Carers' interactions with patients suffering from severe dementia: a difficult balance to facilitate mutual togetherness

Abstract

1. A phenomenological-hermeneutic approach was used to illuminate carers' video-recorded interactions in connection with supervision for individualized nursing care. 2. In order to disclose any changes in the carers' interactions with patients suffering from severe dementia the video recordings were conducted before, during and after the intervention. 3. The content of the videos was transcribed as a text, mainly verbal communication. Due to the rich data the videos and text were kept together as a whole in every step of the analysis. 4. After an initial naïve understanding, different subthemes emerged in the structural analyses: promoting competence, struggling for co-operation, deep communication for communion, showing respect for the unique person, skills in balancing power, distance in a negative point of view, and fragmentary nursing situations. 5. The overall theme was 'Carers' balancing in their interactions, verbal as well as non-verbal, to promote a sense of mutual togetherness with the patient'. 6. The supervision intervention contributed to an improvement in carers' skills in balancing in their interactions. In the caring process carers' and patients' shared experiences and, due to patients' disabilities, interactions depended mainly on carers' qualities and capabilities for this confirming nursing care.

Nurse-patient interaction and communication: A systematic literature review

“…Interaction is seen as pivotal, especially for psychiatric nursing where the use of self and interaction must also be viewed as a therapeutic means and intervention to improve health outcomes Diers et al 1972;Williams et al 2005b). Mutuality is mentioned as an additional attribute of interaction (Dornheim 2003;Hansebo and Kihlgren 2002;Rundell 1991;Salyer and Stuart 1985); it starts naturally and happens between two individuals. Dornheim (2003) describes the mutuality of interaction as a process of cognition and action of the participants.…”

“…Communication is also seen as a dynamic, complex, and context-related ongoing multivariate process in which the experiences of the participants are shared (Daubenmire et al 1978;Edberg et al 1995;Hansebo and Kihlgren 2002;Harding 1987;Sheldon et al 2006). Mutuality and simultaneity are central aspects in communication (Daubenmire et al 1978;Davies 1994;Harding 1987;Shattell 2004;Turnock 1991), too.…”

“…Communication constitutes an important part of the quality of nursing care and predominantly influences patient and resident satisfaction; it is a core element of nursing care, a fundamentally required nursing skill (CarisVerhallen et al 1999a;Dean et al 1982;Gastmans 1998;Hansebo and Kihlgren 2002;Hewison 1995b;Jones 2003;Rundell 1991;Tuckett 2005;Williams and Gossett 2001;Williams et al 2005a).…”

“…Intervention research 8 is even seen as a prerequisite of consciousness of the self itself (Hansebo and Kihlgren 2002;Moreira et al 1997). Important elements of communication are sender, recipient, message, and context (Hollinger and Buschmann 1993).…”

Effects of snoezelen, integrated in 24h dementia care, on nurse–patient communication during morning care

“…To promote a sense of mutual togetherness with the resident, caregivers need to balance in their interactions, verbal as well as nonverbal [33]. Nonverbal communication supports the verbal communication, conveys interpersonal attitudes and emotional states and functions as substitute for language if speech is impossible [7,[34][35][36].…”