Karl-Gustaf Norbergh

Nurses’ Attitudes Towards People with Dementia: the semantic differential technique:

One important aspect of the nurse-patient relationship is nurses’ attitudes towards their patients. Nurses’ attitudes towards people with dementia have been studied from a wide range of approaches, but few authors have focused on the structure of these attitudes. This study aimed to identify a structure in licensed practical nurses’ attitudes towards people with dementia. Twenty-one group dwelling units for people with dementia at 11 nursing homes participated in the study. A total of 1 577 assessments of 178 patients were sent out to 181 respondents and 1 237 answers were returned. The semantic differential technique was used. The scale had 57 bipolar pairs of adjectives that estimate an unknown number of dimensions of nurses’ attitudes towards an identified patient. The assessments were analysed using entropy-based measures of association combined with structural plots. The analysis revealed four dimensions, which related to licensed practical nurses’ opinions of the patients: an ethical and aesthetic dimension; an ability to understand; an ability to experience; and an ability for social interaction. The results of the study indicated that, on the positive to negative attitude continuum, the nurses’ attitudes fell at the positive to neutral end. This is an important finding owing to the personhood perspective, from which it is reasonable to assume that, with a more positive attitude to people with dementia, the prerequisites for person-centred care will improve.

The Integration of Chronic Illness Self-Management

Self-management is crucial for people living with chronic diseases, but the actual process of integrating self-management has not been explored in depth. In this article, we investigate the integration of self-management into the lives of people with chronic illness. In this longitudinal study, we used an interpretive description approach. Twenty-one individuals were interviewed regularly during the first 3 years after they were diagnosed with a chronic condition. We found self-management integration to be an ongoing process that included four phases: seeking effective self-management strategies, considering costs and benefits, creating routines and plans of action, and negotiating self-management that fits one’s life. The participants managed the phases according to their context, e.g., illness experience, life situation, personal beliefs, and social support. Health care providers should therefore facilitate self-management integration by providing support that is adjusted to the person’s phase of self-management integration and life context.

What it means to be an adult child of a person with dementia

The prevalence of dementia as a disease has increased worldwide with advancing age and growing population numbers, affecting whole families. However, most previous research does not separate the spouses or cohabitants from the adult children, but instead regards all next of kin involved in the everyday care of the person suffering from dementia as caregivers. This has made it difficult to find previous research regarding what it means to be an adult child of a person with dementia, and as such, the aim of this study is to explore that topic. The method used was narrative interviews analysed using phenomenological hermeneutics. Our comprehensive understanding showed that to be an adult child of a person with dementia means being burdened with the responsibility to act on behalf of the diseased parent despite a deep sense of grief and loss, which leads to frustration and despondence. The adult childrens existence and reality are threatened not only by the loss of the parent but also by the possibility that one day they too may inherit the disease. This could be compared to a psychic crisis, which is defined as a situation that leads to radical changes in the afflicted persons relationship to life and reality, or, simply, “an upset in a steady state.” The findings suggest that adult children of people with dementia are in need of support for a substantial period of time in order to adapt to the fact that they have lost a parent who is still alive. They also need information about the disease and the process of diagnosis and treatment to feel more a part of the process, as well as understand the behavior and needs of their parent.

Nurses’ Opinions of Pain and the Assessed Need for Pain Medication for the Elderly

The undertreatment of pain in the elderly living in nursing homes is a significant problem. In Swedish nursing homes, the registered nurse on duty is often responsible for 20-40 patients during the day with no daily contact from attending physicians. The aim of this study was to investigate the opinions of registered nurses regarding pain and the assessed need for pain medication for elderly patients using patient scenarios. Two patient scenarios were used in this study; a questionnaire and background information was provided. The scenarios consisted of one smiling patient and one grimacing patient, both with the same numeric rating scale value of pain, blood pressure, pulse rate, and respiration rate. Three questions regarding pain assessment and management followed the scenarios. The questionnaire was sent to all 128 registered nurses working daytime in elderly care in both municipal nursing homes and municipal home care in the mid-Sweden region. A total of 56 nurses participated, providing an answering frequency of 45%. Results showed that registered nurses with more experience did not have the same opinion about pain as the smiling patient and gave inadequate medication, which was not in accordance with recommendations from the county hospital and the World Health Organization.

A retrospective study of functional ability among people with dementia when admitted to group-dwelling

OBJECTIVE To describe functional ability among people with dementia when admitted to group-dwelling (GD) during different time periods, and the probability of their remaining in these units for the rest of their lives. DESIGN Retrospective study of functional ability and likelihood of staying in GD. SETTING Thirteen GD units in the Sundsvall region, Sweden. SUBJECTS One-hundred-and-forty-two demented people admitted to GD in the period 1986-1996. MAIN OUTCOME MEASURES Ability to manage personal care and somatic and psychiatric status were measured with the use of a rating scale. RESULT On comparing people over the years, a significant increase was found in the need of assistance to manage everyday life on admission to GD. The likelihood of living the rest of life in GD has increased over time. CONCLUSIONS Increasing dependency and increasing probability of remaining in GD may influence the intention of GD as a unique way of caring for people with dementia. It is crucial to consider these changes in order to encourage the development of GD.Objective - To describe functional ability among people with dementia when admitted to group-dwelling (GD) during different time periods, and the probability of their remaining in these units for the rest of their lives. Design - Retrospective study of functional ability and likelihood of staying in GD. Setting - Thirteen GD units in the Sundsvall region, Sweden. Subjects - One-hundred-and-forty-two demented people admitted to GD in the period 1986-1996. Main outcome measures - Ability to manage personal care and somatic and psychiatric status were measured with the use of a rating scale. Result ? On comparing people over the years, a significant increase was found in the need of assistance to manage everyday life on admission to GD. The likelihood of living the rest of life in GD has increased over time. Conclusions ? Increasing dependency and increasing probability of remaining in GD may influence the intention of GD as a unique way of caring for people with dementia. It is crucial to consider these changes in order to encourage the development of GD.

The Shift in Existential Life Situations of Adult Children to Parents with Dementia Relocated to Nursing Homes

Background: Previous research describes spouses and adult children of people with dementia as a homogeneous group using one term: family caregivers. Recent research shows that the needs and experiences of spouses and adult children differ, therefore they cannot be studied as a homogeneous group. Aims: The aim of the study was to describe the shift in existential life situations of adult children of a parent with dementia relocated to nursing homes. Design: This is a qualitative study with an interpretive approach. Methods: Face-to-face interviews were held with 11 adult children aged 48-65 years. The interviews lasted 30–60 minutes and data were analysed using interpretive content analysis. Findings: The adult children described how they experienced their life situation before and after their parents’ relocation. Before relocation they described feelings of powerlessness, loneliness in their responsibilities, loss and guilt. After relocation they had feelings of freedom, ongoing responsibility, living with loss and having a new relationship with death. Conclusion: The most important finding in our study was that adult children developed a different relationship with death than before the parent became affected by dementia. It is essential that healthcare staff understand and address the adult children’s existential life situations and the suffering they are experiencing. Healthcare staff need to be conscious about adult children’s needs for support to address their existential life situations before and after their parents relocate to nursing homes.