Ulf Isaksson

Balancing between contradictions: the meaning of interaction with people suffering from dementia and "behavioral disturbances".

Interacting with people who suffer from dementia poses a challenge for care providers, and the presence of behavioral disturbances adds a further complication. Our article is based on the assumption that behavioral disturbances are meaningful expressions of experiences. Six narrative interviews were conducted with care providers with the aim of illuminating the meaning of interaction with people suffering from dementia and behavioral disturbances. The interviews were tape-recorded, transcribed into text, and interpreted using a phenomenological hermeneutic methodology. The findings indicate that interacting with people with dementia and behavioral disturbances, as narrated by care providers, means balancing between contradictions concerning meeting the person in my versus her/his world, feeling powerless versus capable, and feeling rejected versus accepted. Interaction involves being at various positions along these continua at different points in time. Furthermore, it means facing ethical dilemmas concerning doing good for the individual or the collective. This is interpreted as a dialectic process and is reflected on in light of Hegels reasoning about the struggle between the master and the slave.

Violence in nursing homes: perceptions of female caregivers

AIM This study illuminates how female caregivers in nursing home perceive violence. BACKGROUND Previous studies have focused on prevalence and types of violence and injuries in various settings and among various professionals. There are, however, few studies that examine how caregivers perceive violence. METHODS Forty-one female caregivers at nursing homes were asked to reflect on a vignette containing a situation where a female caregiver is exposed to violence from a male resident. The reflections were analysed by qualitative content analysis. FINDINGS The main finding indicates that perceiving an action as violent is in the eye of the beholder. Caregivers perceive violence to be challenging, intentional, excusable, ordinary and contextual relative to their own experience and attitudes. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE As the perception of violence is subjective, there is a risk that violent incidents will be under-reported as well as over-reported. To avoid this, it is important to construct a well-defined operationalised definition of violence for research purposes. Our findings also indicate the need for individually structured and adjusted support for caregivers. To explore the complexity of violence, further research should focus on how caregivers and residents experience violence in a nursing home.

Physically violent behaviour in dementia care: Characteristics of residents and management of violent situations

Objective: Physically violent behaviour (PVB) is common among residents with dementia and often complicates nursing care. This study aims to explore types of caring situations, resident characteristics related to PVB and professional caregivers’ management of PVB. Methods: The study included 40 group homes for 309 residents with dementia. Data was gathered by means of structured interviews, the Multi-Dimensional Dementia Assessment Scale and the Geriatric Rating Scale. Results: Ninety-eight of the residents (31.7%) were assessed as showing PVB during the preceding week. Three factors were independently associated with PVB: male gender, antipsychotic treatment and decline in orientation. Violent residents were more likely to have impaired speech, difficulties understanding verbal communication and prescribed analgesics and antipsychotics than were non-violent residents. PVB occurred mainly in intimate helping situations and was managed by symptom-oriented approaches, such as distraction, medication and isolation. The working team also held frequent discussions about the residents with PVB. Conclusion: This study shows that PVB is frequently displayed among residents in group homes for persons with dementia and the caregivers mainly manage PVB in a symptom-oriented way. To enhance the quality of care for patients with dementia, there is a need for interventions that aim to understand and manage the residents’ physical violent behaviour.

Personality Characteristics of Staff in Elderly Care—A Cross-Cultural Comparison

Communication and interaction between carers and residents in elderly and dementia care can be challenging and demanding. The carers personality, one factor shaping this interaction, seems to have been neglected in the literature. This article looks at cross-cultural comparisons of staff in elderly and dementia care with individuals from the general population matched by age and gender. Compared to individuals in the general population, elderly and dementia care staff are usually slower tempered, more stoic and reflective, tolerant to monotony, and more systematic. They also have more optimistic attitudes in situations that might worry most people, and more confidence in social situations and in the face of danger and uncertainty.

Validity and reliability testing of the Swedish version of Melbourne Decision Making Questionnaire

BACKGROUND The Melbourne Decision-Making Questionnaire (MDMQ) is an attempt to capture and measure coping strategies that people use. The instrument had not previously been translated into Swedish. The aim of this study was to evaluate validity and reliability of the Swedish version of the MDMQ. METHOD A Swedish translation was performed and back-translated. A group of five pilot readers evaluated content validity. The translated questionnaire was tested among 735 patients, healthcare workers, healthcare students and teachers. A parallel analysis (PA), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. RESULT An initial EFA with a four-factor solution showed a low concordance with the original 22-item four-factor model with a very low Cronbachs alpha in one of the dimensions. However, a second EFA with a three-factor solution showed a good model fit for the Swedish translation of the Melbourne Decision-Making Questionnaire (MDMQ-S) with a satisfactory Cronbachs alpha. A CFA showed a goodness of fit after deleting six items. CONCLUSION After testing the MDMQ-S, we found support for validity and reliability of the instrument. We found the 16-item version of MDMQ-S to be satisfactory concerning the subscales vigilance, procrastination and buck-passing. However, we found no support that the hypervigilance dimension could be measured by the MDMQ-S.

Coping styles in decision-making among men and women diagnosed with malignant melanoma

Early care seeking is important for prognosis of malignant melanoma. Coping styles in decision-making to seek care can relate to prognosis since avoidant strategies could delay care seeking. The aim of this study was to compare self-reported coping styles in decision-making between men and women diagnosed with malignant melanoma. We used the Swedish version of the Melbourne Decision-Making Questionnaire to assess coping styles. Men generally scored higher in buck-passing while women and those living without a partner scored higher in hypervigilance. This knowledge could be used in the development of preventive programmes with intention to reach those who delay care seeking.

Swedish women's food habits during pregnancy up to six months post-partum: A longitudinal study.

OBJECTIVES Diet influences the health of the foetus and the woman during pregnancy and later in life. It is therefore important to investigate pregnant womens food habits. The aim of this study was to describe womens food habits during pregnancy and up to six months post-partum. STUDY DESIGN A Food Frequency Questionnaire (VIP-FFQ) was distributed to 163 pregnant women on five occasions during and after pregnancy. Data were analysed using Friedmans ANOVA and a Bonferroni post-hoc test. MAIN OUTCOME MEASURES Food habits in relation to the National Food Agencys (NFA) food index. RESULTS The pregnant womens diets were inadequate according to the NFA food index. A tendency towards an even poorer diet after delivery was identified, something which was related to an increased intake of discretionary food, e.g. sweets, cakes, cookies, crisps, ice cream, and decreased intake of fruit and vegetable. The alcohol consumption was low throughout. CONCLUSIONS The food habits during pregnancy were inadequate compared to recommendations and these habits became unhealthier after delivery. These suggest that dietary counselling needs to be more effective and continued into the lactating period. An increased focus should be given to healthy eating from the life course perspective, not just focus on effects on the foetus and pregnancy outcomes.

Supporting the oldest old when completing a questionnaire : risking bias or gaining reliable results?

The aim of this study was to elucidate the process of completing a questionnaire in a supportive face-to-face manner. A total of 12 participants, age 90 years or older, were asked to answer the Resilience Scale. The statements were read aloud and the participants answered verbally or by pointing to an enlarged copy of the reply form. Transcribed dialogues were analyzed by means of qualitative content analysis. Four types of dialogues were formulated: “Making a prompt decision,” “Deciding after a pensive dialogue,” “Deciding after an explanatory dialogue,” and “Deciding after an encouraging dialogue.” This article discusses risk for bias and ways to overcome the problem. The authors concluded that support via face-to-face interview in answering a questionnaire is valuable to obtaining valid data from very old persons.Supporting the oldest old when completing a questionnaire : risking bias or gaining reliable results?

Exposure to challenging behaviour from nursing home residents is associated with reduced general health and work ability, and increased burnout reported by nurses

Commentary on: Schmidt SG, Dichter MN, Palm R, et al . Distress experienced by nurses in response to the challenging behaviour of residents—evidence from German nursing homes. J Clin Nurs 2012;21:3134–42.[OpenUrl][1][CrossRef][2][PubMed][3] An increasing proportion of people with dementia has and will continue to be admitted to nursing homes or similar accommodations such as special care units. One of the reasons for being admitted to such institutions is challenging, … [1]: {openurl}?query=rft.jtitle%253DJournal%2Bof%2Bclinical%2Bnursing%26rft.stitle%253DJ%2BClin%2BNurs%26rft.aulast%253DSchmidt%26rft.auinit1%253DS.%2BG.%26rft.volume%253D21%26rft.issue%253D21-22%26rft.spage%253D3134%26rft.epage%253D3142%26rft.atitle%253DDistress%2Bexperienced%2Bby%2Bnurses%2Bin%2Bresponse%2Bto%2Bthe%2Bchallenging%2Bbehaviour%2Bof%2Bresidents%2B-%2Bevidence%2Bfrom%2BGerman%2Bnursing%2Bhomes.%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fjocn.12066%26rft_id%253Dinfo%253Apmid%252F23083388%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1111/jocn.12066&link_type=DOI [3]: /lookup/external-ref?access_num=23083388&link_type=MED&atom=%2Febnurs%2F16%2F4%2F124.atom

Dysphoric symptoms in relation to other behavioral and psychological symptoms of dementia, among elderly in nursing homes

BackgroundBehavioral and psychological symptoms of dementia (BPSD) are common and varied in the elderly. The aim of the current study was to explore associations between BPSD and dysphoric symptoms at different levels of cognitive impairment.MethodsAssessments of 4397 elderly individuals living in nursing homes in Sweden were performed. Data on cognitive function and BPSD were collected using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The relationships between dysphoria and eight BPSD factors were plotted against cognitive function to investigate how dysphoria affects BPSD throughout the dementia disease.ResultsOverall, dysphoric symptoms were most prevalent in persons with moderate cognitive impairment. However, moderate to severe dysphoric symptoms showed no clear variation with cognitive impairment. Furthermore, aggressive behavior, verbally disruptive/attention-seeking behavior, hallucinatory symptoms and wandering behavior were more common with concurrent dysphoria regardless of cognitive function. In contrast, passiveness was more common with concurrent dysphoria in mild cognitive impairment but not in moderate to severe cognitive impairment.ConclusionsBPSD, including aggressive behavior and hallucinations, were more common with concurrent dysphoric symptoms, providing insight into behavioral and psychological symptoms among individuals with cognitive impairment. Apathy was more commonly associated with concurrent dysphoria at early stages of cognitive decline but not at later stages, indicating that apathy and dysphoria represent separate syndromes among elderly patients with moderate to severe cognitive impairment.