Interaction relating to privacy, identity, autonomy and security. An observational study focusing on a woman with dementia and "behavioural disturbances", and on her care providers.

AIM The study aims to illuminate how one woman with severe dementia and so-called behavioural disturbances acts in relation to her care providers and how the care providers act in relation to her. METHODS Fourteen participant observations, including one woman with dementia and six care providers, were performed. A reflective dialogue focusing on the interaction between the woman and her care providers followed each observation. The tape-recorded observational notes and reflective dialogues were fixed as a text, which was subjected to a thematic content analysis. FINDINGS The main findings are that the interaction between a woman with severe dementia and "behavioural disturbances" and her care providers relates to privacy, identity, autonomy and security. The phenomena are intertwined and also in conflict with each other. Interaction is a complex dialectic process in which those who are engaged meet problems that can be solved and are involved in dilemmas that cannot be solved, only related to.

[1]  J. Hayter Territoriality as a universal need 0 , 1981 .

[2]  C. Distasio Violence in health care: institutional strategies to cope with the phenomenon. , 1994, The Health care supervisor.

[3]  J. Cohen-Mansfield,et al.  Measurement of inappropriate behavior associated with dementia. , 1999, Journal of gerontological nursing.

[4]  A. Norberg,et al.  Verbal interaction during the lunch-meal between caregivers and vocally disruptive demented patients , 1993 .

[5]  D. Jorgensen Participant Observation: A Methodology for Human Studies , 1989 .

[6]  G. Agich Autonomy and long term care , 1993 .

[7]  T. Nakano,et al.  Longitudinal Changes in Computerized EEG and Mental Function of the Aged: A Nine-Year Follow-Up Study , 1992, International Psychogeriatrics.

[8]  A. Norberg,et al.  Staffs' Interpretation of the Experience behind Vocally Disruptive Behavior in Severely Demented Patients and Their Feelings about it. An Explorative Study , 1990, International journal of aging & human development.

[9]  M. Buber The William Alanson White Memorial Lectures, Fourth Series , 1957 .

[10]  Anna Edberg,et al.  Cooperation during Morning Care between Nurses and Severely Demented Institutionalized Patients , 1995, Clinical nursing research.

[11]  B. Miller,et al.  Aggressive, socially disruptive and antisocial behaviour associated with fronto-temporal dementia , 1997, British Journal of Psychiatry.

[12]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[13]  B. Reisberg,et al.  Pharmacologic Treatment of Alzheimer's Disease: A Methodologic Critique Based Upon Current Knowledge of Symptomatology and Relevance for Drug Trials , 1992, International Psychogeriatrics.

[14]  J. Freedman,et al.  Conceptions of Crowding. (Book Reviews: Crowding and Behavior; The Environment and Social Behavior. Privacy, Personal Space. Territory, Crowding) , 1975 .

[15]  A. Norberg Perspectives of an Institution-Based Research Nurse , 1997, International Psychogeriatrics.

[16]  Krister Malmsten Reflective Assent in Basic Care: A Study in Nursing Ethics , 1999 .

[17]  T. Kitwood,et al.  Toward a Theory of Dementia Care: Ethics and Interaction , 1998, The Journal of Clinical Ethics.

[18]  I. Hallberg,et al.  The relationship of vocally disruptive behavior and previous personality in severely demented institutionalized patients. , 1997, Archives of psychiatric nursing.

[19]  Klaus Krippendorff,et al.  Content Analysis: An Introduction to Its Methodology , 1980 .

[20]  P. Heacock,et al.  Disruptive behaviors of a cognitively impaired nursing home resident. , 1992, Archives of psychiatric nursing.

[21]  B Downe-Wamboldt,et al.  Content analysis: method, applications, and issues. , 1992, Health care for women international.

[22]  B. Lawlor,et al.  Biologic Markers and Neurochemical Correlates of Agitation and Psychosis in Dementia , 1995, Journal of geriatric psychiatry and neurology.

[23]  S. Margulis Conceptions of Privacy: Current Status and Next Steps , 1977 .

[24]  Howard E. Gruber,et al.  Handbook of Creativity: The Case Study Method and Evolving Systems Approach for Understanding Unique Creative People at Work , 1998 .

[25]  A. Norberg,et al.  Nurses' reflections about dementia care, the patients, the care and themselves in their daily caregiving. , 1998, International journal of nursing studies.

[26]  J. Cohen-Mansfield,et al.  A description of agitation in a nursing home. , 1989, Journal of gerontology.

[27]  A. Norberg,et al.  A comparison between the care of vocally disruptive patients and that of other residents at psychogeriatric wards. , 1990, Journal of advanced nursing.

[28]  D. P. Johnson Security Versus Autonomy Motivation in Anthony Giddens’ Concept of Agency , 1990 .

[29]  H. Ragneskog,et al.  Music and other strategies to improve the care of agitated patients with dementia. Interviews with experienced staff. , 1997, Scandinavian journal of caring sciences.