om sporing ved hjelp av Global Positioning System (gps) og om slik sporing kunne vere med å gje brukar og pårørande auka livskvalitet i form av meir tryggleik og fridom. Brukarane sin medverknad skulle være sentral i utviklinga av ein tildelingsmodell. Denne rapporten ønskjer å gje svar på: • Kva forventningar har brukarar, pårørande og helsepersonell til bruk av sporingsteknologi? • Kva erfaring har dei same aktørane etter at sporing har vorte prøvd ut? Intervensjonen bestod i å dele ut ei sporings-eining (SE) og å gje informasjon og opplæring til nære personar om bruk av gps i 5 kommunar på Sunnmøre. Rapporten bygger på data frå intervju av brukarar, pårørande og pleiarar før gps-sporing (N=23), og intervju av dei same personane (N=16) 6 månader etter at dei hadde erfaring med sporing. Undersøkinga syner at det kan vere vanskeleg å nå målgruppa personar med demens/personar med kognitivsvikt i ei fase i sjukdomen der dei har nytte av sporingsteknologi. Brukarar, pårørande og personalet i kommehelsetenesta ynskjer å ta i bruk lokaliseringsteknologi då dei meiner at dette kan gje auka fridom og tryggleik. 16 personar fekk tildelt ein SE. Etter 6 månader var det 5 personar som framleis nytta gps-sporing. Brukarane og pårørande erfarte at å bruke denne teknologien førte til meir tryggleik og fridom i kvardagen. At mange ikkje opplevde dette som ei tenleg løysing var knytt til funksjonaliteten til teknologien, både når det gjaldt batteri, alarmfunksjon og brukargrensesnittet. Organiseringa og oppfølging av eit slik teneste, krev retningslinjer og klare prosedyrar for handtering av sporingsteknologi

Bruk av videokommunikasjon i hverdagsrehabilitering – utprøving og erfaring

Bakgrunn for denne pilotstudien er nasjonale føringer om satsing på hverdagsrehabilitering og velferdsteknologi. Hensikten var å få kunnskap om hvilke erfaringer bruker og fagpersonale fikk ved innføring av videokommunikasjon i hverdagsrehabilitering. Pilotstudien har et kvalitativt eksplorativt design. Videokommunikasjon ble prøvd ut hos to brukere, fire ganger hos den ene brukeren og én gang hos den andre. Brukere, fysioterapeut, ergoterapeut og sykepleier ble intervjuet om sine erfaringer. I tillegg ble data samlet inn ved hjelp av feltnotater. Resultatene kan deles inn i tre områder: 1) nytten av videokommunikasjon, 2) tekniske utfordringer, og 3) suksesskriterier. Både bruker og helsepersonell mente at videokommunikasjon var nyttig fordi det ga alle fagpersoner som var involvert med samme bruker større mulighet for tverrfaglig samhandling. At bruker og sykepleier sammen fikk tilbakemelding fra fysioterapeut via videokommunikasjon under selve øvelsene var med på å kvalitetssikre at øvelsene ble utført riktig. Konklusjon: Det kan se ut til at VK kan åpne opp for økt tverrfaglighet og samhandling som kan kvalitetssikre spesifikke tiltak. Utfordringer med teknologien, som vansker med oppkopling, tilgang og bredbåndsbredde gjør imidlertid at det i dag ikke kan anbefales å ta i bruk mobil VK i hverdagsrehabilitering. Det er behov for tydelige prosedyrer som ivaretar både brukere og helsepersonell i bruken av videokommunikasjon i hverdagsrehabilitering, og det er behov for samarbeid og støtte fra kommunens IT-tjeneste

Moral distress - a threat to dementia care? A qualitative study of nursing staff members’ experiences in long-term care facilities

Background Dementia is a public health priority worldwide due to its rapidly increasing prevalence and poses challenges with regard to providing proper care, including end-of-life care. This study is part of a research project about nursing staff members’ experiences with providing palliative care for people with severe dementia in long-term care facilities. In an earlier study, we found that structural barriers that complicated the provision of palliative care led to moral distress among nursing staff. In this study, we performed a secondary analysis of the same data set to gain a deeper understanding of nursing staff members experiences of moral distress while providing palliative care for residents with severe dementia in long-term care facilities. Methods A qualitative, descriptive design was used. Data were collected during in-depth interviews with 20 nursing staff members from four Norwegian long-term care facilities. Content previously identified as moral distress was reanalysed by thematic text analysis, as described by Braun and Clarke, to gain a deeper understanding of the phenomenon. Results The nursing staff members’ experiences of moral distress were generally of two types: those in which nursing staff members felt pressured to provide futile end-of-life treatment and those in which they felt that they had been prevented from providing necessary care and treatment. Conclusion The findings indicate that nursing staff members’ experiences of moral distress were related to institutional constraints such as time limitations and challenging prioritizations, but they were more often related to value conflicts. Nursing staff members experienced moral distress when they felt obligated to provide care and treatment to residents with severe dementia that conflicted with their own values and knowledge about good palliative care. Both education interventions focused on improving nursing staff members’ skills regarding communication, ethical judgement and coping strategies; in addition, supportive and responsive leadership may have significant value with regard to reducing moral distress. Our findings indicate a need for further research on interventions that can support nursing staff members dealing with ethical conflicts in providing palliative care to residents with dementia.publishedVersio