'On one's own strength' Healthcare providers' experience with introducing Marte Meo Counselling in dementia care.

AIM: The aim of the present action research study was to investigate the healthcare providers' experiences with introducing Marte Meo Counselling (MMC) in a dementia-specific care unit. BACKGROUND: Research on the use of MMC shows that healthcare providers saw the patients' resources and needs more clearly and achieved increased awareness of their own skills. DESIGN AND METHOD: An action-oriented research including a three-phase strategy was applied: the mapping phase, the intervention phase and the evaluation phase. During the 5-month mapping phase, two researchers conducted participant observation of a total of 50 hours. The intervention phase consisted of lectures, clinical supervision in MMC and seven reflection groups and lasted 12 months. In the six-month evaluation phase, participant observation of a total of 48 hours was conducted. Four focus group interviews took place during the whole study period of 2 years. RESULTS: The staff went through a process of change described by the following themes: from challenging behaviour to challenging interaction; from generalised skills to contextualised relational care; and from personal challenges to a professional community. CONCLUSIONS: As a result of MMC, the healthcare providers realised the value of taking into account the patients' context in dementia care and of being active participants in the patients' world. The focus changed from regarding challenging behaviour as symptoms of a disorder to being a challenge to interaction. IMPLICATIONS FOR PRACTICE: Marte Meo Counselling should be combined with continuous reflection to improve healthcare providers' interaction with people who live with dementia. The reflection groups gave the caregivers an opportunity for discussions that would otherwise be impossible in their busy everyday life.

Sensory stimulation - a way of creating mutual relations in dementia care.

The overall aim of this 2-year Norwegian action research study was to improve the interaction between care workers and patients with dementia in a nursing home by means of sensory stimulation. Furthermore, the aim was to investigate how the staff experienced the interaction with patients suffering from behavioral and psychological symptoms of dementia before, under, and after introduction of sensory stimulation methods in clinical practice. An intervention program consisting of lectures and practical guiding in sensory stimulation was implemented. The care workers participated in group meetings to reflect on the progress. Focus group interviews and participant observations were conducted initially to map exciting practice, and at the end to evaluate potential changes in attitude and skills. Observation notes and interview transcripts were analyzed by means of thematic analysis which revealed a gradual emergence of person-centered care. A phenomenological life-world perspective may serve as a theoretical basis to deepen the understanding of the use of sensory stimulation.

Vulnerability in health care--reflections on encounters in every day practice.

Vulnerability is a human condition and as such a constant human experience. However, patients and professional health care providers may be regarded as more vulnerable than people who do not suffer or witness suffering on a regular basis. Acquiring a deeper understanding of vulnerability would thus be of crucial importance for health care providers. This article takes as its point of departure Derek Sellman's and Havi Carel's discussion on vulnerability in this journal. Through different examples from the authors' research focusing on the interaction between health professionals and patients, existential, contextual, and relational dimensions of vulnerability are illuminated and discussed. Two main strategies in the professionals' interactions with patients are described. The strategy that aims at understanding the patients or families from the professional's own personal perspective oftentimes ends in excess attention to the professional's own reactions, thereby impairing the ability to help. The other strategy attempts to understand the patients or families from the patients' or families' own perspective. This latter strategy seems to make vulnerability bearable or even transform it into strength. Being sensitive to the vulnerability of the other may be a key to acting ethically.