Rigmor Einang Alnes

The influence of the learning climate on learning outcomes from Marte Meo counselling in dementia care

AIM   To identify factors that affected the learning outcomes from Marte Meo counselling (MMC). BACKGROUND   Although MMC has shown promising results regarding learning outcomes for staff working in dementia-specific care units, the outcomes differ. METHOD   Twelve individual interviews and four focus group interviews with staff who had participated in MMC were analysed through a qualitative content analysis. RESULTS   The learning climate has considerable significance for the experienced benefit of MMC and indicate that this learning climate depends on three conditions: establishing a common understanding of the content and form of MMC, ensuring staffs willingness to participate and the opportunity to do so, and securing an arena in the unit for discussion and interactions. CONCLUSION   Learning outcomes from MMC in dementia-specific care units appear to depend on the learning climate in the unit. Implication for nursing management  The learning climate needs attention from the nursing management when establishing Marte Meo intervention in nursing homes. The learning climate can be facilitated through building common understandings in the units regarding why and how this intervention should take place, and by ensuring clarity in the relationship between the intervention and the organizations objectives.

Marte Meo Counselling: a promising tool to support positive interactions between residents with dementia and nurses in nursing homes

Marte Meo Counselling (MMC) is an educational video-based counselling method developed to improve interactions between persons. This study aimed at investigating whether changes could be identified in the interactions between people with dementia and their nurses during morning care, following MMC. An intervention study based on video recordings before and after a MMC intervention was used. Thirteen nurses and 10 residents from six dementia-specific care units at six different institutions in Norway participated. Data were collected through video recording of six pairs (nurse and resident) in interaction before and after the staff received MMC. Four pairs participated as controls. The findings suggest that nurses who received MMC succeeded, to a greater degree than did the comparison nurses, in providing care consistent with promoting positive interactions. We found clearer indications of increased positive interactions and a reduction in inappropriate interactions in the intervention group. In the control group, the variation was greater, with both good and poor interactions present in the same cases. This study indicates that MMC can serve as a facilitator for positive interactions and can also lead to a reduction in inappropriate interactions. Further research is needed to evaluate the effect of MMC.

A painful experience of limited understanding: healthcare professionals’ experiences with palliative care of people with severe dementia in Norwegian nursing homes

BackgroundPeople dying with dementia have significant healthcare needs, and palliative care, with its focus on comfort and quality of life, should be made available to these patients. The aim of this study was to explore and increase knowledge of healthcare professionals’ experiences with palliative care to people with severe dementia in nursing homes.MethodsTo describe the phenomenon under investigation, we used a phenomenological research approach grounded in the philosophy of Husserl. Data were collected using in-depth interviews with 20 healthcare professionals from four Norwegian nursing homes.ResultsThe general meaning structure of the healthcare professionals’ experiences with providing palliative care to people with severe dementia is painfulness, due to their limited understanding of patients’ individual modes of expression. The painfulness is illustrated by the following themes: challenges related to “reading” the patients’ suffering, coming up short despite occasional success, handing the patients over to strangers, and disagreeing on the patients’ best interests. The healthcare professionals struggled to understand patients by “reading” their suffering. Occasionally, they succeeded and were able to calm the patients, but they often had the feeling of coming up short in situations related to pain relief and coping with behavioural symptoms, such as aggression and rejection of care. They also found it painful when the weakest patients were moved from the sheltered unit to a somatic long-term unit and were handed over to strangers who did not know the patients’ ways of expression. Although the healthcare professionals emphasized the importance of good collaboration with the patients’ relatives to ensure the best possible palliative care, they frequently found themselves in difficult situations when they disagreed with the family on the patients’ best interests.ConclusionsWe found healthcare professionals’ experiences of providing palliative care to people with severe dementia to be painful. To be able to understand the patients better, long-term familiarity and knowledge of how to “read” and observe patients with severe dementia are necessary. Openness in cooperation with the patients’ relatives and with the professional team may increase healthcare professionals’ understanding of the patients’ situations and hence improve the quality of care.

Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals’ experiences

BackgroundDementia has become a major public health issue worldwide due to its rapidly increasing prevalence and an increasing number of dementia-related deaths in long-term care facilities. The aim of this study was to examine health professionals’ experiences of potential barriers and facilitators in providing palliative care for people with severe dementia in long-term care facilities.MethodsThis was a qualitative descriptive study. The data were collected from four focus groups and 20 individual in-depth interviews with healthcare professionals from four Norwegian nursing homes. The data were analysed by thematic text analysis, as described by Braun and Clarke.ResultsThe major findings indicate that healthcare professionals experience a lack of continuity as the main barrier to facilitating palliative care. Time pressure and increased efficiency requirements especially affect the weakest and bedridden residents with dementia. The healthcare professionals feel conflicted between wanting to spend more time caring for each individual resident and feeling pressure to help everyone. Although resources are scarce, dying residents are always given priority by healthcare professionals, either by the hiring of extra personnel or the reorganization of tasks in a way that facilitates someone staying with the terminal resident. Advanced care planning was highlighted as a facilitator in providing palliative care, but the extensive use of temporary staff among nurses and doctors and the relocation between the sheltered and long-term wards threaten the continuity in planning and providing palliative care.ConclusionsThe findings indicate that healthcare professionals experienced several structural barriers that prevented the provision of palliative care to people with severe dementia in long-term care facilities. Increasing demands for economic rationality lead to a lack of continuity of care. Organizational changes, such as measures to increase the competence and the proportion of permanent employees and the prevention of burdensome end-of-life transitions, should be implemented to improve continuity and quality of care.