Nurse-led ultrasound-guided femoral nerve block: A randomised controlled trial of two different patient flow systems in an emergency department.

INTRODUCTION: Elderly with hip fractures present complex challenges. Effective pain management is crucial for recovery and quality of life. However, pain control can be difficult and requires customized care. METHODS: We conducted an unblinded, randomised controlled trial investigating the effects of ultrasound-guided femoral nerve block in patients with hip fracture performed by specially trained nurses (Group Nurse) compared to anaesthesiologists (Group Anaesthesiologist). The hypothesis was that a single shot ultrasound-guided femoral nerve block would result in a total summarized lower dynamic numeric rating scale score for pain intensity during the first 120 min after admission for patients in Group Nurse compared to Group Anaesthesiologist measured in five timepoints. The primary outcome was measured by a cumulative numeric rating scale score for dynamic pain (with flexion of the hip until maximum 30° from bed surface) during the first 120 min after admission to the emergency department. RESULTS: From February 2020 to June 2021, 263 patients were screened, of which 42 (16.0%) consented and were randomly allocated; 21 in each arm. The primary outcome was not different between groups (p = 0.24), and displayed no substantial superiority of specially trained nurses over anaesthesiologist. No complications or adverse effects were observed in either group. The use of systemic analgesics and the development of delirium was similar between the two groups. In the Nurse Group, patients were administered their ultrasound-guided femoral nerve block earlier. CONCLUSION: Our study did not demonstrate a statistically significant beneficial effect of specially trained nurses over anaesthesiologist on cumulative pain in performing ultrasound-guided femoral nerve blocks, while no side-effects/complications or adverse effects were observed in either group. CLINICALTRIAL: The trial was registered on October 31, 2019 at Clinicaltrials.gov (NCT04145752).

"Keep It Simple"-Co-Creation of a Tailored Newborn Resuscitation Course for Midwifery Students.

PURPOSE: To develop a tailored newborn resuscitation course for midwifery students. PATIENTS AND METHODS: A qualitative study using an explorative, abductive approach was applied. Co-creation through workshops was facilitated to develop a tailored newborn resuscitation course for midwifery students. Four workshops with midwifery students and midwives were conducted from May to October 2020. Twenty participants attended one workshop of their choice. Five out of Norway's six midwifery education programmes participated, and included midwives from across Norway. All workshops were held digitally via the Zoom platform. A seven-step framework analysis method was applied to analyse the workshop data. RESULTS: We identified four themes: 1) practice guidance, 2) technical skills 3) non-technical skills 4) innovative methods. CONCLUSION: Findings emphasize the importance of practice guidance, technical skills, non-technical skills and innovative methods to facilitate the learning process. However, these skills cannot be acquired without the context to facilitate them, and thus a supportive culture is essential to sustain newborn resuscitation expertise as a midwife/midwifery student. We found that midwives expressed the same need to learn, train and prepare themselves for newborn resuscitation as midwifery students. The importance of facilitating the learning of newborn resuscitation with low-dose, high-frequency training in a supportive culture thus matters to both midwifery students and expert midwives.

Feeling valued versus abandoned: Voices of persons who have completed a cognitive assessment.

AIM: To describe older persons' experiences of a cognitive assessment and possible neuropsychiatric symptoms [NPS] related to a neurocognitive diagnosis. BACKGROUND: A cognitive assessment in primary care is offered to persons with suspected dementia with subsequent referral to a specialist clinic if required. The assessment process, with the likelihood of receiving a dementia diagnosis, is surrounded by uncertainty with long waiting times. Although NPS are common among persons with cognitive impairment persons are not routinely asked about these symptoms during a cognitive assessment. METHOD: Interviews were held with 18 participants who had completed a cognitive assessment. The Neuropsychiatric Inventory [NPI] was incorporated into one of the interview questions enabling participants to self-report NPS, if present. Interview data were analysed using Interpretive Description. RESULTS: Two main themes were identified: a matter of trust and making sense of a cognitive diagnosis. Experiences of the assessment process ranged from feeling valued to abandoned with variations of trust in the process. A diagnosis of mild cognitive impairment was experienced as an abstract diagnosis devoid of follow-up support. A lack of preparedness for the assessment existed among participants. Some experienced the process as standardised. One half of participants self-reported the presence of one to four NPS, regardless of neurocognitive diagnosis. Irritability and depression were most common NPS identified. CONCLUSIONS: Experiences of a cognitive assessment varied from feeling valued by society to abandoned in the absence of follow-up support. The assessment was viewed as a standardised procedure failing to see the person behind the testing. Diagnosis disclosure conversations were experienced as diffuse with participants unprepared for a dementia diagnosis. The NPI enabled participants to identify and report the presence of NPS which otherwise could go undetected during the cognitive assessment, impacting on the person's well-being and daily life.

Embarking on a memory assessment voices of older persons living with memory impairment.

AIM: To describe older persons who had commenced a memory assessment, experiences of living with memory impairment and related symptoms. BACKGROUND: Persons with subjective memory impairment are two times more likely to develop dementia over the years than their peers. Older persons seldom seek help from primary health care clinics solely for subjective memory impairment. Of those who seek help, it can take up to 35 months from the person experiencing initial symptoms to referral to a memory clinic. Further research is needed regarding how older persons live with memory impairment with related symptoms before they receive a memory diagnosis. METHOD: A qualitative study with 23 participants who had commenced a memory assessment in primary care. Semi-structured interviews were held. During the interviews, the Neuropsychiatric Inventory was completed and discussed with the participants. Interview data were analysed using Interpretive Description. RESULTS: The results are presented under four themes: Conflicting views about the situation, Unveiling the presence of neuropsychiatric symptoms, Compensating with external and internal strategies to recall and Worrying about self and future. Persons with memory impairment were encouraged by family members or others to seek a memory assessment. Few persons were self-referred as memory impairment was often seen as a part of aging. Polarised viewpoints existed within the families regarding the impact of memory impairment on daily life. The presence of neuropsychiatric symptoms appeared unexplored in the participants seeking a memory assessment. In this study, the majority of participants experienced neuropsychiatric symptoms at the time of contact for a memory assessment. CONCLUSIONS: Memory problems experienced were often viewed by the person as being part of an aging process. The presence of neuropsychiatric symptoms was not acknowledged as being connected to memory impairment. Contextualising 'memory impairment' as a part of a 'cognitive process' may help the person in identifying the presence of neuropsychiatric symptoms.

Strategies used by people with Alzheimer's disease for outdoor wayfinding: A repeated observational study.

This study aimed to describe the wayfinding strategies used during outdoor walks by people with Alzheimer's disease. Inspired by an ethnographic approach, observations and conversations during repeated outdoor walks with five people with Alzheimer's disease living in their own homes were conducted. Data were analyzed using qualitative content analysis. The wayfinding strategies the participants described were: (1) landmarks, (2) used their senses, (3) stopped, looked around, and thought, (4) walking the same way or loop and in familiar areas, and (5) only walked in places and on routes where they could see other people and houses. Using wayfinding strategies might help people with Alzheimer's disease to be independent during outdoor walks, and discussing these strategies with relatives and nursing care staff may help finding people with Alzheimer's disease if lost outdoors. Wayfinding during the winter might be facilitated if temporary and changeable objects are avoided in people with Alzheimer's disease's walking route.

Control as a Core Component of User Involvement in Reablement: A Qualitative Study.

BACKGROUND: Reablement, also known as restorative care, supports older adults in regaining or maintaining their independence in daily life through the optimization of functional ability. Users' goals and healthcare professionals' use of a "hands-off" approach are key, thus user involvement is central to reablement logic. The aim of this study was to explore user involvement in reablement from users' perspectives from the beginning of an intervention. METHODS: The study has an explorative qualitative design and includes thematic content analysis of data from repeat, individual semi-structured interviews with ten users accepting reablement intervention services in an urban Norwegian municipality. FINDINGS: Control emerged as a core component. Users handed control over their time and body to professionals, balanced by drawing on an inner strength to control own limits, retain the right to make own judgements and decisions, and dream. Five themes were seen: Positive, but with a "wait and see" attitude; Professionals have goals, users have dreams; Desire to control schedule and activity; Regaining faith in one's own capacity and strengthening one's dreams; and Keep going, hold on to your dreams. CONCLUSION: User involvement interpreted as user-set goals may be over-emphasized. Users possess the information that professionals need to set goals, consider these the goals important for professionals, and seek to facilitate professionals in their work. Based on a belief in own competence and a trust in professional's expertise, users invite professionals into a co-creation process. User involvement has previously been defined as a willingness and positive attitude toward reablement activities, but we find it can be expressed in different ways. Reablement logic does not always match users' understanding or desires, and it may be time to rethink user involvement in reablement. The reablement concept should be developed further, so that it better suits the individuals it should serve.

Improving quality in clinical placement studies in nursing homes (QUALinCLINstud): the study protocol of a participatory mixed-methods multiple case study design.

INTRODUCTION: Improved quality in clinical supervision and assessment of student nurses in nursing home clinical placements is vitally important to effective recruitment and preparation for this healthcare sector. Knowledge regarding supervision and assessment practices within these settings is limited. Also, knowledge of evolving e-learning tools on the quality and effectiveness of these educational practices seems to be absent. METHODS AND ANALYSIS: The aim of the "Improving quality in clinical placement studies in nursing homes" (QUALinCLINstud) study is to develop and evaluate how a web-based programme can optimise supervision, assessment and learning during nursing home placements. The study applies a participatory, mixed-methods case study design, organised in four work packages (WPs). WP1 will explore how the nurse education institution address the quality of student nurses' clinical placements in nursing homes. In WP2, clinical supervision and assessment practices will be explored, and described from multiple stakeholder perspectives. In WP3, based on the findings from WP1 and WP2, a web-based pedagogical supervision and assessment programme will be developed through a developmental co-productive process between nurse education institutions, practice settings and student nurses. In WP4, the web-based programme will be pilot-tested and evaluated through a mixed-methods approach. A range of data collection procedures will be used throughout the project, for example, questionnaires, interviews, observations and workshops. ETHICS AND DISSEMINATION: The ethical conduct of the study is approved by the Norwegian Centre for Research Data (2018/61309 and 489776). The results will be disseminated through scientific articles, three PhD theses, presentations at national and international conferences, and through publicly accessible trade journals and newspapers. The results will generate knowledge to inform supervision and assessment practices in nursing home placements. Moreover, the study will generate knowledge concerning the developmental process of a web-based supervision and assessment programme, and the value of e-learning tools applied in clinical nursing education.

Balancing Life and Death During the Golden Minute - Midwives' Experiences of Performing Newborn Resuscitation.

PURPOSE: To explore midwives' experiences in performing newborn resuscitation on maternity wards. PATIENTS AND METHODS: It was a qualitative study, using a phenomenological hermeneutic approach. Individual interviews with 16 clinical midwives working in Norwegian maternity wards were conducted from August 2018 to January 2019. RESULTS: The complexity underlying how midwives balance responsibility and vulnerability when performing newborn resuscitation during the Golden Minute was revealed. Midwives described the stress they experienced during resuscitation events and their need for support and confirmation after performing newborn resuscitation. CONCLUSION: The vulnerability and responsibility that midwives bear for mothers and newborns simultaneously affected midwives in several ways. We saw that midwives need support and confirmation to be prepared for newborn resuscitation. We also found that a lack of knowledge, skills and experience were barriers to midwives feeling prepared. Simulation training, including tailored programs, are suggested to improve midwives' skills and help them feel prepared for real-life resuscitations. The importance of midwives' assessment during the Golden Minute and further investigation from other perspectives are needed to understand fully this clinical complexity.

Collaboration between home care staff, leaders and care partners of older people with mental health problems: a focus on personhood.

BACKGROUND: Collaboration with care partners is a political aim in recent white papers in Norway and internationally. Home care services regularly work closely with care partners, but there are many indications that the collaboration does not work satisfactorily. AIM: To explore home care staff and leaders' experiences of collaborating with care partners of older people with mental health problems through a personhood perspective. METHODS: The study had a qualitative design and comprised eight health professionals in two focus groups and in-depth interviews with three leaders in one home care district. The data were analysed using a thematic framework analysis building on previous research on personhood. criteria for reporting qualitative reporting guidelines were used to ensure comprehensive reporting. RESULTS: Four themes were identified in the analysis: 'non-negotiated relationships', 'contradictory agendas', 'weak paternalism' and 'moral compromise'. CONCLUSION: There seems to be a lack of facilitation of collaborative relationships through all levels of the home care organisation. The interactions between care partners and home care staff sometimes appear to produce low or negative levels of emotional energy, and situations where the personhood of neither of them is respected occurs. Paying attention to the four modes of being as a framework for understanding personhood creates the foundation for a person-centred approach that enhances the potential of creating stronger partnership in care relationships.

Living with a well-known stranger: Voices of family members to older persons with frontotemporal dementia.

AIM: To describe family members' experiences of living with persons with neuropsychiatric symptoms (NPS) related to frontotemporal dementia (FTD). BACKGROUND: The majority of persons with dementia during the disease trajectory develop NPS. Persons with FTD are likely to develop greater levels of NPS than persons with other types of dementias. Research-based knowledge regarding family members' experiences of living with persons with FTD and NPS is limited. METHODS: Nine family members of persons with FTD were interviewed. Interviews commenced with completion of the Neuropsychiatric Inventory (NPI). Upon completion of the NPI, questions were posed from an interview guide where study participants provided in-depth information about NPS identified. Interview data were analysed using qualitative content analysis. RESULTS: Interviewed family members highlighted that persons with FTD had developed between four and eight co-existing NPS. Irritability and disinhibition were the most common NPS, with variations in severity, frequency and distress. From the interview data, two themes emerged: Living with a well-known stranger and Coping and overstepping social norms. CONCLUSIONS: Living with a well-known stranger depicted a new co-existence with a loved one with changes in personality and behaviour, which were not inherent to the person or predictable any more. The presence of NPS can threaten the safety of the person with FTD and their family in real world and on social media. Support offered should focus on the person's physical and psychological needs, not on a diagnosis. IMPLICATIONS FOR PRACTICE: From a health care perspective it is important to see the person with FTD and their family as unique individuals with specific needs.

Experiences and perceptions of infant dental enucleation among Somali immigrants in Sweden: a phenomenographic study.

Objective: The aim of this study was to explore and describe ways of experiencing and perceiving the Eastern African practice of infant dental enucleation (IDE) among immigrants of Somali origin living in Sweden. Material and methods: Six informants, three men and three women aged 26-54 years, were recruited for semi-structured individual interviews. Phenomenographic analysis of the interview transcripts was performed. Findings: Informants described four ways of experiencing and perceiving IDE: as an effective, necessary treatment; as a disputed tradition; as an alternative to failure; and as a desperate measure. The experiences and perceptions were highly influenced by the contexts the informants had been in, namely, communities in which traditional treatments were used frequently, in which other people were influential over their daily lives, and in which negative experiences of formal health care were common, as well as other difficult circumstances beyond the informants' individual control. Conclusions: The findings contribute to deepened understanding of IDE and the importance of context to the practice of it. Further, the findings deepen understanding of the decision to have the practice performed on infants, which may help dental and health care personnel to adequately communicate with individuals of Somali origin about the harmfulness of IDE.

Voices of Spouses Living with Partners with Neuropsychiatric Symptoms Related to Dementia.

Persons with dementia, who reside in their own homes, are often cared for by family members. The presence of a family career is said to have a protective effect, postponing admissions to residential care. The majority of persons with dementia develop behavioural and personality changes during the disease trajectory also known as neuropsychiatric symptoms. Quality of life for both the person with neuropsychiatric symptoms and their careers are affected, increasing suffering and risk for hospitalisation and admission to long-term residential care. Family careers to persons with dementia have identified behavioural changes as more distressing than cognitive impairment leading to increased burden of care and admissions to residential care. Knowledge gaps exist regarding how family careers living with persons with dementia experience neuropsychiatric symptoms in a community setting. The aim was to describe spouses' experiences of living with partners who have developed neuropsychiatric symptoms related to dementia in a community setting. Semi-structured interviews were carried out with 14 spouses of partners with dementia. The interviews included completion of the neuropsychiatric inventory. Interview data were analysed using a content analysis approach. The results showed that spouses identified in the neuropsychiatric inventory that partners with dementia had on average five to eight co-existing symptoms. Frequency, severity and distress varied. From the narrative data, the theme living on the edge lacking support and time for self, emerged. The findings of this study suggest that support offered to persons with dementia and their spouses should have a person-centred approach meeting individual needs. Safety and welfare of persons with dementia and their spouses residing in their own homes may be jeopardised in the presence of neuropsychiatric symptoms. A greater awareness is required in the community regarding the well-being of these persons.

Invisible cornerstones. A hermeneutic study of the experience of care partners of older people with mental health problems in home care services.

OBJECTIVES: To explore the lived experiences and support needs of the care partners of older people with mental health problems living at home with assistance from home care services. Care partners face significant challenges in their care role and they often feel unsupported. An understanding of their experiences may help improve home care to support their needs. METHOD: An exploratory qualitative approach was used. The study is based on the SRQR and COREQ reporting guidelines. In-depth interviews were conducted with six Norwegian care partners from two municipalities. Data were collected during 2012-2013 and 2016. The data were analysed using Gadamer's hermeneutics. RESULTS: Three themes were identified: "invisible cornerstones," "dimensions of collaboration" and "unwanted roles." CONCLUSION: Few or no routines for collaboration exist between care partners and home care, and the care partners seem to have little knowledge of legal rights. They request more information, spare time and the opportunity to remain in their original family role. However, their main focus is for the patient to receive the necessary help from home care. Home care have restricted resources for meeting these needs and share a sense of powerlessness and lack of influence over their own everyday life with the care partners. There is a need for a systematic, person-centred approach to collaboration. A correlation is necessary between what is communicated at the system level and the means of realising this in practice for home care to meet care partners' needs.

Ideal and reality; Community healthcare professionals' experiences of user-involvement in reablement.

Many welfare states offer reablement, also known as restorative care, as an intervention to promote healthy ageing and support older adults in regaining or maintaining their independence in daily life. Reablement is a time-limited, intensive, multidisciplinary, person-centred and goal-directed rehabilitative intervention. Reablement emanates from the user's goals, thus user-involvement is a key factor. The aim of our study was to explore healthcare professionals' experiences of user-involvement in reablement. The context for the study was an urban municipality in south-eastern Norway where reablement had been implemented into home-care services 1.5 years prior to the study. Eighteen healthcare professionals recruited from home-care services participated in focus groups. The material was analysed using qualitative content analysis. The findings resulted in one main theme: Transforming user-involvement from ideal to reality-a demanding process, and four sub-themes: (a) An ideal of self-determination and co-operation; (b) Diverse ability to commit to what user-involvement requires; (c) Continuous co-creation processes; and (d) Challenged by old traditions. User-involvement is a valued ideal that professionals strive towards when providing healthcare. Two main strategies that professionals use to enable user-involvement were identified here: spending sufficient time and having patience with users during the initial stage of an intervention, and starting an intervention by introducing small tasks that users can master. It was also seen that if the time and arenas for interdisciplinary meetings were lacking, professionals could demonstrate traditional attitudes and practice when faced with limited user-involvement in the intervention. There is a need for follow-up over time at the structural, personal, and cultural levels to develop reablement as an intervention with a strong person-centred approach. The findings of this study have relevance for practice development in several reablement settings.

Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach.

BACKGROUND: The general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services. METHOD: This study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations (n = 122), memos and informal interviews with registered nurses (n = 8), and nurse assistants (n = 4). The transcribed texts were analyzed with interpretive content analysis. RESULTS: The inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues. CONCLUSIONS: This study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.

The experience of lived space in persons with dementia: a systematic meta-synthesis.

BACKGROUND: Identifying how persons with dementia experience lived space is important for enabling supportive living environments and creating communities that compensate for the fading capabilities of these persons. Several single studies have explored this topic; however, few studies have attempted to explicitly review and synthesize this research literature. The aim of this systematic meta-synthesis was therefore to interpret and synthesize knowledge regarding persons with dementia's experience of space. METHODS: A systematic, computerized search of AgeLine, CINAHL Complete, Embase, Medline and PsycINFO was conducted using a search strategy that combined MeSH terms and text words for different types of dementia with different descriptions of experience. Studies with 1) a sample of persons with dementia, 2) qualitative interviews as a research method and 3) a description of experiences of lived space were included. The search resulted in 1386 articles, of which 136 were identified as eligible and were read and assessed using the CASP criteria. The analysis was inspired by qualitative content analyses. RESULTS: This interpretative qualitative meta-synthesis included 45 articles encompassing interviews with 672 persons with dementia. The analysis showed that living in one's own home and living in long-term care established different settings and posed diverse challenges for the experience of lived space in persons with dementia. The material revealed four main categories that described the experience of lived space: (1) belonging; (2) meaningfulness; (3) safety and security; and (4) autonomy. It showed how persons with dementia experienced a reduction in their lived space due to the progression of dementia. A comprehensive understanding of the categories led to the latent theme: "Living with dementia is like living in a space where the walls keep closing in". CONCLUSION: This meta-synthesis reveals a process whereby lived space gradually becomes smaller for persons with dementia. This underscores the importance of being aware of the experiences of persons with dementia and the spatial dimensions of their life-world. To sustain person-centred care and support the preservation of continuity and identity, one must acknowledge not only the physical and social environment but also space as an existential experience for persons with dementia.

The third person in the room: The needs of care partners of older people in home care services-A systematic review from a person-centred perspective.

AIMS AND OBJECTIVES: To identify and synthesise the needs of care partners of older people living at home with assistance from home care services. BACKGROUND: "Ageing in place" is a promoted concept where care partners and home care services play significant roles. Identifying the needs of care partners and finding systematic ways of meeting them can help care partners to cope with their role. DESIGN/METHODS: This study is based on the PRISMA reporting guidelines. The systematic review of qualitative and quantitative studies was guided by the Joanna Briggs Institute methodology. RESULTS: In total, 16 studies were included in the review, eleven qualitative and five quantitative. Three main categories were revealed in the analysis: the need for quality interaction, the need for a shared approach to care and the need to feel empowered. CONCLUSION: Care partners of older people have several, continuously unmet needs. A person-centred perspective can contribute new understandings of how to meet these needs. A knowledge gap has been identified regarding the needs of care partners of older people with mental health problems. There is a need to develop a tool for systematic collaboration between home care services and care partners, so that the identified needs can be met in a more thorough, systematic and person-centred way. RELEVANCE TO CLINICAL PRACTICE: The carers in home care services need competence to identify and meet the needs of care partners. The implementation of person-centred values in home care services can contribute to meet the needs of care partners to a greater extent than today. Future research on the needs of care partners of older people with mental health problems needs to be undertaken.

Clinical Ethics Support for Healthcare Personnel: An Integrative Literature Review.

This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different countries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a "bottom-up" perspective might give healthcare personnel opportunities to think and reflect more than a "top-down" perspective. A "bottom-up" approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a "top-down" approach risks removing such moral responsibility.

The Experience of Relations in Persons with Dementia: A Systematic Meta-Synthesis.

BACKGROUND: Dementia influences a person's experience of social relationships, as described in several studies. In this systematic meta-synthesis of qualitative studies, we aim to interpret and synthesize the experiences of persons with dementias and their relations with others. SUMMARY: Living with dementia changes life, leading to new social roles and different social statuses. Persons with dementia experience being disconnected and dependent on others, feeling like being a burden, and being a person who is treated in paternalistic ways. Family, friends and others with dementia might play significant roles in their ability to maintain a meaningful life. Key Messages: Three categories emerged from the data, change in life, change in relations, and maintenance of meaningful aspects in life; these categories are intertwined and essential in sustaining a lifeline for persons with dementia. The comprehensive meaning of the material is understood as the expression: Living a meaningful life in relational changes.