Biographiearbeit in der stationären Langzeitpflege von Menschen mit Demenz

Improving Quality of Work life for Care Providers by Fostering the Emotional well-being of Persons with Dementia: A Cluster-randomized Trial of a Nursing Intervention in German long-term Care Settings

We tested the feasibility of a nursing intervention (DEMIAN) in routine care and its effects on care providers’ job satisfaction, motivation, and work strain.

This cluster-randomized trial was conducted in 20 German long-term care facilities. We randomly assigned 20 facilities to an intervention group (84 care providers, 42 residents with dementia) or a control group (96 care providers, 42 residents with dementia). Intervention group providers received two training days on the intervention; 68 providers attended both training days. Sixty two providers completed both baseline and follow-up questionnaires.

Trained providers created individualized mini-intervention plans for participating residents. Control group residents received ‘usual care’. Intervention group providers stated that the intervention was feasible and helped them improve emotional well-being of residents with dementia. We found significantly decreased time pressure and decreased job dissatisfaction for intervention group providers.

DEMIAN is an effective and pragmatic contribution to implementing person-centred care in long-term care, with positive effects on providers’ working conditions.

Insights Into Care Providers’ Understandings of Life Story Work With Persons With Dementia: Findings From a Qualitative Study

Background and Purpose: In Germany, life story work, an approach which acknowledges humans as narrative beings and honors biographies, is required by health authorities to be integrated in care provided in nursing homes. Insufficient attention to life story work could place residents at risk of dehumanization, particularly residents with dementia, who depend on support of others to tell and make meaning of their life experiences. Methods: We conducted a qualitative study to gain insights into care providers’ perceptions and practices of life story work with persons with dementia. Thirty-six care providers in 7 nursing homes participated in semistructured interviews or group discussions. We derived subjective theories (individual understandings) of care providers and higher-order concept patterns following the principles and processes of grounded theory. Results: We found a great variation in participants’ understandings of life story work. Some participants were unsure if and how life story work impacts persons with dementia. Starting points for improving the integration of life story work into practice are discussed. Implications for Practice: We conclude that care providers need a better understanding of life story work as a nursing intervention. The importance of the notion of humans as narrative beings and the multiple ways in which we story our lives as well as embody life stories needs to be further developed. Knowledge is required about the practical and systemic challenges of integrating life story work in the care of persons with dementia.

Life story work with persons with dementia in nursing homes: A Grounded Theory study of the perspectives of care staff

In Germany, the use of life story work as an approach to care in nursing homes has not been implemented successfully. Using Grounded Theory, we explored care staff’s understandings of life story work when caring for persons with dementia. Thirty-six staff from seven nursing homes participated in semi-structured interviews or group discussions. In this paper we discuss new aspects and theoretical connections between understandings and practices of life story work. For some participants, obtaining ‘true facts’ about a resident’s course of life was considered the most important topic. Others highlighted the importance of narratives as well as embodied stories told by persons with dementia, as aspects that generated emotionally meaningful situations. Delivering sound life story work can be challenging for care staff working with persons with dementia. To enhance care in nursing homes, the importance of life story work needs to be further developed.

Inclusion of the personal biography in daily care – a qualitative study / Einbezug der Biographie in den Pflegealltag – eine qualitative Studie

Introduction

In Switzerland, 39% of nursing home residents have a dementia related disease. Behavioral symptoms are increasingly observed as dementia progresses. These symptoms impair patients’ quality of life and are distressing to family caregivers and nurses. A person-centered approach, which includes the resident’s individual biography, reduces such symptoms. The most current literature describes how therapists include biographical information in designated therapies. However person-centered care takes place not only in specific activities. Nurses are responsible for their patients’ care 24 hours a day.

Aim

The goal of this study is to explore how nurses include biographical information in their daily care.

Method

Data were collected from qualitative interviews with registered nurses (n=10) in a nursing home and analysed according to the Charmaz Grounded Theory approach.

Results

The inclusion of the personal biography in daily care appears as a continuous, repetitive process with three main categories: “negotiating”, “connecting” and “being-in-good-hands”. Nurses in this study report that they can trigger positive reactions and reduce behavioral symptoms by means of meaningful interventions, when connected to the residents’ biography. Meaningful interventions can support residents in making contact to their current everyday life, acting independently and perceiving self-efficacy (= connecting). To initiate meaningful interventions, nurses need to connect biographical information to current experiences of the resident (= negotiating). This requires a thorough understanding of the residents’ situation. Nurses obtain an in-depth understanding through caring relationships, which are characterized by continuity of care and a mutual dialogue, where needs and experiences are shared, understood and evaluated (= being-in-good-hands).

Caring for people with dementia in general hospitals: an education curriculum from the Alzheimer's Society of Lower Saxony, Germany

Since 2006, the Alzheimer's Society of Lower Saxony, Germany, has been working to improve care and medical treatment for people with cognitive impairment or dementia in general hospitals. An interdisciplinary team systematically worked on the topic for several years and presented results at various symposia. In 2011, a two-stage curriculum was completed and sent in combination with additional training documents to all hospitals and nursing training colleges in Lower Saxony, Germany. The manual comprised a two-step approach with a 14-h training for hospital staff and a 160-h training for qualification of trainers and dementia appointees/chaperones. In addition, the manual included a list of 13 essential points for "dealing with demented people in a general hospital," the information sheet of the German Alzheimer's Society on aspects requiring special attention when a demented person is admitted to a hospital, short descriptions of best practice models, a list of established speakers in the field, and a 30-min film. In 2012, the project won the "Preis für Engagement und Selbsthilfe" of the Hertie Foundation and the "Niedersächsischen Gesundheitspreis" awarded by the Lower Saxon Ministry for Social, Women, Family, and Health Affairs.