Integrity Promoting Care of Demented Patients: Patterns of Interaction during Morning Care

Video-recorded morning care sessions (n = 49) of demented nursing home patients (n = 5), were analyzed before, as well as after, training of the staff in integrity promoting care. A phenomenological-hermeneutic analysis was performed based on the Erikson theory of “eight stages of man” and musical notations were used for the analysis of courses of events. The analysis revealed five main patterns of interaction; positive, negative, intermediate, negative/intermediate turned into positive by the patient, and negative/intermediate turned into positive by the caregiver. Before the training, negative and intermediate patterns dominated (58%), while positive patterns dominated (84%) after the training. The positive patterns of interaction were characterized by the caregiver communicating with the patient as a competent partner, showing humanity, respect and support. The activity was carried out in intimacy. This led to the patient displaying more and more ability.

[1]  I. Hallberg Vocally disruptive behaviour in severely demented patients in relation to institutional care provided , 1990 .

[2]  Alfred W. Kaszniak,et al.  Communication and Cognition in Normal Aging and Dementia , 1987 .

[3]  A. Norberg,et al.  Caregivers' perceptions and interpretations of severely demented patients during feeding in a task assignment system. , 1990, Scandinavian journal of caring sciences.

[4]  A. Fernald,et al.  A cross-language study of prosodic modifications in mothers' and fathers' speech to preverbal infants , 1989, Journal of Child Language.

[5]  A. Norberg,et al.  Morning care of patients with Alzheimer-type dementia. A theoretical model based on direct observations. , 1986, Journal of advanced nursing.

[6]  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.

[7]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.

[8]  S. Katz,et al.  A Measure of Primary Sociobiological Functions , 1976, International journal of health services : planning, administration, evaluation.

[9]  H. R. Bohling,et al.  Communication with Alzheimer's Patients: An Analysis of Caregiver Listening Patterns , 1991, International journal of aging & human development.

[10]  Paul Ricœur,et al.  Interpretation Theory: Discourse and the Surplus of Meaning , 1976 .

[11]  A. Norberg,et al.  Relationship between Bilingual Demented Immigrants and Bilingual/Monolingual Caregivers , 1993, International journal of aging & human development.

[12]  Miss A.O. Penney (b) , 1974, The New Yale Book of Quotations.

[13]  M. Tappan,et al.  Reading for self and moral voice: A method for interpreting narratives of real-life moral conflict and choice. , 1989 .

[14]  B. Reisberg,et al.  Dementia: a systematic approach to identifying reversible causes. , 1986, Geriatrics.

[15]  S. Whitbourne,et al.  Dependency in the institutional setting: a behavioral training program for geriatric staff. , 1981, The Gerontologist.

[16]  E Melin,et al.  Nurse-patient interaction after training in integrity promoting care at a long-term ward: analysis of video-recorded morning care sessions. , 1993, International journal of nursing studies.

[17]  A. Norberg,et al.  Care of demented patients with severe communication problems. , 1991, Scandinavian journal of caring sciences.

[18]  P. Heacock,et al.  Nursing interventions for patients with Alzheimer's disease. , 1988, The Nursing clinics of North America.

[19]  Communicating effectively with dementia patients. , 1989, Journal of psychosocial nursing and mental health services.

[20]  A. Norberg,et al.  Effects of the training of integrity--promoting care on the interaction at a long-term ward. Analysis of video-recorded social activities. , 1990, Scandinavian journal of caring sciences.

[21]  A. Norberg,et al.  Experience of at-homeness and homesickness in patients with Alzheimer's disease , 1993 .

[22]  P. Fell,et al.  Depression, Dementia and Disability in the Elderly , 1987, British Journal of Psychiatry.

[23]  M. Nehrke Aging and the Environment , 1982 .

[24]  C. Wells Communication and Cognition in Normal Aging and Dementia , 1990 .

[25]  A. Norberg,et al.  Relearning to eat late after a stroke by systematic nursing intervention: a case report. , 1986, Journal of advanced nursing.

[26]  L. Hemsi Living with dementia. , 1982, Postgraduate medical journal.

[27]  D. Jeste,et al.  Overview of depression and psychosis in Alzheimer's disease. , 1989, The American journal of psychiatry.

[28]  Patient and Situational Factors That Affect Nursing Students' Like Or Dislike of Caring for Patients , 1987, Nursing research.

[29]  A. Norberg,et al.  Long-Term Influences on Demented Patients in Different Caring Milieus, a Collective Living Unit and a Nursing Home: A Descriptive Study , 1992 .

[30]  Eva Johanson High precision registration of complicated longitudinal and cross-sectional data , 1991 .

[31]  J. Rehfeld,et al.  Changes of CSF neuropeptides after environmental stimulation in dementia , 1985 .

[32]  P. Ricoeur From text to action , 1991 .

[33]  Rolf Adolfsson,et al.  Facial expressions in severely demented patients—a stimulus–response study of four patients with dementia of the Alzheimer type , 1991 .

[34]  C. Gilleard Living With Dementia: Community Care of the Elderly Mentally Infirm , 1984 .

[35]  A. Norberg,et al.  Integrity‐promoting care of demented nursing home patients: Psychological and biochemical changes , 1989 .

[36]  Paul Ricoeur,et al.  The Model of the Text: Meaningful Action Considered as a Text , 1973 .

[37]  A. Norberg,et al.  Elevated CSF somatostatin concentrations in demented patients parallel improved psychomotor functions induced by integrity‐promoting care , 1989, Acta psychiatrica Scandinavica.

[38]  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.