Family carers' experiences of attending a multicomponent psychosocial intervention program for carers and persons with dementia

Background: Psychosocial interventions for persons with dementia and their primary family carers are promising approaches to reducing the challenges associated with care, but, obtaining significant outcomes may be difficult. Even though carers in general are satisfied with such interventions, few studies have evaluated the interventions by means of qualitative methods. Aim: The objective of the study reported here was to investigate family carers’ experiences of a multicomponent psychosocial intervention program, and also to offer advice on how to develop the intervention program. Methods: Content analyses were taken from individual qualitative interviews conducted in 2012 with 20 carers (aged 50–82 years) who participated in a psychosocial intervention program that included education, individual and family counseling, and parallel group sessions for carers and persons with dementia. Results: Two main categories emerged: 1) benefits of the intervention program, which sets out the informants’ experiences for the benefits of participation, described in the subcategories “importance of content and group organization” and “importance of social support”; and 2) missing content in the intervention program, which details the informants’ suggestions for future interventions, contained in the subcategories “need for extended content” and “need for new group organization”. Conclusion: The carers found the interventions useful. The importance of even earlier and more flexible interventions for the family carers, the extended family, and the persons with dementia was underscored.publishedVersio

Grindagutar på sjukeheim: Tilsette sin erfaring med kulturprosjekt

Grindagutar at nursing home: Employees experience with cultural project.Background: Culture activity contributes to holistic care for nursing home residents, and the employees are key personnel for success.Aim: Explore the employees’ experience putting culture projects into life in a nursing home.Methods: The material, based on four focus group interviews with employees in the nursing home, is categorized and analyzed through text condensation.Results: The culture projects created activity and were sources for thriving. However, not participating directly in the activity, the employees let the artists in, were available for them, and watched the patients during the performances. Their function as “door-openers/-keepers” resulted in hosting responsibility, leading to a position of confusion regarding the role as protectors for the patients. Main challenges were how to give feedback regarding whether the patients liked/disliked the performance, and the feeling of being trapped in a position as bystander rather than making the culture activity a common happening for the patients and the employees

Impact of errors in recorded compressed breast thickness measurements on volumetric density classification using volpara v1.5.0 software

Purpose: Mammographic density has been demonstrated to predict breast cancer risk. It has been proposed that it could be used for stratifying screening pathways and recommending additional imaging. Volumetric density tools use the recorded compressed breast thickness (CBT) of the breast measured at the x-ray unit in their calculation, however the accuracy of the recorded thickness can vary. The aim of this study was to investigate whether inaccuracies in recorded CBT impact upon volumetric density classification and to examine whether the current quality control (QC) standard is sufficient for assessing mammographic density. Methods: Raw data from 52 digital screening mammograms were included in the study. For each image, the clinically recorded CBT was artificially increased and decreased to simulate measurement error. Increments of 1mm were used up to ±15% error of recorded CBT was achieved. New images were created for each 1mm step in thickness resulting in a total of 974 images which then had Volpara Density Grade (VDG) and volumetric density percentage assigned. Results: A change in VDG was recorded in 38.5% (n= 20) of mammograms when applying ±15% error to the recorded CBT and 11.5 % (n= 6) were within the QC standard prescribed error of ±5mm. Conclusion: The current QC standard of ±5mm error in recorded CBT creates the potential for error in mammographic density measurement. This may lead to inaccurate classification of mammographic density. The current QC standard for assessing mammographic density should be reconsidered

Older Norwegians' understanding of loneliness

This interpretive study explored older people's understanding of loneliness and what they considered appropriate and effective ways of dealing with it. Thirty elderly people were interviewed in-depth; 12 described themselves as “lonely” and 18 as “not lonely.” We found a striking difference in the way “lonely” and “not lonely” people talked about loneliness. The “not lonely” participants described loneliness as painful, caused by the person's negative way of behaving and a state they should pull themselves out of. The “lonely” participants also described loneliness as painful, and gave more detailed descriptions of loneliness as disconnection from others, from their former home and from today's society. The “lonely” participants were more reserved and subdued in trying to explain loneliness, attributing it partly to themselves, but mostly to the lack of social contact with important others. Some felt able to handle their loneliness, while others felt unable to cope. This study underlines the importance of subjective experiences in trying to understand a phenomenon like loneliness and of developing support for lonely older people unable to cope on their own

Jo mere vi er sammen, jo gladere vi blir? – ein feltmetodisk studie av sjukeheimen som heim

Bakgrunn: Bakgrunnen for avhandlinga er den klårt uttalte fagpolitiske viljen om å gjere sjukeheimen meir heimleg. Formål: Formålet med avhandlinga er å avdekke korleis ideen om sjukeheimen som heim er realisert. Design: Empirien er samla inn i ein tradisjonell norsk sjukeheim. Det er nytta deltakande observasjon, intervju og dokumentstudier (feltmetodikk) ved to langtidsavdelingar i ein tidsperiode på 15 veker. I analysen vert det nytta samfunnsvitskaplege innsikter om heimlege kjenneteikn, så som betydninga av å skilje det private frå det offentlege, samt betydninga av private relasjonar og den definisjonsmakta heimens eigar har. Resultat: Analysen fokuserer for det første på korleis fellesromma i avdelingane er organisert og brukt. Med utgangspunkt i skilje mellom offentleg og privat, viser avhandlinga korleis både ytre symbol og bruk av fellesromma er prega av doble og delvis motstridande forventningar. Grensene mellom det private og det offentlege er tvitydige for alle aktørane, både for bebuarane, pårørande og dei tilsette. For det andre vert det sosiale fellesskapet i langtidsavdelinga undersøkt grundig. Analysen indikerer at det sosiale fellesskapet i fellesromma er skjør og bryt saman når personalet ikkje er til stades. Kommunikativ kollaps er eit hovudbegrep som beskriv vesentlege trekk ved fellesskapet mellom bebuarane. Materialet viser også ei tydeleg søking etter kontakt med personalet. Avhandlinga dokumenterer at dei bebuarane som kan forflytte seg sjølv ”flyktar” frå daglegstova så fort personalet forlet rommet. Dei unndrar seg fellesskapet med medbebuarane og styrkar sin eigen muligheit til privatliv. Dei immobile vert derimot sitjande att i eit påtvunge fellesskap med personar dei ikkje har noko felles med, samstundes som daglegstovas tvitydige karakter ikkje innbyr til å utvikle private og nære relasjonar. Konklusjon: Avslutningsvis viser avhandlinga at fellesskap ikkje er eit gode for ein kvar pris. Det har sine skuggesider, men og sine muligheiter. Den store muligheita ligg i klårt definerte former for sosialt liv med tydeleg skilje mellom det private og det offentlege. Her er personalet si forståing og bruk av ulike arenaer som primært offentlege, eller som primært private, ein føresetnad. Dersom ideen om sjukeheimen som heim skal realiserast er det ei løysing å tydeleggjere fellesromma som offentleg arena samstundes som bebuarane må gjevast høve til å utvikle ei privat livsform utanom fellesromma

Balancing the use of language to enable care: a qualitative study of oral and written language used in assessments and allocations of community healthcare services for persons with dementia

Background: Although a large number of people are diagnosed with dementia each year, the syndrome is still perceived as a sensitive and tabooed topic. Communication about dementia to those living with the syndrome and their relatives is often experienced as challenging by health professionals. Failure to communicate clearly may threaten assessment and allocation of appropriate, effective healthcare services. Accordingly, the aim of this study was to explore how purchasers, assessing and allocating healthcare services to home-dwelling older people with dementia, described challenges in communicating about dementia with those with the syndrome and their relatives. Furthermore, the study aimed to explore the purchasers’ justifications for their choice of words. Methods: A qualitative study was conducted to investigate two data sources: focus group interviews with purchasers assessing need for healthcare services, and a review of administrative decisions written by those allocating services. Focus group data were explored using an interpretive approach and qualitative content analysis was carried out with the administrative decisions. Results: The purchasers found it challenging to talk and write about dementia to those with the syndrome and their relatives when assessing and allocating services. The purchasers were flexible in their communication and aimed to be open when talking and writing about dementia. However, euphemisms and omission were used extensively. Four justifications for the chosen verbal and written language were identified: avoiding disclosure; protecting the person with dementia; protecting the relatives/avoiding conflict; and last, taboo and stigma. Conclusions: Despite purchasers experiencing difficulties in communicating about dementia to those with the syndrome and their relatives, they did manage to communicate in a conscious and flexible way. The purchasers had several justifications for their language choice. However, extensive use of euphemisms and omission might threaten appropriate identification of needs and provision of high quality healthcare services. The challenges experienced by the purchasers demonstrate the need to focus on appropriate and flexible strategies for individually-tailored communication about dementia with people living with the syndrome.publishedVersio

Meeting psychosocial needs for persons with dementia in home care services – a qualitative study of different perceptions and practices among health care providers

Background The majority of persons with dementia are home-dwelling. To enable these persons to stay in their own homes as long as possible, a holistic, individual and flexible care is recommended. Despite a requirement for meeting psychological, social and physical needs, home care services seem to focus on patients’ physical needs. Accordingly, the aim of this study was to explore how the psychosocial needs of home-dwelling, older persons with dementia were perceived, emphasized and met by home care services. Methods A descriptive, qualitative approach was used. Data were collected through semi-structured focus group interviews with 24 health care providers in home care services from four municipalities. Data were analysed using systematic text condensation. Results This study showed major differences in how health care providers perceived the psychosocial needs of older home-dwelling persons with dementia and how they perceived their responsibilities for meeting those psychosocial needs. The differences in the health care providers’ perceptions seemed to significantly influence the provided care. Three co-existing logics of care were identified: the physical need-oriented logic, the renouncement logic and the integrated logic. Conclusions The differences in how health care providers perceived the psychosocial needs of persons with dementia and their responsibilities for meeting those needs, influenced how the psychosocial needs were met. These differences indicates a need for a clarification of how psychosocial needs should be conceptualized and who should be responsible for meeting these needs. Further, increased competence and increased consciousness of psychosocial needs and how those needs can be met, are essential for delivering high-quality holistic care that enables persons with dementia to live in their own home for as long as possible. Keywords Home care services Dementia care Psychosocial Holistic care Health services research Focus group Qualitative researchpublishedVersio