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Care of people with dementia: patients' characteristics, organisational climate and staff attitudes
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Syftet med denna avhandling var att undersöka funktionsförmågor hos personer med demens vid inflyttning till gruppboende under olika tidsperioder, hur personer med demens tillbringar sin tid i olika vårdformer samt strukturen i vårdares attityder till personer med demens. Data baseras på: 1) retrospektiva data av funktionell förmåga bland personer med demens vid inflyttning till gruppboende; 2) icke-deltagande observationer av patienters aktiviteter (2024 observationer) på en psykogeriatrisk avdelning; 3) icke-deltagande observationer av patienters aktiviteter i gruppboende skattade som ett ”kreativt organisationsklimat” (3061 observationer) och i gruppboende skattade som ett ”mindre kreativt organisationsklimat” (3399 observationer); 4) semantisk differentialteknik för att identifiera strukturen i vårdares attityder till personer med demens (1237 skattningar). Resultatet visar att vid jämförelse av patienternas funktionsförmågor vid inflyttning till gruppboende har beroendet av assistans för att klara dagligt liv ökat dessutom har möjligheten att bo kvar i gruppboende ökat över tid (β= -0.3134; p< 0.001) (I). Studien av personer med demens på en psykogeriatrisk avdelning (II) visar att 31,1 procent av tiden tillbringades med vårdare och 50,3 procent av tiden i ensamhet. De patienter med försämrad kommunikationsförmåga erhöll mindre tid från vårdare (p< 0.001). Jämförelse mellan gruppboendeenheter med ett kreativt organisationsklimat och enheter med ett mindre kreativt klimat (III) visade att i enheter med ett kreativt organisationsklimat tillbringade personerna med demens 45,2 procent av tiden med vårdare och i det mindre kreativa klimatet 25,6 procent (p< 0.001). Den tid som tillbringades i ensamhet var nästan densamma i både det kreativa och mindre kreativa klimatet (39,1% och respektive 38,8%, ns). Fyra dimensioner framkom vid analysen av vårdares attityder till personer med demens, vilka relateras till vårdarnas uppfattning om patienterna utifrån a) en etisk/estetisk dimension, b) förmågan att förstå, c) förmågan att uppleva och d) deras förmåga till sociala interaktioner. På ett positivt till negativt attitydkontinuum visar sig vårdarnas attityder ligga mellan positiva till neutrala attityder. Sammanfattningsvis så har personer med demens förändrats speciellt med avseende på funktionell förmåga vid inflyttning till gruppboende, dessutom har möjligheten att bo kvar ökat. I gruppboende med ett kreativt organisationsklimat tillbringade patienterna mindre tid i ensamhet och patient-vårdar interaktionen ökade. Vidare så är vårdarnas attityder överlag positiva till neutrala på ett positivt till negativt attitydkontinuum och den mest positiva och generella attityden kan ses i den etiska/estetiska dimensionen. Keywords: dementia, group-dwelling, work sampling, patients activities classification, organisational climate, attitudes, semantic differential.

Place, publisher, year, edition, pages
Sundsvall: Mittuniversitetet , 2005. , p. 44
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 3
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-8859ISBN: 91-85317-11-X (print)OAI: oai:DiVA.org:miun-8859DiVA, id: diva2:214794
Public defence
2005-10-27, Lubbesalen, M 108, Humlegården, Mittuniversitetet, Campus Sundsvall, Sundsvall, 00:00 (English)
Opponent
Available from: 2009-05-06 Created: 2009-05-06 Last updated: 2011-08-17Bibliographically approved
List of papers
1. A retrospective study of functional ability among people with dementia when admitted to group-dwelling
Open this publication in new window or tab >>A retrospective study of functional ability among people with dementia when admitted to group-dwelling
2001 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 1, p. 39-42Article in journal (Refereed) Published
Abstract [en]

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-hundered-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 óf 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 to encourage the development of GD.

Keywords
Dementia, group-dwelling, ADL capacity
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-3731 (URN)000167708900009 ()11303546 (PubMedID)2-s2.0-0035106483 (Scopus ID)3948 (Local ID)3948 (Archive number)3948 (OAI)
Available from: 2008-09-30 Created: 2008-09-30 Last updated: 2017-12-12Bibliographically approved
2. How patients´ with dementia spend their time in a psycho-geriatric unit
Open this publication in new window or tab >>How patients´ with dementia spend their time in a psycho-geriatric unit
Show others...
2001 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 15, no 3, p. 215-221Article in journal (Refereed) Published
Abstract [en]

This paper presents the findings of a work sampling study conducted at an assessment unit for patients with dementia at a university hospital in Nothern Sweden. The aim of the study was to describe the activity of the demented patients´day at apsycho-geriatric unit, and to investigate the correlation between the patients´ characteristics and time provided by nursing staff, in order to increase our knowledge of institutionalized demented patients situation. The sample consited of 24 patients with dementia. The activities of patients were monitored at 10-min interval between 7.00 a.m. and 9.10 p.m. In total, 2024 activities were recorded. The findings showed that being demented and placed in a psycho-geriatric unit is a life in solitude for most of the time. The variationin time patients spent in solitude could partly be explanied by their communication abilities. For patients with dementia, communication is essential for their well-being. It seems important to enhance our knowledge about the reasons, that influence the nursing staffs' perceptions of patients with dementia, to decrease their time in solitude.

Keywords
dementia, work sampling, patient activities classification, solitude
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-3732 (URN)10.1046/j.1471-6712.2001.00015.x (DOI)000171306100003 ()11564228 (PubMedID)2-s2.0-0035725322 (Scopus ID)3949 (Local ID)3949 (Archive number)3949 (OAI)
Available from: 2008-09-30 Created: 2008-09-30 Last updated: 2017-12-12Bibliographically approved
3. The relationship between organisational climate and the content of daily life for people with dementia living in group-dwelling
Open this publication in new window or tab >>The relationship between organisational climate and the content of daily life for people with dementia living in group-dwelling
2002 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 2, p. 237-246Article in journal (Refereed) Published
Abstract [en]

One factor influencing the outcome of care may be nursing staff's experience of the organizational work climate. The aim of the study was to investigate how people with dementia spend their time in group-dwelling units (GD) with either a creative or less creative organizational climate. 2. For the study, two GD units assessed as having a creative organizational climate and two units assessed as having a less creative climate were selected. Eighteen residents living in the units assessed as creative and 20 residents living in the units assessed as less creative participated in the study. 3. For measuring the organizational climate the Creative Climate Questionnaire was used. Observations of residents' activities were classified according to the Patient Activity Classification. For measuring residents' functional ability the Multi-Dimensional Dementia Assessment Scale was used. Their cognitive capacity was measured with the Mini Mental State Examination. 4. Residents living in the units assessed as having a creative organizational climate spent 45.2% of the time with nursing staff, while those in the less creative climate spent 25.6% (P < 0.001). Time spent with fellow residents in the creative climate was 13.9% and in the less creative climate 31.3% (P < 0.001). There was no significant difference between the units according time spent with relatives and time spent alone. 5. Since the purpose of GD is to offer care adapted to the abilities and psychosocial needs of people suffering from dementia, a less creative climate can be a threat to the aims of GD. In order to maintain these, it is important for managers to be aware of the work climate and its impact on care for people with dementia.

Keywords
dementia, group-dwelling, organizational climate, patient activities classification
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-1710 (URN)10.1046/j.1365-2702.2002.00579.x (DOI)000174468100013 ()11903723 (PubMedID)2-s2.0-0036515976 (Scopus ID)362 (Local ID)362 (Archive number)362 (OAI)
Available from: 2008-11-19 Created: 2008-11-19 Last updated: 2017-12-13Bibliographically approved
4. Nurses' attitudes towards people with dementia: the semantic differential technique
Open this publication in new window or tab >>Nurses' attitudes towards people with dementia: the semantic differential technique
Show others...
2006 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 3, p. 264-274Article in journal (Refereed) Published
Abstract [en]

One important aspect of the nurse-patient relationship is the nurses' attitudes towards their patients. Nurses' attitudes towards people with dementia have been studied from a wide range of approaches, but few of them have focused on the structure in nurses' 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 eleven nursing homes participated in the study. In all, 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 has 57 bipolar pairs of adjectives, which 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. These four dimensions related to licensed practical nurses' opinion of the patients; from an ethical and aesthetic dimension; their ability to understand; their ability to experience; their ability for social interaction. The study indicates that, on the positive to negative attitude continuum, attitudes fall at the positive to neutral end of the continuum. This is an important finding due to the personhood perspective. From this perspective, it is reasonable to assume that with a more positive attitude to people with dementia, the prerequisites for person-centred care will improve.

Keywords
attitudes, dementia, entropy, nursing, semantic differential, Omvårdnad
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-804 (URN)000236924400007 ()16711185 (PubMedID)2-s2.0-33646678478 (Scopus ID)3954 (Local ID)3954 (Archive number)3954 (OAI)
Available from: 2008-09-30 Created: 2008-09-30 Last updated: 2017-12-13Bibliographically approved

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