Caregivers´ singing facilitates mutual encounter : implementation and evaluation of music therapeutic caregiving in complex dementia care situations

Persons with severe dementia suffer from major cognitive impairment, and are in need of considerable caring services. They commonly react with problematic behaviors, such as resistance and aggression in close care (e.g., morning care situations). Non-pharmacological treatments such as care interventions should be used to enhance mutuality in encounters and minimize problematic behaviors. Music Therapeutic Caregiving (MTC) is one such intervention and involves the caregiver singing for or together with the persons with dementia during caregiving. MTC is proposed to decrease expressions of aggressive behaviors and enhance communication between persons with dementia and their caregivers. In addition, it has been suggested that MTC can enhance the posture and sensory awareness of persons with dementia, as well as alter the characteristics of the emotions and moods of both the caregivers and the persons with dementia. This thesis was designed with the aim of demonstrating if and in that case how the intervention of using MTC impacted the participants in this study, which included patients with severe dementia and their caregivers. Five studies were included in this thesis, each of which focused on specific aspects of morning care situations with or without the use of MTC. The first study (I) aimed to describe professional caregivers’ experiences of caring for persons with dementia during morning care situations without and with MTC. The second study (II) aimed to present professional caregivers´ experiences of persons with dementia during morning care situations without and with MTC. The third study (III) aimed to describe how persons with dementia and their caregivers express verbal and non-verbal communication and make eye contact during the care activity ‘getting dressed’ during morning care situations without and with MTC. The fourth study (IV) was a single case study and described expressed emotions and expressions of resistiveness to care in two nursing home residents with severe dementia, during morning care situations without and with MTC. Study V aimed to describe expressions of emotions and resistiveness to care among persons with dementia during morning care situations without and with MTC. Study I revealed that during usual morning care situations (without the use of MTC), the caregivers often had problems reaching the persons with dementia and described a struggle when it was necessary to physically restrain some patients due to aggression and resistance. They found consolation when the persons with dementia showed them affection. In study II, the persons with dementia were described as not mentally present during usual morning care situations, and their resistance and aggression lead to difficulties in communicating and cooperating. Study III revealed that the caregivers communicated mainly with verbal instructions and body movements, and that they seldom invited the persons with dementia to participate in the communication. The responses of persons with dementia were at times active and compliant, and other times confused, disruptive, resistant and aggressive. During MTC, the caregivers described a feeling of well-being, as positive emotions seemed dominant for both the caregivers (study I) and the persons with dementia (study II). The caregivers sense of well-being led to a joyful and positive encounter with the persons with dementia (study I). In study II, caregivers found the persons with dementia better able to express themselves appropriately. Expressions of positive emotions were dominant amongst patients and they were mainly described as relaxed, self-confident, and pliable. Study III also showed that the persons with dementia commonly responded to caregivers’ communication in a composed manner, by being active, compliant and relaxed. Study III further revealed that the caregivers seemed more interested in communicating with the persons with dementia and solicited mutual engagement. In study IV, both residents increased positive expressed emotions, while the negative expressed emotions and resistance decreased. Study V also revealed that the positive emotions, such as pleasure and general alertness significantly increased during MTC, while resistant behaviors, such as pulling away, grabbing objects and adduction, were significantly reduced. From this thesis, it can be concluded that the use of MTC during morning care situations with persons with dementia can increase their positive expressed emotions, decrease their negative expressed emotions and resistance to care, and lead to a more positive interaction for both them and their caregivers. It can also be concluded that MTC can enhance communication between persons with dementia and their caregivers during caring and thus increase the mutuality in the encounter, thereby facilitating an interpersonal relation during morning care situations. More research concerning MTC is needed and should be conducted using larger samples, different data collection and analysis methods, as well as different care situations

Reactions of Persons with Dementia to Caregivers Singing in Morning Care Situations

’Music therapeutic caregiving’, when caregivers sing for or together with persons with severe dementia during care situations, has been suggested as a way to reduce problematic behaviors in dementia care. The present study implemented this technique as an intervention in dementia care. Six caregivers participated in group interviews about their experiences of morning care situations without and with’Music therapeutic caregiving’. Through a qualitative content analysis two themes emerged.’Being in a different reality’ was based on’usual’ morning care situations. The caregivers’ experienced the persons with dementia as absent-minded; communication and cooperation were difficult. The second theme,’Being present’, was based on morning care situations with the intervention. The caregivers described communication as enhanced; the persons with dementia expressed themselves more appropriately, making cooperation possible. The results indicate that’Music therapeutic caregiving’ might lead to a more positive experience of the person with dementia and seems to increase receptivity to caregiving

Recombinant Hepatitis E Capsid Protein Self-Assembles into a Dual-Domain T = 1 Particle Presenting Native Virus Epitopes

AbstractThe three-dimensional structure of a self-assembled, recombinant hepatitis E virus particle has been solved to 22-Å resolution by cryo-electron microscopy and three-dimensional image reconstruction. The single subunit of 50 kDa is derived from a truncated version of the open reading frame-2 gene of the virus expressed in a baculovirus system. This is the first structure of a T = 1 particle with protruding dimers at the icosahedral two-fold axes solved by cryo-electron microscopy. The protein shell of these hollow particles extends from a radius of 50 Å outward to a radius of 135 Å. In the reconstruction, the capsid is dominated by dimers that define the 30 morphological units. The outer domain of the homodimer forms a protrusion, which corresponds to the spike-like density seen in the cryo-electron micrograph. This particle retains native virus epitopes, suggesting its potential value as a vaccine

Can humming caregivers´ facilitate feeding during mealtime situations with persons with dementia? A qualitative study

Background. ‘Music Therapeutic Caregiving’, defined as when caregivers’ sing for or together with persons with dementia care situations, has been shown to facilitate the caring situation, and enhance positive and decrease negative expressions in persons with dementia. No studies about singing during mealtimes have been conducted, and this project was designed to elucidate this. However, since previous studies have shown that there is a risk that persons with dementia will start to sing along with the caregiver, the caregiver in this study hummed such that the person with dementia did not sing instead of eat. Aim. To describe professional caregivers’ experiences of humming during meal time while feeding persons with dementia. Method. An intervention with caregivers humming was implemented during lunch time. Focus group interviews were conducted to fetch the caregivers experiences. Qualitative content analysis was used to analyse the interviews. Results. The caregivers described that humming disseminated relaxation and joy, and awakened memories about the songs hummed which encouraged the persons with the dementia to join in the songs. They also described that humming seemed to make the persons with dementia associate with mealtime and could make them eat more. However it also revealed suspiciousness and agitation from the persons with dementia. Conclusion. Humming during mealtime revealed mainly positive as well as some negative influences. More and larger studies are needed to be able to draw general conclusions

Perspectives on formative assessment in two school forms

Den svenska skolan är en ”skola för alla”, trots det har många elever i kognitiva svårigheter svårt att få det stöd de behöver för att utveckla sitt lärande. Syftet med studien var att ta reda på vilka metoder som lärare, verksamma i skolår 1-6 i grundsärskolan och grundskolan, använder för att ge alla elever möjlighet till utveckling och lärande. Sex lärare verksamma i de två skolformerna djupintervjuades utifrån deras uppfattning om arbete med formativ bedömning och dess effekter. Studien visar att alla lärare använder formativ bedömning i olika grad och att metoderna varierar. Lärarna menar att de behöver öka sin kompetens för att utveckla gynnsamma metoder och arbetssätt i sina klassrum. För att nå framgång behöver de mer tid och resurser samt en organisation som skapar kontinuitet kring fortbildning och kollegialt lärande.The Swedish school is a “school for everyone”, despite this, many pupils with cognitive disabilities have difficulties getting the support they need to develop in their learning. The purpose with this study was to discover what methods teachers, in the school years 1-6 in primary school and special needs school, utilise to give all students abilities for developing and learning. Six teachers active in the two school forms were deep interviewed about their perception of working with formative assessment and its affects. The study shows that all the teachers utilise formative assessment of various degrees and that the methods vary. The teachers believe that they need to increase their skills in order to develop favourable methods and work for their classrooms. To reach success, they will need more time and resources as well as an organisation that creates continuity among further training and peer learning.

Vårdarsång - En kommunikationsmetod med fokus att främja komplexa omvårdnadssituationer i vård av personer med demenssjukdom

This article is a review of studies with Music Therapeutic Caregiving (also known as Caregiver singing) in the care of persons with dementia. The term Music Therapeutic Caregiving, in Swedish, Vårdarsång, was developed in 2001 with the definition ”when caregivers sing for or together with persons with dementia during care”. Persons with dementia have difficulties in communicating, which commonly results in resistive behaviors or verbal or physical aggressiveness in interaction with others. These behaviors mainly occur during care situations that threaten integrity for example in various bathroom situations. Research of Music Therapeutic Caregiving has in research shown to solve these situations, as it becomes a way to communicate and thus a way for the person and caregivers to encounter and cooperate.Denna artikel sammanställer genomförda studier om Vårdarsång inom demensvård. Begreppet Music Therapeutic Caregiving, på svenska Vårdarsång, myntades år 2001 med definitionen ”när vårdare sjunger för eller tillsammans med personer med demenssjukdom under omvårdnad”. Som en del av sjukdomen har personer med demenssjukdom svårigheter att kommunicera. Detta resulterar ofta i beteenden som motsträvighet och verbal och fysisk aggressivitet i interaktion med andra. Dessa reaktioner är vanliga under vardagliga integritetshotande omvårdnadssituationer, såsom hjälp med kroppshygien och toalettbesök. Forskningresultat med Vårdarsång har visat sig kunna underlätta dessa situationer, då vårdarens sång för eller tillsammans med den demenssjuka ger förbättrad möjlighet till kommunikation, samarbete och genomförande av omvårdnadshandlingar

Being used for the greater good while fighting on the frontline : care staff's experiences of working with older people during the COVID-19 pandemic in Sweden

BAKGROUND: Worldwide, older people were more severely affected during the COVID-19 pandemic than others. In Sweden, those living in residential care facilities had the highest mortality rate, followed by those receiving home care services. The Swedish and international literature on the working environment for assistant nurses and care aides during the pandemic shows an increase in stress, anxiety, depression and post-traumatic stress syndromes. Care organisations were badly prepared to prevent the virus from spreading and to protect the staff from stress. In order to be better prepared for possible future pandemics, the health and well-being of the staff, the care of older people and the experiences of the staff both during and after a pandemic are important aspects to take into account. Therefore, this study aims to describe the experiences of assistant nurses and care aides working in the care of older people during the COVID-19 pandemic in Sweden, their working conditions and the impact all this had on their lives. METHODOLOGY: The study has a qualitative, descriptive design. The data was collected in four focus group interviews with 21 participants and analysed using qualitative content analysis. RESULTS: The results revealed the theme, Being used for the greater good while fighting on the frontline, which was then divided into three categories: portrayed as a risk for older people, not being valued and being burnt out. The worsening working conditions that the pandemic contributed to resulted in a high degree of stress and risk of burnout, with staff members both wanting to and actually leaving their employment. After the pandemic they felt forgotten again and left to cope in an even worse situation than before. CONCLUSIONS: The pandemic had a major effect on assistant nurses and care aides in terms of their working environment and their private lives. To be better prepared for future pandemics or disasters, organisations with responsibility for the care of older people will need to ensure that their staff have the necessary competencies and that there is adequate staffing in place. This also means that adequate government funding and multiple interventions will be needed

From risky to safer home care : health care assistants striving to overcome a lack of training, supervision, and support

Patients receiving home care are becoming increasingly dependent upon competent caregivers’ 24-h availability due to their substantial care needs, often with advanced care and home care technology included. In Sweden, care is often carried out by municipality-employed paraprofessionals such as health care assistants (HC assistants) with limited or no health care training, performing advanced care without formal training or support. The aim of this study was to investigate the work experience of the HC assistants and to explore how they manage when delivering 24-h home care to patients with substantial care needs. Grounded theory methodology involving multiple data sources comprising interviews with HC assistants (n19) and field observations in patients’ homes was used to collect data and constant comparative analysis was used for analysis. The initial analysis revealed a number of barriers, competence gap; trapped in the home setting; poor supervision and unconnected to the patient care system, describing the risks associated with the situations of HC assistants working in home care, thus affecting their working conditions as well as the patient care. The core process identified was the HC assistants’ strivings to combine safe home care with good working conditions by using compensatory processes. The four identified compensatory processes were: day-by-day learning; balancing relations with the patient; self-managing; and navigating the patient care system. By actively employing the compensatory processes, the HC assistants could be said to adopt an inclusive approach, by compensating for their own barriers as well as those of their colleagues’ and taking overall responsibility for their workplace. In conclusion, the importance of supporting HC assistants in relation to their needs for training, supervision,and support from health care professionals must be addressed when organising 24-h home care to patients with substantial care needs in the future

From risky to safer home care : health care assistants striving to overcome a lack of training, supervision, and support

Patients receiving home care are becoming increasingly dependent upon competent caregivers’ 24-h availability due to their substantial care needs, often with advanced care and home care technology included. In Sweden, care is often carried out by municipality-employed paraprofessionals such as health care assistants (HC assistants) with limited or no health care training, performing advanced care without formal training or support. The aim of this study was to investigate the work experience of the HC assistants and to explore how they manage when delivering 24-h home care to patients with substantial care needs. Grounded theory methodology involving multiple data sources comprising interviews with HC assistants (n19) and field observations in patients’ homes was used to collect data and constant comparative analysis was used for analysis. The initial analysis revealed a number of barriers, competence gap; trapped in the home setting; poor supervision and unconnected to the patient care system, describing the risks associated with the situations of HC assistants working in home care, thus affecting their working conditions as well as the patient care. The core process identified was the HC assistants’ strivings to combine safe home care with good working conditions by using compensatory processes. The four identified compensatory processes were: day-by-day learning; balancing relations with the patient; self-managing; and navigating the patient care system. By actively employing the compensatory processes, the HC assistants could be said to adopt an inclusive approach, by compensating for their own barriers as well as those of their colleagues’ and taking overall responsibility for their workplace. In conclusion, the importance of supporting HC assistants in relation to their needs for training, supervision,and support from health care professionals must be addressed when organising 24-h home care to patients with substantial care needs in the future

Patients in 24-hour home care striving for control and safety

Background: This article concerns Swedish patients receiving 24-hour home care from health care assistants (HCassistants) employed by the municipality. Home care is a complex interactive process involving the patient, family,HC assistants as well as professional care providers. Previous studies exploring patient perspectives on home carehave been based mainly on patient interviews. In contrast, the present study took a broad perspective on patients’experiences and thoughts by combining field observations on care situations with patient and HC assistantinterviews. The aim of the study presented in this article was to promote a new and broadened understanding ofpatients receiving 24-hour home care by constructing a theoretical model to illuminate their main concern.Methods: Field observations and semi-structured interviews were conducted with four patients receiving 24-hourhome care and their HC assistants. Grounded theory methodology was used.Results: The core process identified was Grasping the lifeline, which describes compensatory processes throughwhich patients strived for control and safe care when experiencing a number of exposed states due to inadequatehome care. Patients tried to take control by selecting their own HC assistants and sought safe hands by instructinguntrained HC assistants in care procedures. When navigating the care system, the patients maintained contacts withprofessional care providers and coordinated their own care. When necessary, a devoted HC assistant could takeover the navigating role. The results are illuminated in a theoretical model.Conclusions: The results accentuate the importance to patients of participating in their own care, especially in theselection of HC assistants. The model illustrates some challenging areas for improvement within the organisation of24-hour home care, such as personnel continuity and competence, collaboration, and routines for acute care.Furthermore, it may be used as a basis for reflection during the planning of care for individual patients withinhome care