Can humming caregivers´ facilitate feeding during mealtime situations with persons with dementia? A qualitative study

Background. ‘Music Therapeutic Caregiving’, defined as when caregivers’ sing for or together with persons with dementia care situations, has been shown to facilitate the caring situation, and enhance positive and decrease negative expressions in persons with dementia. No studies about singing during mealtimes have been conducted, and this project was designed to elucidate this. However, since previous studies have shown that there is a risk that persons with dementia will start to sing along with the caregiver, the caregiver in this study hummed such that the person with dementia did not sing instead of eat. Aim. To describe professional caregivers’ experiences of humming during meal time while feeding persons with dementia. Method. An intervention with caregivers humming was implemented during lunch time. Focus group interviews were conducted to fetch the caregivers experiences. Qualitative content analysis was used to analyse the interviews. Results. The caregivers described that humming disseminated relaxation and joy, and awakened memories about the songs hummed which encouraged the persons with the dementia to join in the songs. They also described that humming seemed to make the persons with dementia associate with mealtime and could make them eat more. However it also revealed suspiciousness and agitation from the persons with dementia. Conclusion. Humming during mealtime revealed mainly positive as well as some negative influences. More and larger studies are needed to be able to draw general conclusions.

Reactions of Persons with Dementia to Caregivers Singing in Morning Care Situations

Music therapeutic caregiving', when caregivers sing for or together with persons with severe dementia during care situations, has been suggested as a way to reduce problematic behaviors in dementia care. The present study implemented this technique as an intervention in dementia care. Six caregivers participated in group interviews about their experiences of morning care situations without and with'Music therapeutic caregiving'. Through a qualitative content analysis two themes emerged.'Being in a different reality' was based on'usual' morning care situations. The caregivers' experienced the persons with dementia as absent-minded; communication and cooperation were difficult. The second theme,'Being present', was based on morning care situations with the intervention. The caregivers described communication as enhanced; the persons with dementia expressed themselves more appropriately, making cooperation possible. The results indicate that'Music therapeutic caregiving' might lead to a more positive experience of the person with dementia and seems to increase receptivity to caregiving.  

Humming as a mean of communicating during meal time situations : A Single Case study involving a women with severe dementia and her caregiver

Objective: ‘Music Therapeutic Caregiving’, when caregivers sing for or together with persons with dementia during morning care situations, has been shown to increase verbal and nonverbal communication between persons with dementia and their caregivers, as well as enhance positive and decrease negative emotions in persons with dementia. No studies about singing during mealtimes have been conducted, and this pilot project was designed to elucidate this. However, since previous studies have shown that there is a risk that persons with dementia will start to sing along with the caregiver, the caregiver in this study hummed such that the person with dementia did not sing instead of eat. The aim of this pilot project was threefold: to describe expressed emotions in a woman with severe dementia, and describe communication between her and her caregivers without and with the caregiver humming. The aim was also to measure food and liquid intake without and with humming. Method: The study was constructed as a Single Case ABA design in which the ordinary mealtime constituted a baseline which comprised a woman with severe dementia being fed by her caregivers in the usual way. The intervention included the same woman being fed by the same caregiver who hummed while feeding her. Data comprised video observations that were collected once per week over 5 consecutive weeks. The Verbal and Nonverbal Interaction Scale and Observed Emotion Rating Scale were used to analyze the recorded interactions. Results: A slightly positive influence of communication was shown for the woman with dementia, as well as for the caregiver. Further, the women with dementia showed a slight increase in expressions of positive emotions, and she ate more during the intervention. Conclusion: Based on this pilot study no general conclusions can be drawn. It can be concluded, however, that humming while feeding persons with dementia might slightly enhance communication, and positive expressed emotions in persons with dementia. To confirm this, more studies on group levels are needed. Because previous studies have found that caregiver singing during caring situations influences persons with dementia positively it might be desirable to test the same during mealtime.

Can therapy dogs evoke awareness of one's past and present life in persons with Alzheimer's disease?

BACKGROUND: Persons with Alzheimer's disease (AD) sometimes express themselves through behaviours that are difficult to manage for themselves and their caregivers, and to minimise these symptoms alternative methods are recommended. For some time now, animals have been introduced in different ways into the environment of persons with dementia. Animal-Assisted Therapy (AAT) includes prescribed therapy dogs visiting the person with dementia for a specific purpose. AIM: This study aims to illuminate the meaning of the lived experience of encounters with a therapy dog for persons with Alzheimer's disease. METHOD: Video recorded sessions were conducted for each visit of the dog and its handler to a person with AD (10 times/person). The observations have a life-world approach and were transcribed and analysed using a phenomenological hermeneutical approach. RESULTS: The result shows a main theme 'Being aware of one's past and present existence', meaning to connect with one's senses and memories and to reflect upon these with the dog. The time spent with the dog shows the person recounting memories and feelings, and enables an opportunity to reach the person on a cognitive level. CONCLUSIONS: The present study may contribute to health care research and provide knowledge about the use of trained therapy dogs in the care of older persons with AD in a way that might increase quality of life and well-being in persons with dementia. IMPLICATIONS FOR PRACTICE: The study might be useful for caregivers and dog handlers in the care of older persons with dementia.

Faktorer som påverkar patientens delaktighet i omvårdnad – en litteraturstudie

Bakgrund: Patientens rätt att vara delaktig i planering och genomförande av sin vård betonas idag, men många patienter är mindre delaktiga än de önskar vara. Det finns många fördelar med att patienten är delaktig. Syfte: Att beskriva vilka faktorer som påverkar patientens delaktighet i omvårdnad från patientens och sjuksköterskans perspektiv inom somatisk slutenvård. Metod: Litteraturstudie baserad på 16 vetenskapliga artiklar, publicerade mellan åren 2006 och 2015. Sökning skedde i databaserna PubMed och CINAHL, samt i de funna artiklarnas referenslistor. Resultat: Fem kategorier med faktorer som påverkade patientens delaktighet i omvårdnad identifierades; kunskap, relationen mellan patienten och sjuksköterskan, sjuksköterskans förhållningssätt, patientens situation och egenskaper samt organisationen. Slutsats: Faktorerna inom de fem kategorierna utgör ett komplicerat samspel och varje patient är en unik person med egna önskemål och preferenser för delaktighet.

Erfarenheter av att vårda personer med demenssjukdom : En kvalitativ intervjustudie med distriktssköterskor

Bakgrund: Demenssjukdom är vanligt förekommande och denna patientgrupp ingår i distriktssköterskors uppdrag. Syfte: Att belysa distriktssköterskors erfarenheter av att möta personer med demensdiagnos och hur de anpassar vården utifrån vårdtagarens behov. Metod: En kvalitativ intervjustudie genomfördes med fyra stycken distriktssköterskor. För bearbetning av insamlad data användes innehållsanalys. Resultat: Analysen ledde till fram till fyra stycken kategorier: att möta en komplex vårdsituation, att bli utmanad, att ta till vara resurser och att anpassa sina vårdåtgärder till den enskilde eller till demenssjukdomen. Deltagarna förmedlade att personer med demenssjukdom är en utsatt och sårbar grupp och att vårda dem innebar en utmaning på flera olika plan. Det kräver fördjupade kunskaper och en förmåga att se till alla faktorer som omger denna patientgrupp, det är både utmanande, komplext och spännande. Att arbeta personcentrerat är något som både eftersträvas och görs i praktiken, även att ta till vara resurser som kommer vårdtagaren till godo. Slutsats: Distriktssköterskornas glädje och engagemang var framträdande och verkade vara kopplat till att de hade utbildning och kunskap. Forskning på personer med demenssjukdom och andra med nedsatt beslutsförmåga behövs och är önskvärt. Deras deltagande skulle ge värdefull kunskap som kan leda till att utveckla vården för denna patientgrupp.

Att hantera funktionärer utifrån organisationers perspektiv : En kvalitativ studie om hur organisationer som arrangerar idrottsevenemang hanterar funktionärer gällande rekrytering och behållande

Flertalet evenemang är idag beroende av funktionärer för att genomföras. Att ha funktionärer till hjälp är ekonomiskt bärkraftigt för organisationer som anordnar evenemang, då de inte behöver anställa betald personal. Vetenskapliga studier menar att organisationer bör upprätta tydliga planer eller strategier för hur de ska hantera funktionärer då konkurrensen om funktionärerna ökar. Eftersom det är kostsamt att rekrytera nya funktionärer bör det vara av stor vikt för organisationer att försöka behålla sina funktionärer inför framtiden. Syftet är att undersöka organisationer som arrangerar årligen återkommande idrottsevenemang för att få en djupare förståelse för hur de arbetar med sina funktionärer. För att undersöka detta har vi intervjuat tre av Sveriges största årligen återkommande idrottsevenemang som alla är beroende av funktionärer. Intervjuerna genomfördes personligen med respektive person i organisationen som hade det övergripande ansvaret för funktionärer. Undersökningen visar att väletablerade evenemang, som de i studien, har vissa likheter i hur de hanterar funktionärer som vetenskapliga studier förespråkar. Att följa en strikt plan för hur arbetet med funktionärer bör gå till visar sig inte vara nödvändigt. Det visade sig att samtliga organisationer delegerar ansvaret för funktionärer till projektledare eller huvudfunktionärer. Det som var viktigt vid rekryteringen var; synliggöra, intervjuer och utbildning. Det som utmärkte sig vid att försöka få funktionärerna att återkomma var; förmåner, kommunikation och relationen. Resultatet visade att arbetet med funktionärerna, trots att de kan vara många till antalet, inte behöver vara komplicerat.

Personcentrerad omvårdnad vid demens : En deskriptiv kvalitativ studie

Bakgrund: Demens är en av de stora folksjukdomarna och vårdpersonal möter dessa personer med demens både inom akutsjukvård och kommunal vård. På slutet av sitt liv bor de flesta personer som drabbats av demens på institution. Personcentrerad vård beskrivs vara gynnsamt i vården av personer med demens och personalens erfarenhet av detta har stor betydelse. Syfte: Syftet var att studera sjuksköterskors, enhetschefers och undersköterskors erfarenhet av personcentrerad omvårdnad inom kommunal hälso och sjukvård. Metod: Designen var en deskriptiv studie med kvalitativ ansats som har analyserats med hjälp av en induktiv innehållsanalys. Deltagarna som inkluderades i intervjustudien kom från samma kommun. Det var tio personer och bestod av fyra sjuksköterskor, fyra undersköterskor och två enhetschefer. De valdes ut av verksamhetschefen där inklusionskriteriet var att ha arbetat med personer med demens i minst fem år. Resultat: I resultatet framkom fyra kategorier och 12 subkategorier. Personcentrerad omvårdnad ansågs relevant i samband med god omvårdnad av personer med demens. I arbetet med personcentrerad vård var fokus att; anpassa sig till personen med demens, att se till dennes identitet och personlighet. Vidare lades vikt vid anhörigas deltagande, bemötande och ett gemensamt arbetssätt, vilket bestod av att identifiera behov och se personen bakom sjukdomen. Slutsats: Resultatet visade att de flesta intervjupersonerna hade liknande erfarenheter i att arbeta med personer med demens. Det framkom i studien att bemötandet hade stor betydelse i omvårdnaden. Fokus i personcentrerad omvårdnad var de redovisade kategorierna och dess innehåll och ansågs betydelsefull och nödvändig för att personer med demens får ett så bra och värdigt liv som möjligt efter sjukdomsdebuten.

Prosodic Morphology : Gender in Arabic Perfect Active and Passive 3rd Person Singular Verbs

Prosodic /template Morphology, that "draws heavily on the theoretical apparatus and formalisms of the generative phonology model known as autosegmental phonology" (Katamba, F. 1993: 154), is the best analysis that can handle Arabic morphology. Verbs in Arabic are represented on three independent tiers: root tier, the skeletal tier and the vocalic melody tier (Katamba, F. 1993). Vowel morphemes, which are represented by diacritics, are inserted within the consonant morphemes, which are represented by primary symbols, to form words. The morpheme tier hypothesis paves the way to understand the nonconcatenative Arabic morphology. This paper analyzes gender in perfect active and passive 3rd person singular verbs on the basis of PM. The focus of the analysis shall be drawn heavily on the most common Arabic verbs; triconsonantal verbs, with brief introduction of the less common verbs; quadriconsonantal perfect active and passive masculine and feminine 3rd person singular verbs. I shall, too, cast the light on some vowel changes that some verbs undergo when voice changes.

Animalism and Person as a Basic Sort

In this paper Animalism is analysed. It will be argued that Animalism is correct in claiming (i) that being of a certain sort of animal S is a fundamental individuative substance sortal concept (animal of the species Homo Sapiens), (ii) that this implies that Animalism is correct in claiming that persons such as us are, by necessity, human beings, (iii) that remaining the same animal is a necessary condition for our identity over time. Contrary to Animalism it will be argued that this does not imply that person should be understood as a phased sortal concept. It will be argued that Animalism rests upon a prior conception of person, and that this implies that person must be understood as a basic substance sortal concept through which we have to individuate ourselves and others. It is further argued that this, together with the insights of Animalism, implies that persons, by necessity, are beings of a biological nature.

Familjemedlem till person med psykossjukdom : bemötande och utanförskap i psykiatrisk vård

This thesis focused on the situation of family members of persons with psychotic illness, particular on their experience of the approach of the healthcare professionals and of their feelings of alienation regarding the professional care of their family member. A further aim was to explore how siblings who have participated in a support group for siblings experienced their situation. A questionnaire was developed that enabled the aims of this thesis to be investigated (I). Seventy family members from various parts of Sweden participated, and data were collected via the questionnaire developed in study I (II-III). Thirteen siblings who previously had participated in a support group participated in follow-up focus groups interviews (IV). The questionnaire developed was shown to be reliable and valid in these studies (I). In many cases, the participants had experienced an approach from professionals that indicated that they did not experience openness, confirmation and cooperation, and that they felt powerless and socially isolated in relation to the care. There was also found to be a certain degree of association between how the participants experienced the approach and whether they felt alienation (II). The majority of the participants considered openness, confirmation, and cooperation to be important aspects of professional’s approach. The result also identified a low level of agreement between the participants’ experience and what they considered to be significant in the professional’s approach (III). The findings revealed the complexity of being a sibling of an individual with psychotic illness. Participating in a support group for siblings can be of importance in gaining knowledge and minimizing feelings of being alone (IV). Although the psychiatric care services in Sweden have been aware of the importance of cooperating with family members, the results indicated that there is a need for further research in this area.

Being a bridge : Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study

Background: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence. Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis. Results: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women. Conclusion: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

The fall descriptions and health characteristics of older adults with hip fracture : a mixed methods study

Background: In light of the multifactorial etiology of fall-related hip fracture, knowledge of fall circumstances may be especially valuable when placed in the context of the health of the person who falls. We aimed to investigate the circumstances surrounding fall-related hip fractures and to describe fall circumstances in relation to participants' health and functional characteristics. Methods: The fall circumstances of 125 individuals (age >= 50 years) with hip fracture were investigated using semi-structured interviews. Data concerning participants' health (comorbidities and medications) and function (self-reported performance of mobility, balance, personal activities of daily living and physical activity, previous falls and hand grip strength) were collected via medical records, questionnaires and dynamometry. Using a mixed methods design, both data sets were analysed separately and then merged in order to provide a comprehensive description of fall events and identify eventual patterns in the data. Results: Fall circumstances were described as i) Activity at the time of the fall: Positional change (n = 24, 19%); Standing (n = 16, 13%); Walking (n = 71, 57%); Balance challenging (n = 14, 11%) and ii) Nature of the fall: Environmental (n = 32, 26%); Physiological (n = 35, 28%); Activity-related indoor (n = 8, 6%) and outdoor (n = 8, 6%); Trips and slips on snow (n = 20, 16%) and in snow-free conditions (n = 12, 10%) and Unknown (n = 10, 8%). We observed the following patterns regarding fall circumstances and participants' health: those who fell i) during positional change had the poorest functional status; ii) due to environmental reasons (indoors) had moderate physical function, but high levels of comorbidity and fall risk increasing medications; iii) in snow-free environments (outdoors) appeared to have a poorer health and functional status than other outdoor groups. Conclusions: Our findings indicate that patterns exist in relation to the falls circumstances and health characteristics of people with hip fracture which build upon that previously reported. These patterns, when verified, can provide useful information as to the ways in which fall prevention strategies can be tailored to individuals of varying levels of health and function who are at risk for falls and hip fracture.

What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register

OBJECTIVES: There is a growing emphasis on the perspective of individuals living with diabetes and the need for a more person-centred diabetes care. At present, the Swedish National Diabetes Register (NDR) lacks patient-reported outcome measures (PROMs) based on the perspective of the patient. As a basis for a new PROM, the aim of this study was to describe important aspects in life for adult individuals with diabetes. DESIGN: Semistructured qualitative interviews analysed using content analysis. SETTING: Hospital-based outpatient clinics and primary healthcare clinics in Sweden. PARTICIPANTS: 29 adults with type 1 diabetes mellitus (DM) (n=15) and type 2 DM (n=14). INCLUSION CRITERIA: Swedish adults (≥18 years) living with type 1 DM or type 2 DM (duration ≥5 years) able to describe their situation in Swedish. Purposive sampling generated heterogeneous characteristics. RESULTS: To live a good life with diabetes is demanding for the individual, but experienced barriers can be eased by support from others in the personal sphere, and by professional support from diabetes care. Diabetes care was a crucial resource to nurture the individual's ability and knowledge to manage diabetes, and to facilitate life with diabetes by supplying support, guidance, medical treatment and technical devices tailored to individual needs. The analysis resulted in the overarching theme 'To live a good life with diabetes' constituting the two main categories 'How I feel and how things are going with my diabetes' and 'Support from diabetes care in managing diabetes' including five different categories. CONCLUSIONS: Common aspects were identified including the experience of living with diabetes and support from diabetes care. These will be used to establish a basis for a tailored PROM for the NDR.