The Impact of Using Measurements of Electrodermal Activity in the Assessment of Problematic Behaviour in Dementia.

BACKGROUND: A major and complex challenge when trying to support individuals with dementia is meeting the needs of those who experience changes in behaviour and mood. AIM: To explore how a sensor measuring electrodermal activity (EDA) impacts assistant nurses' structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions. METHODS: Fourteen individuals with dementia wore a sensor that measured EDA. The information from the sensor was presented to assistant nurses during structured assessments of problematic behaviours. The evaluation process included scorings with the instrument NPI-NH (Neuropsychiatric Inventory-Nursing Home version), the care interventions suggested by assistant nurses to decrease problematic behaviours, and the assistant nurses' experiences obtained by focus group interviews. RESULTS: The information from the sensor measuring EDA was perceived to make behavioural patterns more visual and clear, which enhanced assistant nurses' understanding of time-related patterns of behaviours. In turn, this enhancement facilitated timely care interventions to prevent the patterns and decrease the levels of problematic behaviour. CONCLUSION: With the addition of information from the sensor, nursing staff could target causes and triggers in a better way, making care interventions more specific and directed towards certain times throughout the day to prevent patterns of problematic behaviours.

Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning.

ABSTRACTBackground:The ability of nursing staff to assess and evaluate behavioral and psychological symptoms of dementia (BPSD) to determine when intervention is needed is essential. In order to assist with the assessment process, the current use of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) is internationally accepted. Even though the NPI-NH is thoroughly validated and has several advantages, there are also various challenges when implementing this system in practice. Thus, the aim of this study was to explore clinical reasoning employed by assistant nurses when utilizing the NPI-NH as a tool to assess frequency and severity of BPSD in individuals with advanced dementia. METHOD: Twenty structured assessment sessions in which assistant nurses used the NPI-NH were audio recorded and analyzed with a discourse analysis focusing on the activities in the communication. RESULTS: Four categories were identified to convey assistant nurses' clinical reasoning when assessing and evaluating BPSD using the NPI-NH: considering deteriorations in ability and awareness, incorporating individual and contextual factors, overcoming variations in behaviors and ambiguous formulations in the instrument, and sense-making interactions with colleagues. CONCLUSION: The NPI-NH served as a supportive frame and structure for the clinical reasoning performed during the assessment. The clinical reasoning employed by assistant nurses became a way to reach a consensual and broader understanding of the individual with dementia, with the support of NPI-NH as an important framework.

Human capabilities in advanced dementia: Nussbaum's approach.

AIMS AND OBJECTIVES: To explore how Martha Nussbaum's approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes. BACKGROUND: Challenges experienced when supporting people with advanced dementia who express problematic behaviours include understanding their needs and ensuring a dignified life for them. DESIGN AND METHODS: Data were gathered using an ethnographic approach based on participatory observation. Nussbaum's capability approach was then used as a framework for the analysis. Four women diagnosed with advanced dementia who also expressed problematic behaviours were recruited from a nursing home in Northern Sweden. The data collection was performed during 2015. FINDINGS: Individuals with advanced dementia had difficulties in participating in the planning of their lives and achieving the human capability of practical reasoning. They were also at risk of being placed outside the social group, thus hindering them from attaining the human capability of affiliation. A dignified life for individuals with advanced dementia requires nursing staff to be present and to provide adapted support to ensure that the individual can actually pursue human capabilities. CONCLUSION: Creating opportunities for the human capabilities of practical reasoning and affiliation is essential as they permeate all other human capabilities. For these individuals, it was crucial not only to create opportunities for human capabilities but also to attend to their expressions and needs and to guide and steer them towards a dignified life. IMPLICATIONS FOR PRACTICE: The normative structure of the capability approach described by Nussbaum can ensure that nursing staffs move beyond fulfilling patients' basic needs to consider other capabilities vital for a dignified life.

Need for reassurance in self-care of minor illnesses.

AIMS AND OBJECTIVES: This study describes people's need for reassurance in self-care of minor illnesses. BACKGROUND: Self-care and active surveillance are advocated as important strategies to manage minor illnesses. Reassurance influences patient satisfaction and confidence in the practicing of self-care. DESIGN: This study is a descriptive and interpretive qualitative study. METHODS: Twelve persons with experience in self-care and receiving self-care advice were recruited, and data were collected using semi-structured interviews between September-December 2014. Data were analysed using qualitative content analyses. RESULTS: Having previous experience and the ability to actively manage symptoms using self-care interventions was described as reassuring. Participants became stressed and concerned when the symptoms persisted and interventions lacked the desired effect, which often resulted in a decision to consult. Participants wanted to feel that the nurse was an actual person, who was sympathetic, present and understanding, when they received self-care advice. The nurse's assessment and reasoning of the symptoms facilitated care-seekers' assessments of risk, and clear and concrete advice on how to manage the symptoms exerted a calming effect. Patients needed to trust that the nurse understood their situation to embrace the advice, and being invited to return created a feeling that the nurse had listened and taken them seriously. CONCLUSIONS: Reassurance has the potential to allay doubts and fears to build confidence, which influences self-care and consultation behaviour. Personal presence in the encounter, receiving an assessment and an explanation of the symptoms and precise advice are reassuring. RELEVANCE TO CLINICAL PRACTICE: The needs of nursing care may persist despite the absence of medical needs. The encounter between the nurse and care-seeker is a unique possibility for reassurance and confidence that a minor illness is self-limiting in its nature, and self-care interventions provide relief and comfort.

Aspects of Self and Identity in Narrations About Recent Events: Communication with Individuals with Alzheimer's Disease Enabled by a Digital Photograph Diary.

The ability to narrate autobiographical memories is important for maintaining the identity of individuals with Alzheimer's disease (AD). The current study explored how the sense of self is manifested in narrations about recent events, enabled via a digital photograph diary. Use of a digital photograph diary was tested with seven individuals with AD and their household members. Narrative analysis was used to analyze audiorecordings of the pairs' communication about recent events shown in the photographs. The results show how individuals with AD understand events illustrated in recent photographs in relation to their sense of self and associated skills and abilities that are facets of their selfhood. This type of digital photograph diary has the potential to support individuals with AD to maintain their sense of self and participation in everyday life, and strengthen their relationships with household members; it could be an important tool in person-centered care. [Journal of Gerontological Nursing, 43(6), 25-31.].

Utilizing a Wristband Sensor to Measure the Stress Level for People with Dementia.

Stress is a common problem that affects most people with dementia and their caregivers. Stress symptoms for people with dementia are often measured by answering a checklist of questions by the clinical staff who work closely with the person with the dementia. This process requires a lot of effort with continuous observation of the person with dementia over the long term. This article investigates the effectiveness of using a straightforward method, based on a single wristband sensor to classify events of "Stressed" and "Not stressed" for people with dementia. The presented system calculates the stress level as an integer value from zero to five, providing clinical information of behavioral patterns to the clinical staff. Thirty staff members participated in this experiment, together with six residents suffering from dementia, from two nursing homes. The residents were equipped with the wristband sensor during the day, and the staff were writing observation notes during the experiment to serve as ground truth. Experimental evaluation showed relationships between staff observations and sensor analysis, while stress level thresholds adjusted to each individual can serve different scenarios.

Taking personal responsibility: Nurses' and assistant nurses' experiences of good nursing practice in psychiatric inpatient care.

Therapeutic nurse-patient relationships are considered essential for good nursing practice in psychiatric inpatient care. Previous research suggests that inpatient care fails to fulfil patients' expectations in this regard, and that nurses might experience the reality of inpatient care as an obstruction. The aim of the present study was to explore nurses' and assistant nurses' experiences of good nursing practice in the specific context of psychiatric inpatient care. Qualitative interviews were conducted with 12 skilled, relationship-oriented nurses and assistant nurses in order to explore their experiences with nursing practice related to psychiatric inpatient care. Interviews were transcribed and analysed using an interpretive descriptive approach. Findings describe good nursing practice as a matter of nurses and assistant nurses taking personal responsibility for their actions and for the individual patient as a person. Difficulties in providing dignified nursing care and taking personal responsibility cause them to experience feelings of distress and frustration. Shared values and nursing leadership supports being moral and treating patients with respect, having enough time supports being present and connecting with patients, and working as a part of a competent team with critical daily discussions and diversity supports being confident and building trust. The findings suggest that taking personal responsibility is integral to good nursing practice. If unable to improve poor circumstances, nurses might be forced to promote their own survival by refuting or redefining their responsibility. Nurses need to prioritize being with patients and gain support in shaping their own nursing practice. Nursing leadership should provide moral direction and defend humanistic values.

Influence of self-care advice on patient satisfaction and healthcare utilization.

AIM: The aim of this study is to explore the influence of nurse-led self-care advice on healthcare utilization and patients' satisfaction with telephone nursing. BACKGROUND: Many consultations in high-cost settings are for conditions that are manageable through self-care and callers with greater satisfaction with the nurse interaction are nearly four times more likely to engage in self-care. DESIGN: Cross-sectional study. METHODS: Questionnaires were sent out to 500 randomly selected callers to the Swedish Healthcare Direct in Northern Sweden during March 2014. Callers were asked about their satisfaction with the consultation, their intended actions prior to consultation, the recommendation given by the nurse and the action undertaken after the call. RESULTS: Young callers and persons recommended watchful waiting or recurrence if no improvements were significantly less satisfied with their care. When calling on their own behalf, both men and women rated the severity of their symptoms equally and were advised to self-care to the same extent. Self-care advice had a constricting influence on self-reported healthcare utilization, with 66·1% of cases resulting in a lower level of care than first intended. Feeling reassured after the call was the aspect of nursing care that influenced satisfaction the most. CONCLUSION: Receiving self-care advice rather than referral to a general practitioner influences patient satisfaction negatively. Feeling reassured after consultation is strongly related to satisfaction, which in turn has been found to increase the likelihood of engaging in self-care behaviour.

"Easy But Not Simple"--Nursing Students' Descriptions of the Process of Care in a Psychiatric Context.

The nurse-patient interaction is the cornerstone of psychiatric care, yet the concept "mental health nursing" is difficult to describe. This article aims to address this problem through the experiences of nursing students. Online journals from 14 nursing students were analyzed using qualitative content analysis, resulting in three categories: Trusting the Trusting Relationship, Voicing the Unspoken Needs, and Balancing the Dynamics of Doing and Being. This study demonstrates that providing nursing care based on trusting relationships is not a demanding task, but it takes place in a complex environment that has a tendency to make easy things complicated.

Perceptions of needs related to the practice of self-care for minor illness.

AIMS AND OBJECTIVES: The aim of this study was to describe people's perceptions of needs to feel confident in self-care for minor illnesses as well as their perceptions about supporting and obstructing factors in the practice of self-care. BACKGROUND: Minor illness constitutes a large part of primary care, and patients' attendance to doctors' appointments for minor illness has been seen to increase future attendance for the same condition. Almost half of the consultations with telenurses result in the provision of self-care advice. DESIGN: A cross-sectional survey. METHOD: Primary data were collected using a questionnaire, and the study participants (n = 315) were randomly selected from the national Swedish address register. RESULTS: Having knowledge and receiving health care advice and reliable information were perceived to be needs in order for participants to feel confident in self-care. Having family or friends to consult with was perceived to be a positive factor influencing confidence in self-care, especially for persons under the age of 35. Health care services were perceived to support self-care practice by offering easy access to care, giving information about self-care, and offering increased follow-up after consultations. Lack of knowledge, along with difficulties being away from work, were obstructing factors in the practice of self-care. CONCLUSIONS: Young age was the factor influencing people's perceptions of needs and supporting factors the most. Young age and low knowledge scores about minor illnesses were the two factors that had the most influence on perceived obstructing factors. RELEVANCE TO CLINICAL PRACTICE: Nurses play a major role in the promotion of self-care and in the dissemination of self-care advice. If health care services fail to meet the needs of care-seekers with minor illnesses, patients might turn to out-of-hours clinics and emergency departments for help.

A self-destructive care: self-reports of people who experienced coercive measures and their suggestions for alternatives.

Coercive measures are commonly used as a method of intervention, despite insufficient evidence for their effectiveness and benefits. The aim of this study was to describe how people who self-harm perceive alternatives to coercive measures in relation to actual experiences of psychiatric care. A total of 19 self-reports have been analysed with qualitative content analysis, resulting in three categories: a wish for understanding instead of neglect; a wish for mutual relation instead of distrust; a wish for professionalism instead of a counterproductive care. In conclusion, if the caregivers can understand and collaborate with the patient, there is seldom any need for coercive measures.

Person-centred care: clarifying the concept in the context of inpatient psychiatry.

This paper reports an analysis of the concept of person-centred care in the context of inpatient psychiatry. It has been suggested that person-centred care in inpatient psychiatry might differ from person-centred care in other contexts, indicating a need to clarify the concept in this specific context. Scholarly papers from health-related disciplines were identified following a systematic search of the electronic databases CINAHL, PUBMED and PsycINFO, covering records indexed up until March 2014. An evolutionary approach to concept analysis was applied, integrating principles for data extraction and analysis in integrative reviews. The concept of person-centred care was defined as cultural, relational and recovery-oriented. It aspires to improve care and calls for a transformation of inpatient psychiatry. The concept is closely related to the concepts of recovery and interpersonal nursing. The result is described in terms of attributes, antecedents, consequences and related concepts. It is concluded that the further development of the concept needs to consider the contexts of the concept at both conceptual and praxis levels. Further research should explore the nature of and relationships between context, culture, care practice and outcomes in inpatient psychiatry from a perspective of person-centred care. The results of this analysis can provide a framework for such research.

Self-care for minor illness.

AIM: To describe experiences with and knowledge of minor illness, self-care interventions used in minor illness and channels of information used when providing self-care for minor illness. BACKGROUND: Although minor illness is self-limiting, symptoms can be substantial and have a great impact on the affected person's wellbeing. Possibilities to seek and find information about health and self-care have significantly increased through internet-based communities, forums, and websites. Still, a considerable number of consultations with general practitioners are for conditions that are potentially self-treatable. Seeking advanced care for minor illnesses is costly for society and can create discomfort for patients as they are down-prioritized at emergency departments. METHODS: Study participants were recruited randomly from the Swedish Address Register. A questionnaire was sent out, and the final sample included 317 randomly selected persons aged 18-80 and living in Sweden. FINDINGS: Having experienced a specific illness correlated with self-reported knowledge. Preferred self-care interventions differed between different conditions, but resting and self-medicating were commonly used, along with consulting health care facilities. Compliance to advice was the highest for official information channels, and family members were a popular source of advice.

Solving the staff's problem or meeting the patients' needs: staff members' reasoning about choice of action in challenging situations in psychiatric inpatient care.

Coercion in challenging situations is often seen as a necessary component of psychiatric care. This study aims to describe staff members' reasoning about their choice of action in challenging situations in inpatient psychiatric care. Focus group interviews with 26 staff members were analyzed using qualitative content analysis. The results provide an overview of the integrated structure of participants' reasoning and suggest that staff members' reasoning about choice of action can be described as a matter of either solving the staff's problems or meeting the patients' needs. These results can be of use in further research, educational interventions, and staff development activities.

Stories about life narrated by people with Alzheimer's disease.

AIM: To explore how people with Alzheimer's disease present their life story. BACKGROUND: Life story work is a key concept in a person-centred care. An important aspect in understanding the subjective experience and supporting the identity of people with dementia is to listen to their life stories. DESIGN: A narrative design with interviews was used. METHOD: Nine participants with Alzheimer's disease were encouraged to tell about their lives from childhood, adult life, to present life and about their thoughts on the future. The interviews were conducted between September 2010-March 2011 in the participants' homes, with their spouses present and were analysed with a method for analysis of narratives. FINDINGS: Contentment, Connectedness, Self-reliance and Personal growth were identified as core dimensions in the participants' life stories and shown like threads throughout life, from childhood, adult life to present life. All participants expressed an overall contentment with life, and connectedness was related to their relation with significant persons and to be included in the local community. Self-reliance was expressed as a strong confidence in the own ability and an overall curiosity throughout life as a sustained quest for personal growth. CONCLUSIONS: It is important for healthcare professionals, who work with people with dementia, to understand that people with Alzheimer's disease can maintain an overall trusting and hopeful approach to life. It is also important to use life story work to enhance feelings of being connected to the world and thereby support their identity and sense of self.

Knowledge of the patient as decision-making power: staff members' perceptions of interprofessional collaboration in challenging situations in psychiatric inpatient care.

Challenging situations in psychiatric inpatient settings call for interprofessional collaboration, but the roles and responsibilities held by members of different professions is unclear. The aim of this study was to describe staff members' perceptions of interprofessional collaboration in the context of challenging situations in psychiatric inpatient care. Prior to the study taking place, ethical approval was granted. Focus group interviews were conducted with 26 physicians, ward managers, psychiatric nurses, and nursing assistants. These interviews were then transcribed and analysed using qualitative content analysis. Results described participants' perceptions of shared responsibilities, profession-specific responsibilities and professional approaches. In this, recognising knowledge of the patient as decision-making power was understood to be a recurring theme. This is a delimited qualitative study that reflects the specific working conditions of the participants at the time the study was conducted. The findings suggest that nursing assistants are the most influential professionals due to their closeness to and first-hand knowledge of patients. The results also point to the possibility of other professionals gaining influence by getting closer to patients and utilising their professional knowledge, thus contributing to a more person-centred care.

Parenteral nutrition in home-based palliative care: Swedish district nurses experiences.

AIM: The aim of this study was to describe the experiences of district nurses in caring for patients with home-parenteral nutrition (HPN) in palliative care. METHOD: A qualitative approach was adopted using thematic content analysis of semi-structured interviews. Twelve district nurses working with primary health care in Sweden participated in the study that was conducted during 2011. FINDINGS: The analysis resulted in one overarching theme: The agony of terminating hope and three categories: all focus is on the infusion, alone without support, confidence in the relationship. HPN seemed to have a symbolic meaning when patients and family members connected the infusion with hope and life. District nurses expressed that they felt alone with the responsibility for the HPN due to the lack of a structured plan. Difficult discussions around termination of the infusion seemed to be connected to a feeling of agony of terminating hope among the district nurses. All district nurses expressed a need for support in their work, and factors like experience and the development of a good relationship with the patient and the family, could decrease the agony. CONCLUSION: The draw up of a plan when starting HPN, could be a support for the district nurse and make the aim, follow-up and future termination clearer. The establishment of a plan could make the work easier and reduce the feeling of agony of terminating hope among the district nurses.

Supporting conversations between individuals with dementia and their family members.

Remembrance of recent events is a major problem for individuals with dementia. Consequently, this article explores the process of acceptance and integration of a digital photograph diary (DPD) as a tool for remembrance of and conversations about daily life events. A design for multiple case studies was used. Seven couples, in which one individual in the couple had Alzheimer's disease, tested the DPD for 6 months. Data were collected in three sequences with interviews, observations, and screening instruments. In the analysis, all data were integrated to find common patterns of content. Some couples became regular users, while others used the DPD more sporadically. Factors contributing to regular use were how the DPD matched expectations, actual use, support, experienced usefulness, and reactions from family and friends. For those couples who became regular users, the DPD facilitated their conversation about recent daily activities.

Caring relationships in home-based nursing care - registered nurses' experiences.

The caring relationship between the nurse and the person in need of nursing care has been described as a key concept in nursing and could facilitate health and healing by involving the person's genuine needs. The aim of this study was to explore registered nurses' experiences of their relationships with persons in need of home-based nursing care. Individual interviews with nurses (n=13 registered nurses and 11 district nurses) working in home-based nursing care were performed. A thematic content analysis was used to analyze the transcribed interviews and resulted in the main theme Good nursing care is built on trusting relationship and five sub-themes, Establishing the relationship in home-based nursing care, Conscious efforts maintains the relationship, Reciprocity is a requirement in the relationship, Working in different levels of relationships and Limitations and boundaries in the relationship. A trusting relationship between the nurse and the person in need of healthcare is a prerequisite for good home-based nursing care whether it is based on face-to-face encounters or remote encounters through distance-spanning technology. A trusting relationship could reduce the asymmetry of the caring relationship which could strengthen the person's position. The relationship requires conscious efforts from the nurse and a choice of level of the relationship. The trusting relationship was reciprocal and meant that the nurse had to communicate something about themself as the person needs to know who is entering the home and who is communicating through distance-spanning technology.

Encounters in home-based nursing care - registered nurses' experiences.

The encounter between registered nurses and persons in need of healthcare has been described as fundamental in nursing care. This encounter can take place face-to-face in physical meetings and through meetings via distance-spanning technology. A strong view expressed in the literature is that the face-to-face encounter is important and cannot entirely be replaced by remote encounters. The encounter has been studied in various healthcare contexts but there is a lack of studies with specific focus on the encounter in home-based nursing care. The aim of this study was to explore the encounter in home-based nursing care based on registered nurses' experiences. Individual interviews were performed with 24 nurses working in home-based nursing care. The transcribed interviews were analyzed using thematic content analysis and six themes were identified: Follows special rules, Needs some doing, Provides unique information and understanding, Facilitates by being known, Brings energy and relieves anxiety, and Can reach a spirit of community. The encounter includes dimensions of being private, being personal and being professional. A good encounter contains dimensions of being personal and being professional and that there is a good balance between these. This is an encounter between two human beings, where the nurse faces the person with herself and the profession steadily and securely in the back. Being personal and professional at the same time could encourage nurses to focus on doing and being during the encounter in home-based nursing care.