"I Do It With Love": Engagement in Caring for People With Dementia

Challenging Behaviors as a Relational Phenomenon: Findings From a Qualitative Study in a Nursing Home in Norway

Challenging behaviors are common in nursing homes. Drawing on rich qualitative data from fieldwork and in-depth interviews with staff in a nursing home in Norway, we will explore (a) how challenging behaviors unfolded, and (b) how such incidents were handled and talked about among staff. Our data is presented firstly through Anna's story as an introduction to discussing: (1) the problem of contrasting approaches to avoid challenging behaviors and (2) the importance of knowing the resident. Christopher's story then works as an introduction to discuss (3) the importance of understanding how to prioritize, (4) the importance of caring with connection and concern, and (5) the importance of sharing success stories among staff. In conclusion we argue that we should develop a more flexible organizational culture and a staffing practice in which care workers are empowered to use their discretion and thus to care for the residents with more connection and sensitivity than is currently the case.

Up-Close and Personal: Conceptualizing the Self as Dementia Caregiver: a Study in Soweto, South Africa

The aim of this study was to understand how dementia caregivers in the township of Soweto, South Africa interpret their role in the context of caregiving through the personal constructs identified using the Self- Characterization technique. Thirty family caregivers were recruited via purposive sampling methods and completed a Self-Characterization Sketch during semi-structured interviews. Content analysis of construct pairs was thematically coded using the Classification System for Personal Constructs (CSPC) - a reliable method to analyse personal constructs that are generated by constructivist assessments. Findings revealed that caregivers' interpretations of themselves was characterized by moral, emotional and cognitive attributes. Specifically, a sense of mastery, self-efficacy, strength, selflessness and unconditional positive regard characterized the most meaningful constructs of care within caregiver narratives in response to their loved ones with dementia. These adaptive outcomes, despite the challenging, pervasive, complex nature of dementia and its manifestations, suggest psychological and emotional resilience, higher levels of adjustment and caregiver well-being. However, it is important to consider possible consequences such as physical fatigue and burnout despite adaptive outcomes. Therefore, it is recommended that approaches to psychoeducational initiatives, emotional and psychological interventions and awareness campaigns include teaching caregivers how to self-care encourage the importance of consistent exercise, rest, sleep, nutrition as well as reaching out for social support. Lastly, empowering caregivers to use their personal resources would prove valuable in support groups, and individual to facilitate self-awareness, sustained coping and mental health.

'The desire for a harmonious interaction': A qualitative study of how healthcare professionals in community-based dementia teams perceive their role in reaching and supporting family caregivers from minority ethnic backgrounds

AIMS AND OBJECTIVES

To explore how healthcare professionals in community-based dementia teams perceive their role in reaching and supporting family caregivers from minority ethnic backgrounds when caring for a family member suffering from dementia or cognitive impairment.

BACKGROUND

Despite increased focus on barriers to accessing the dementia healthcare service for family caregivers from minority ethnic backgrounds, the lack of knowledge on how to address these barriers in order to reach and support this group is evident.

DESIGN

The study has a qualitative, explorative design. The principles of consolidated criteria for reporting qualitative research (COREQ) were applied for reporting methods and findings.

METHODS

Based on data from semi-structured interviews (n = 9) conducted in two large Norwegian municipalities, a thematic analysis influenced by Braun and Clarke was used. The analytical findings draw on Pierre Bourdieu's theoretical concepts of field, habitus and capital.

FINDINGS

'The desire for a harmonious interaction' was identified as an overarching theme. However, while desirable, the analysis shows that healthcare professionals in community-based dementia teams do not always succeed in reaching and supporting family caregivers from minority ethnic backgrounds. The study reveals that the dementia healthcare service is a complex, normative and sometimes rigid system that requires a number of distinct attributes to navigate.

CONCLUSIONS

The different social structures within the dementia healthcare service can both create and retain barriers that prevent family caregivers from minority ethnic backgrounds from receiving support on their own terms.

RELEVANCE TO CLINICAL PRACTICE

A practical implication of allowing critical reflection on the dementia healthcare service is that it provides opportunities for discussion. Healthcare professionals in community-based dementia teams need to reflect on how normative ideals and 'taken-for-granted' mindsets can affect their ability to reach and support family caregivers from minority ethnic backgrounds.

Comparing perspectives of family caregivers and healthcare professionals regarding caregiver burden in dementia care: results of a mixed methods study in a rural setting

Background

Persons with dementia (PwD) need support to remain in their own homes as long as possible. Family caregivers, homecare nurses and general practitioners (GPs) play an important role in providing this support, particularly in rural settings. Assessing caregiver burden is important to prevent adverse health effects among this population. This study analysed perceived burden and needs of family caregivers of PwD in rural areas from the perspectives of healthcare professionals and family caregivers.

Methods

This was a sequential explanatory mixed methods study that used both questionnaires and semi-structured interviews. Questionnaires measuring caregiver burden, quality of life and nursing needs were distributed to the caregivers; health professionals received questionnaires with adjusted items for each group. Additionally, in-depth qualitative interviews were carried out with eight family caregivers.

Results

The cross-sectional survey population included GPs (n = 50), homecare nurses (n = 140) and family caregivers (n = 113). Healthcare professionals similarly assessed the psychosocial burden and stress caused by behavioural disturbances as most relevant. Psychological stress, social burden and disruptive behaviour (in that order) were regarded as the most important factors from the caregivers’ perspective. It was found that 31% of caregivers reported permanent or frequent caregiver overload. Eight themes related to caregiver burden emerged from the subsequent interviews with caregivers.

Conclusions

Professional support at home on an hourly basis was found to be highly relevant to prevent social isolation and compensate for lack of leisure among caregivers of PwD. Improvement of interprofessional dementia-related education is needed to ensure high-quality primary care.