Caring and Uncaring Encounters between Assistant Nurses and Immigrants with Dementia Symptoms in Two Group Homes in Sweden-an Observational Study

Abstract

Background: The total number of people with dementia symptoms is expected to double every 20 years and there will also be an increase in the number of older immigrants in several countries. There are considerable deficiencies in the present knowledge of how to conduct well-functioning health care for immigrants with dementia symptoms. The aim of this study was to explore caring and uncaring encounters between assistant nurses and immigrants in two group homes for persons with dementia symptoms in Sweden: a Finnish-speaking as well as a Swedish-speaking context. In addition, this study aims to describe how caring and uncaring encounters are manifested in these two contexts according to Halldórsdóttir’s theory of “Caring and Uncaring encounters”. Method: Descriptive field notes from 30 separate observations were analyzed using qualitative deductive content analysis. Results: The main category “caring encounters” focused on reaching out to initiate connection through communication, removing masks of anonymity by acknowledging the unique person, acknowledgment of connection by being personal. Reaching a level of truthfulness by being present and showing respect, raising the level of solidarity by equality and true negotiation of care, based on the residents’ needs. The main category, uncaring encounters, focused on disinterest in and insensitivity towards the other, coldness in the connection and lack of humanity in care situations. The observations showed that caring encounters occurred more in the Finnish-speaking context and uncaring encounters more often in the Swedish context. Conclusion: Encounters could be caring, uncaring, and carried out using a person-centered approach. Communication and relationships could be facilitated using the same language but also through learning to interpret residents’ needs and desires.

The dignity of older individuals with Alzheimer’s disease and related dementias: A scoping review

“…In another study, researchers attempted to explore caring and uncaring encounters between nursing assistants ( N = 17) and individuals with ADRD ( N = 16) in a nursing home in Sweden, using a descriptive qualitative approach (Söderman et al, 2018). Emerged themes for caring encounters included “Initiating connection” (verbal and nonverbal communication), “Removing masks of anonymity” (calling residents by their names and removing stereotypes), “Truthfulness” (being present and showing respect), “Solidarity” (feeling of equality rather than alienation), and “True negotiating of care” (maintaining residents’ dignity by explaining procedures and asking for their permission or approval) (Söderman et al, 2018). Uncaring encounters, on the other hand, were characterized by coldness (task-oriented and lack of emotions), disinterest (lack of attentiveness to residents’ needs), insensitivity (not responding to residents’ questions), and lack of humanity (ridiculing the resident and lack of respect) (Söderman et al, 2018).…”

“…Emerged themes for caring encounters included “Initiating connection” (verbal and nonverbal communication), “Removing masks of anonymity” (calling residents by their names and removing stereotypes), “Truthfulness” (being present and showing respect), “Solidarity” (feeling of equality rather than alienation), and “True negotiating of care” (maintaining residents’ dignity by explaining procedures and asking for their permission or approval) (Söderman et al, 2018). Uncaring encounters, on the other hand, were characterized by coldness (task-oriented and lack of emotions), disinterest (lack of attentiveness to residents’ needs), insensitivity (not responding to residents’ questions), and lack of humanity (ridiculing the resident and lack of respect) (Söderman et al, 2018). Similar findings emerged in a qualitative study (focus groups) involving 15 residents and 17 certified nurse assistants (CNAs) in two nursing homes in the United States.…”

“…The majority of findings depicted encounters that did not meet the characteristics of “dementia-competent care” characterized by person-centeredness, respect to person’s individuality, ethicality, responsibility, and care coordination that promote the dignity of older individuals (Yamaguchi et al, 2019). Nonetheless, themes such as “Initiating connection,” “Removing masks of anonymity,” “True negotiating of care” (Söderman et al, 2018), and others that emerged in a few studies suggest that healthcare encounters did not always pose a threat to the social dignity of individuals with ADRD. Findings also showed that the perception of HCPs regarding individuals with ADRD was not altered (Nolan, 2006) and that they acknowledged the importance of attentiveness to details, person-centeredness, and patient empowerment during delivery of care (Prato et al, 2019).…”

Dementia across cultural borders : Reflections and thought patterns of elderly Iranians with dementia in Sweden, their relatives and staff at a culturally profiled nursing home

“…Furthermore, without any knowledge about the resident's background, contextual experiences led to social isolation and a sense of loneliness and friendlessness. Having knowledge about a person with dementia's early life was highlighted by Söderman et al (2018), who stated that knowing their language and details of their early life could be a way of understanding those with dementia; otherwise, this could present a challenge for residents and healthcare professionals in their daily work.…”

The meaning of significant encounters in forensic care

“…These encounters range from short clinical interactions without much emotional involvement to extended interactions where the HCPs go beyond their duties as professionals (1). The encounter could also be on a continuum from a caring encounter with a focus on healing and alleviating suffering (2) to an uncaring encounter characterised by a lack of humanity and indifference (3, 4). Forensic psychiatry research is characterised by both caring and uncaring encounters, but forensic psychiatry remains an under‐researched field (5), especially concerning person‐oriented care (6).…”