A model for implementing guidelines for person-centered care in a nursing home setting.

BACKGROUND: Systematic evaluations of knowledge translation interventions in nursing homes to improve practice are scarce. There is also a lack of studies focusing on creating sustainable evidence-based practice in the setting of residential dementia care. METHODS: The aim of this paper is to describe a model for implementing national evidence-based guidelines for care of persons with dementia in nursing homes. The secondary aim is to outline the nursing home staff experiences during the first year of the implementation process. The intervention had a participatory action research approach. This included educational activities such as: (i) thematic seminars introducing national guidelines for dementia care, (ii) regular unit-based seminars; and (iii) later dissemination of information in reflective seminars and several days of poster-exhibitions. Areas of practice development were selected on each of the 24 units, based on unit-specific needs, and a quality improvement strategy was applied and evaluated. Each unit met ten times during a period of eight months. Data for this study were extracted from the reflective seminars and poster presentations, analyzed using a qualitative content analysis. RESULTS: Findings showed that implementation of guidelines were perceived by staff as beneficial for both staff and the residents. However, barriers to identification of relevant sources of evidence and barriers to sustainable implementation were experienced. CONCLUSIONS: One of our assumptions was that dementia nursing homes can benefit from becoming knowledge driven, with care practices founded in evidence-based sources. Our findings show that to be partly true, even though most staff units found their efforts to pursue and utilize knowledge adversely impacted by time-logistics and practical workload challenges.

The older patient's experience of encountering professional carers and close relatives during an acute confusional state: an interview study.

BACKGROUND: Acute confusional state (ACS) is a common and difficult condition among older patients with a variety of opinions about how to act when encountering patients with ACS. Few studies to our knowledge have been found exploring the encounter from the perspective of older patients and their experiences. OBJECTIVES: The aim of this study was to understand the experiences of older patients with ACS when encountering professional carers and close relatives. DESIGN: In order to understand older patients' experiences of encounters during their ACS a latent qualitative content analysis was used. SETTINGS: The data collection took place at two geriatric wards in an emergency hospital in a metropolitan area. PARTICIPANTS: The inclusion criteria included being aged 65 years or older and having suffered from ACS, according to the DSM-IV criteria, and having regained lucidity. Participants were being cared for at one of two geriatric wards. Patients diagnosed with dementia were excluded. About 150 patients were screened, 67 patients fulfilled the inclusion criteria and seven patients were included in the study, four females and three males, aged between 78 and 98 years. METHODS: Data were collected by interviews. RESULTS: Three themes were found, namely; 'Feeling lonely within the perceived reality of ACS', with three sub-themes: the unequal encounter, keeping a distance and being an outsider; 'striving towards understanding' with two sub-themes: searching for answers and it takes time to understand; and 'feelings of participation in the encounter' with two sub-themes: a mutual understanding and feeling safe and supported. CONCLUSIONS: Within the encounter the older patients with ACS are searching for answers to what is happening and why. The patients feel dependent on the persons they encounter and their willingness to understand and communicate. The patients also feel lonely, unnecessarily questioned and untrustworthy; but they can also feel safe, trusted and understood.

Relatives' experiences of encountering the older person with acute confusional state: experiencing unfamiliarity in a familiar person.

Aims and objectives. The aim was to understand the lived experience of close relatives encountering older persons with acute confusional state. Background. Little is known about relatives of patients with acute confusional state and their experiences while encountering a family member exhibiting acute confusional state. Design. A descriptive phenomenological research approach was used. Methods. Data were collected by interviewing 10 close relatives of older people with acute confusional state at two hospital wards. Results. Relatives experience the encounter as encountering a familiar person who has suddenly become unfamiliar, struggling to separate the familiar from the unfamiliar and trying to understand the causes of acute confusional state and the behaviour of the person. Six constituents illuminate the phenomenon: 'change in the other person', 'rapid and unexpected changes', 'experiencing insecurity in the encounter', 'trusting or mistrusting the other person', 'experiencing loss' and 'experiencing exposure'. Relevance to clinical practice. It is important for professional carers to support relatives on how to encounter the person with acute confusional state, and to co-operate with relatives to gain knowledge about the unique person behind the acute confusional state. Conclusion. Relatives' difficulties in dealing with strong emotions evoked within the encounter, experiencing limitation and lack of trust is essential knowledge for professional carers in all care settings.

Encountering the older confused patient: professional carers' experiences.

UNLABELLED: THE STUDY'S RATIONALE: Confusion is a common condition among older patients and often a fearful experience. Opinions vary as to how to communicate with and care for confused patients and professional carers often find the patients' situation almost as distressing as the patients' themselves do. AIMS AND OBJECTIVES: The aim of this study was to describe professional carers' experiences of their encounters with older confused patients. METHODOLOGICAL DESIGN AND JUSTIFICATION: Data was collected from interviews with 10 professional carers working on a ward specializing in the care of older confused patients. A descriptive phenomenological research approach was used to gather knowledge of professional carers' experiences of encounters with older confused patients. ETHICAL ISSUES AND APPROVAL: A Regional Board of Research Ethics granted ethical permission for the study. The appropriate ethical principles were followed. The participants were contacted personally and received a letter providing information on the study. Written consent was requested before the interview. If needed, the participants were able to get in contact with the staff health service for a follow-up after the interview. Names or places have been changed in order to ensure confidentiality. RESULTS: The encounter with the confused patient is experienced as an encounter with an unfamiliar person, where the patients' actions and words are unforeseeable and with a lack of immediate trust. The essential meaning is further illuminated by the meaning constituents: the unforeseeable encounter, always being on guard and using oneself as a tool. RELEVANCE TO CLINICAL PRACTICE: This paper focuses on the importance of encouraging professional carers to pay attention to the complexity of the encounter with the confused patient, reflecting upon their own behaviour within these encounters and the importance of knowledge of the patient's preferred senses and life stories. Caring for confused patients involves a great responsibility where both the professional carers and the patients are vulnerable and exposed.