Marion Bär

Emotional bedeutsame Situationen im Alltag demenzkranker Heimbewohner

Zusammenfassung.Demenzerkrankungen führen im fortgeschrittenen Stadium zum Verlust der Fähigkeit, Emotionen verbal auszudrücken. Wir sind in der vorliegenden Studie von der Annahme ausgegangen, dass Emotionen allerdings auch bei fortgeschrittener Demenz fortbestehen. Das Ziel, Emotionen zu erfassen, lässt sich in diesem Stadium nur noch auf dem Wege der Analyse des nonverbalen Emotionsausdrucks verwirklichen. Es war Ziel unserer Studie, zu ermitteln, in welchen Situationen positive und negative Emotionen auftreten. Diese Situationen sollten zum einen von Mitarbeitern stationärer Einrichtungen benannt werden, zum anderen wurde der nonverbale Emotionsausdruck mit Hilfe von psychologischen Instrumenten der mimischen Ausdrucksanalyse untersucht (FACS, EMFACS). Beteiligt waren 29 Pflegeheimbewohnerinnen mit mittelgradiger und schwerer Demenz. Bei fast allen Bewohnerinnen wurden von den Mitarbeitern unterschiedliche Emotionen wahrgenommen; zudem ließen sich für den größten Teil der beschriebenen Emotionen auslösende Situationen benennen. Die Überprüfung der von den Mitarbeitern für spezifische Situationen genannten Emotionen mit Hilfe von FACS und EMFACS ergab eine hohe Validität der Mitarbeiterurteile. Die Analyse der Situationen, in denen positive Emotionen auftreten, machte deutlich, dass ein Teil positiv erlebter Situationen durch die Bewohnerinnen selbst hergestellt wird; daraus lässt sich folgern, dass Menschen auch bei fortgeschrittener Demenz über eigene Handlungsspielräume zur Realisierung positiver Emotionen verfügen. Durch konzentrierte, individualisierende Formen der Zuwendung können positiv erlebte Situationen eher hergestellt werden.Summary.An advanced stage of dementia implies a loss of the ability to express emotions verbally. However, this does not mean that these patients do not feel emotions anymore. Analyses of nonverbal behaviour are the only way to realise the aim of assessing emotional states in people suffering from severe dementia. In the present study, we tried to identify characteristic situations which are regularly accompanied by positive or negative emotions. Such situations should be described by members of the institutional staff. Moreover, patients’ nonverbal behaviour was analysed with psychological instruments developed for analyses of mimic expressions of emotion (FACS, EMFACS). Twenty-nine female residents of nursing homes suffering from moderate or severe dementia participated in the study. Nearly all of them were perceived to show different emotional states by the staff. Most emotions seemed to occur regularly in specific situations. Measures of FACS and AMFACS suggest that predictions of the staff are highly valid. Analyses of situations which were said to be accompanied by positive emotions showed that the respective situations are often created by the residents themselves. This finding implies that even an advanced stage of dementia does not necessarily prevent people from leading a self-determined life. Concentrated and individualised attention enables the staff to shape positive emotions in residents suffering from moderate or severe dementia.

Situations of emotional significance in residents suffering from dementia

Zusammenfassung.Demenzerkrankungen führen im fortgeschrittenen Stadium zum Verlust der Fähigkeit, Emotionen verbal auszudrücken. Wir sind in der vorliegenden Studie von der Annahme ausgegangen, dass Emotionen allerdings auch bei fortgeschrittener Demenz fortbestehen. Das Ziel, Emotionen zu erfassen, lässt sich in diesem Stadium nur noch auf dem Wege der Analyse des nonverbalen Emotionsausdrucks verwirklichen. Es war Ziel unserer Studie, zu ermitteln, in welchen Situationen positive und negative Emotionen auftreten. Diese Situationen sollten zum einen von Mitarbeitern stationärer Einrichtungen benannt werden, zum anderen wurde der nonverbale Emotionsausdruck mit Hilfe von psychologischen Instrumenten der mimischen Ausdrucksanalyse untersucht (FACS, EMFACS). Beteiligt waren 29 Pflegeheimbewohnerinnen mit mittelgradiger und schwerer Demenz. Bei fast allen Bewohnerinnen wurden von den Mitarbeitern unterschiedliche Emotionen wahrgenommen; zudem ließen sich für den größten Teil der beschriebenen Emotionen auslösende Situationen benennen. Die Überprüfung der von den Mitarbeitern für spezifische Situationen genannten Emotionen mit Hilfe von FACS und EMFACS ergab eine hohe Validität der Mitarbeiterurteile. Die Analyse der Situationen, in denen positive Emotionen auftreten, machte deutlich, dass ein Teil positiv erlebter Situationen durch die Bewohnerinnen selbst hergestellt wird; daraus lässt sich folgern, dass Menschen auch bei fortgeschrittener Demenz über eigene Handlungsspielräume zur Realisierung positiver Emotionen verfügen. Durch konzentrierte, individualisierende Formen der Zuwendung können positiv erlebte Situationen eher hergestellt werden.Summary.An advanced stage of dementia implies a loss of the ability to express emotions verbally. However, this does not mean that these patients do not feel emotions anymore. Analyses of nonverbal behaviour are the only way to realise the aim of assessing emotional states in people suffering from severe dementia. In the present study, we tried to identify characteristic situations which are regularly accompanied by positive or negative emotions. Such situations should be described by members of the institutional staff. Moreover, patients’ nonverbal behaviour was analysed with psychological instruments developed for analyses of mimic expressions of emotion (FACS, EMFACS). Twenty-nine female residents of nursing homes suffering from moderate or severe dementia participated in the study. Nearly all of them were perceived to show different emotional states by the staff. Most emotions seemed to occur regularly in specific situations. Measures of FACS and AMFACS suggest that predictions of the staff are highly valid. Analyses of situations which were said to be accompanied by positive emotions showed that the respective situations are often created by the residents themselves. This finding implies that even an advanced stage of dementia does not necessarily prevent people from leading a self-determined life. Concentrated and individualised attention enables the staff to shape positive emotions in residents suffering from moderate or severe dementia.

Linguistic validation of the Alberta Context Tool and two measures of research use, for German residential long term care

BackgroundTo study the association between organizational context and research utilization in German residential long term care (LTC), we translated three Canadian assessment instruments: the Alberta Context Tool (ACT), Estabrooks’ Kinds of Research Utilization (RU) items and the Conceptual Research Utilization Scale. Target groups for the tools were health care aides (HCAs), registered nurses (RNs), allied health professionals (AHPs), clinical specialists and care managers. Through a cognitive debriefing process, we assessed response processes validity–an initial stage of validity, necessary before more advanced validity assessment.MethodsWe included 39 participants (16 HCAs, 5 RNs, 7 AHPs, 5 specialists and 6 managers) from five residential LTC facilities. We created lists of questionnaire items containing problematic items plus items randomly selected from the pool of remaining items. After participants completed the questionnaires, we conducted individual semi-structured cognitive interviews using verbal probing. We asked participants to reflect on their answers for list items in detail. Participants’ answers were compared to concept maps defining the instrument concepts in detail. If at least two participants gave answers not matching concept map definitions, items were revised and re-tested with new target group participants.ResultsCognitive debriefings started with HCAs. Based on the first round, we modified 4 of 58 ACT items, 1 ACT item stem and all 8 items of the RU tools. All items were understood by participants after another two rounds. We included revised HCA ACT items in the questionnaires for the other provider groups. In the RU tools for the other provider groups, we used different wording than the HCA version, as was done in the original English instruments. Only one cognitive debriefing round was needed with each of the other provider groups.ConclusionCognitive debriefing is essential to detect and respond to problematic instrument items, particularly when translating instruments for heterogeneous, less well educated provider groups such as HCAs. Cognitive debriefing is an important step in research tool development and a vital component of establishing response process validity evidence. Publishing cognitive debriefing results helps researchers to determine potentially critical elements of the translated tools and assists with interpreting scores.

German translation of the Alberta context tool and two measures of research use: methods, challenges and lessons learned

BackgroundUnderstanding the relationship between organizational context and research utilization is key to reducing the research-practice gap in health care. This is particularly true in the residential long term care (LTC) setting where relatively little work has examined the influence of context on research implementation. Reliable, valid measures and tools are a prerequisite for studying organizational context and research utilization. Few such tools exist in German. We thus translated three such tools (the Alberta Context Tool and two measures of research use) into German for use in German residential LTC. We point out challenges and strategies for their solution unique to German residential LTC, and demonstrate how resolving specific challenges in the translation of the health care aide instrument version streamlined the translation process of versions for registered nurses, allied health providers, practice specialists, and managers.MethodsOur translation methods were based on best practices and included two independent forward translations, reconciliation of the forward translations, expert panel discussions, two independent back translations, reconciliation of the back translations, back translation review, and cognitive debriefing.ResultsWe categorized the challenges in this translation process into seven categories: (1) differing professional education of Canadian and German care providers, (2) risk that German translations would become grammatically complex, (3) wordings at risk of being misunderstood, (4) phrases/idioms non-existent in German, (5) lack of corresponding German words, (6) limited comprehensibility of corresponding German words, and (7) target persons’ unfamiliarity with activities detailed in survey items. Examples of each challenge are described with strategies that we used to manage the challenge.ConclusionTranslating an existing instrument is complex and time-consuming, but a rigorous approach is necessary to obtain instrument equivalence. Essential components were (1) involvement of and co-operation with the instrument developers and (2) expert panel discussions, including both target group and content experts. Equivalent translated instruments help researchers from different cultures to find a common language and undertake comparative research. As acceptable psychometric properties are a prerequisite for that, we are currently carrying out a study with that focus.

[Biographical work in inpatient long-term care for people with dementia: potential of the DEMIAN nursing concept].

ZusammenfassungIn der Pflege und Betreuung von Menschen mit Demenz ist die Biographiearbeit ein weitverbreitetes Konzept. In Literatur und Praxis finden sich jedoch zahlreiche unterschiedliche Vorstellungen davon, wie diese angewendet werden soll. Auch im DEMIAN-Konzept, einem Pflegekonzept zur Förderung des subjektiven Wohlbefindens, nimmt die Biographiearbeit einen zentralen Stellenwert ein. Der vorliegende Artikel gibt einen Überblick über den Stellenwert der Biographiearbeit in der Pflege und Betreuung von Menschen mit Demenz. Insbesondere wird die Rolle und Gestaltung von Biographiearbeit im DEMIAN-Konzept thematisiert. Im Rahmen der Anamnese des DEMIAN-Pflegekonzepts werden durch Gespräche mit den verschiedenen Akteuren (Menschen mit Demenz, Angehörige bzw. Bezugspersonen sowie Mitarbeitende im Pflege- und Betreuungsteam) und durch gezielte Beobachtung Themen erfasst, die für die Person mit Demenz individuell bedeutsam sind. Diese dienen als Grundlage für die gezielte Gestaltung positiver Alltagssituationen im Pflege- und Betreuungsalltag mit dem Ziel, das emotionale Wohlbefinden zu fördern. Die Potenziale des DEMIAN-Konzepts werden diskutiert und Weiterentwicklungsmöglichkeiten aufgezeigt.AbstractIn nursing care for people with dementia, biographical work is a popular concept. In the literature and practice, many different viewpoints of the way biographical work can/should be promoted exist. In the DEMIAN concept, a nursing concept to promote emotional well-being for people with dementia, it is also of major significance. This article gives an overview of the importance of biographical work in caring for people with dementia. In particular, the role and arrangement of biographical work in the DEMIAN concept are described. Within the anamnesis of the DEMIAN concept, meaningful themes are identified in conversations with different participants (person with dementia, reference persons, and care workers) and through observations. From these findings, specific interventions, aimed at supporting emotional well-being of people with dementia, are derived and integrated into everyday nursing care to promote emotional well-being. The potential of the DEMIAN nursing concept are discussed and further possibilities are highlighted.In nursing care for people with dementia, biographical work is a popular concept. In the literature and practice, many different viewpoints of the way biographical work can/should be promoted exist. In the DEMIAN concept, a nursing concept to promote emotional well-being for people with dementia, it is also of major significance. This article gives an overview of the importance of biographical work in caring for people with dementia. In particular, the role and arrangement of biographical work in the DEMIAN concept are described. Within the anamnesis of the DEMIAN concept, meaningful themes are identified in conversations with different participants (person with dementia, reference persons, and care workers) and through observations. From these findings, specific interventions, aimed at supporting emotional well-being of people with dementia, are derived and integrated into everyday nursing care to promote emotional well-being. The potential of the DEMIAN nursing concept are discussed and further possibilities are highlighted.

Biographiearbeit in der stationären Langzeitpflege von Menschen mit Demenz

ZusammenfassungIn der Pflege und Betreuung von Menschen mit Demenz ist die Biographiearbeit ein weitverbreitetes Konzept. In Literatur und Praxis finden sich jedoch zahlreiche unterschiedliche Vorstellungen davon, wie diese angewendet werden soll. Auch im DEMIAN-Konzept, einem Pflegekonzept zur Förderung des subjektiven Wohlbefindens, nimmt die Biographiearbeit einen zentralen Stellenwert ein. Der vorliegende Artikel gibt einen Überblick über den Stellenwert der Biographiearbeit in der Pflege und Betreuung von Menschen mit Demenz. Insbesondere wird die Rolle und Gestaltung von Biographiearbeit im DEMIAN-Konzept thematisiert. Im Rahmen der Anamnese des DEMIAN-Pflegekonzepts werden durch Gespräche mit den verschiedenen Akteuren (Menschen mit Demenz, Angehörige bzw. Bezugspersonen sowie Mitarbeitende im Pflege- und Betreuungsteam) und durch gezielte Beobachtung Themen erfasst, die für die Person mit Demenz individuell bedeutsam sind. Diese dienen als Grundlage für die gezielte Gestaltung positiver Alltagssituationen im Pflege- und Betreuungsalltag mit dem Ziel, das emotionale Wohlbefinden zu fördern. Die Potenziale des DEMIAN-Konzepts werden diskutiert und Weiterentwicklungsmöglichkeiten aufgezeigt.AbstractIn nursing care for people with dementia, biographical work is a popular concept. In the literature and practice, many different viewpoints of the way biographical work can/should be promoted exist. In the DEMIAN concept, a nursing concept to promote emotional well-being for people with dementia, it is also of major significance. This article gives an overview of the importance of biographical work in caring for people with dementia. In particular, the role and arrangement of biographical work in the DEMIAN concept are described. Within the anamnesis of the DEMIAN concept, meaningful themes are identified in conversations with different participants (person with dementia, reference persons, and care workers) and through observations. From these findings, specific interventions, aimed at supporting emotional well-being of people with dementia, are derived and integrated into everyday nursing care to promote emotional well-being. The potential of the DEMIAN nursing concept are discussed and further possibilities are highlighted.In nursing care for people with dementia, biographical work is a popular concept. In the literature and practice, many different viewpoints of the way biographical work can/should be promoted exist. In the DEMIAN concept, a nursing concept to promote emotional well-being for people with dementia, it is also of major significance. This article gives an overview of the importance of biographical work in caring for people with dementia. In particular, the role and arrangement of biographical work in the DEMIAN concept are described. Within the anamnesis of the DEMIAN concept, meaningful themes are identified in conversations with different participants (person with dementia, reference persons, and care workers) and through observations. From these findings, specific interventions, aimed at supporting emotional well-being of people with dementia, are derived and integrated into everyday nursing care to promote emotional well-being. The potential of the DEMIAN nursing concept are discussed and further possibilities are highlighted.

Persons with dementia in individual everyday situations. First results of an intervention study

ZusammenfassungDer vorliegende Beitrag stellt erste Ergebnisse einer laufenden Interventionsstudie zur emotionalen Förderung demenzkranker Heimbewohner vor. Ziel der Studie ist die empirische Prüfung eines individuenzentrierten Ansatzes in der Pflege demenzkranker Menschen, bei dem über die Erfassung und gezielte Realisierung individuell positiv valenter Alltagssituationen das seelische Befinden der Teilnehmer verbessert werden soll. Nach den ersten Erkenntnissen lassen sich für Menschen mit leichter, mittelgradiger und fortgeschrittener Demenz solche individuellen Alltagssituationen identifizieren, die im Sinne positiver Reaktionen der Teilnehmer wirksam sind und die durch die Pflegepersonen umgesetzt werden können. Besonders hoch ist dabei der Anteil solcher Situationen, in denen die Teilnehmer Zuwendung erfahren bzw. in denen die Kommunikation zwischen Pflegepersonen und Teilnehmern im Mittelpunkt steht.SummaryFirst outcomes of a current intervention study focussing on emotions of nursing home residents with mild, moderate and severe dementia are discussed in the present contribution. The aim of the study was to prove the effect from an individual approach in the care of people with dementia. By promoting individual everyday situations for each resident, positive emotions should be stimulated and individual well-being should be improved. Findings show the possibility to gain such individual everyday-situations for people with mild, moderate and severe dementia, which stimulate positive reactions and may be integrated into the care process. Of particular importance are those positive situations which focus on the communication between nurses and residents or in which the residents receive personal attention from nurses.

Improving quality of work life for care providers by fostering the emotional well-being of persons with dementia: A cluster-randomized trial of a nursing intervention in German long-term care settings:

We tested the feasibility of a nursing intervention (DEMIAN) in routine care and its effects on care providers’ job satisfaction, motivation, and work strain. This cluster-randomized trial was conducted in 20 German long-term care facilities. We randomly assigned 20 facilities to an intervention group (84 care providers, 42 residents with dementia) or a control group (96 care providers, 42 residents with dementia). Intervention group providers received two training days on the intervention; 68 providers attended both training days. Sixty two providers completed both baseline and follow-up questionnaires. Trained providers created individualized mini-intervention plans for participating residents. Control group residents received ‘usual care’. Intervention group providers stated that the intervention was feasible and helped them improve emotional well-being of residents with dementia. We found significantly decreased time pressure and decreased job dissatisfaction for intervention group providers. DEMIAN is an effective and pragmatic contribution to implementing person-centred care in long-term care, with positive effects on providers’ working conditions.

Biographiearbeit in der stationären Langzeitpflege von Menschen mit Demenz@@@Biographical work in inpatient long-term care for people with dementia: Potenziale des DEMIAN-Pflegekonzepts@@@Potential of the DEMIAN nursing concept

ZusammenfassungIn der Pflege und Betreuung von Menschen mit Demenz ist die Biographiearbeit ein weitverbreitetes Konzept. In Literatur und Praxis finden sich jedoch zahlreiche unterschiedliche Vorstellungen davon, wie diese angewendet werden soll. Auch im DEMIAN-Konzept, einem Pflegekonzept zur Förderung des subjektiven Wohlbefindens, nimmt die Biographiearbeit einen zentralen Stellenwert ein. Der vorliegende Artikel gibt einen Überblick über den Stellenwert der Biographiearbeit in der Pflege und Betreuung von Menschen mit Demenz. Insbesondere wird die Rolle und Gestaltung von Biographiearbeit im DEMIAN-Konzept thematisiert. Im Rahmen der Anamnese des DEMIAN-Pflegekonzepts werden durch Gespräche mit den verschiedenen Akteuren (Menschen mit Demenz, Angehörige bzw. Bezugspersonen sowie Mitarbeitende im Pflege- und Betreuungsteam) und durch gezielte Beobachtung Themen erfasst, die für die Person mit Demenz individuell bedeutsam sind. Diese dienen als Grundlage für die gezielte Gestaltung positiver Alltagssituationen im Pflege- und Betreuungsalltag mit dem Ziel, das emotionale Wohlbefinden zu fördern. Die Potenziale des DEMIAN-Konzepts werden diskutiert und Weiterentwicklungsmöglichkeiten aufgezeigt.AbstractIn nursing care for people with dementia, biographical work is a popular concept. In the literature and practice, many different viewpoints of the way biographical work can/should be promoted exist. In the DEMIAN concept, a nursing concept to promote emotional well-being for people with dementia, it is also of major significance. This article gives an overview of the importance of biographical work in caring for people with dementia. In particular, the role and arrangement of biographical work in the DEMIAN concept are described. Within the anamnesis of the DEMIAN concept, meaningful themes are identified in conversations with different participants (person with dementia, reference persons, and care workers) and through observations. From these findings, specific interventions, aimed at supporting emotional well-being of people with dementia, are derived and integrated into everyday nursing care to promote emotional well-being. The potential of the DEMIAN nursing concept are discussed and further possibilities are highlighted.In nursing care for people with dementia, biographical work is a popular concept. In the literature and practice, many different viewpoints of the way biographical work can/should be promoted exist. In the DEMIAN concept, a nursing concept to promote emotional well-being for people with dementia, it is also of major significance. This article gives an overview of the importance of biographical work in caring for people with dementia. In particular, the role and arrangement of biographical work in the DEMIAN concept are described. Within the anamnesis of the DEMIAN concept, meaningful themes are identified in conversations with different participants (person with dementia, reference persons, and care workers) and through observations. From these findings, specific interventions, aimed at supporting emotional well-being of people with dementia, are derived and integrated into everyday nursing care to promote emotional well-being. The potential of the DEMIAN nursing concept are discussed and further possibilities are highlighted.