Introduction
Method
Identification of stakeholder groups
People with cognitive impairment | Mini-mental-status-examination (15–29) and clinically documented diagnosis of mild cognitive impairment (MCI) or dementia Age ≥ 65 years Resident in a nursing home and/or experiences with hospital admission within the past 2 years |
Relatives | Related to a person living with dementia or MCI residing in a nursing home and/or experienced hospital admission within the past 2 years Degree of relation: spouse or son/daughter (in law) |
Healthcare professionals | Experiences in the treatment of people with dementia in their work life Occupational groups working in medical care such as physicians, nurses, therapists, and related occupations |
Elicitation of stakeholders’ values and needs
Participants
Patients or residents living with dementia | ||||||
---|---|---|---|---|---|---|
ID | Duration audiofile (hours) | Group of interviewees | Age (years) | Sex | Former occupation | MMSE |
Inpat01 | 00:18:14 | Inpatient | 77 | Female | No response | 19 |
Inpa02 | 00:25:07 | Inpatient | 92 | Female | No response | 29 |
Inpa03 | 00:15:50 | Inpatient | 88 | Female | No response | 26 |
Res04 | 00:27:02 | Resident | 98 | Female | Post office clerk | 27 |
Res05 | 00:32:06 | Resident | 83 | Female | Factory worker | 15 |
Res06 | 00:14:31 | Resident | 98 | Female | Foreign language correspondent | 23 |
Res07 | 00:41:32 | Resident | 82 | Female | Healthcare employees | 22 |
Res08 | 00:42:46 | Resident | 78 | Female | Sales woman and train conductor | 26 |
Pat09 | 00:22:46 | Former patient | 69 | Male | Engineer | 27 |
Pat10 | 00:15:29 | Former patient | 79 | Male | Bricklayer | 22 |
Mean | 00:25:32 | 5 residents/5 in-/former patients | 84.4 | 2 male/8 female | 23.6 |
Relatives | ||||||
---|---|---|---|---|---|---|
ID | Duration audiofile (hours) | Group of interviewees | Age (years) | Sex | Former occupation | Employment status |
Rel01 | 00:30:12 | Child | 64 | Female | No response | employed |
Rel 02 | 00:33:00 | Spouse | 76 | Female | Physician | retired |
Rel 03 | 00:33:08 | Child | 55 | Male | Engineer | employed |
Rel 04 | 00:38:14 | Spouse | 81 | Female | Farmer (academic) | retired |
Rel05 | 01:04:23 | Spouse | 84 | Male | Medical professor | retired |
Rel06 | 00:22:16 | Child | 56 | Male | Managing director | employed |
Rel07 | 01:16:18 | Spouse | 68 | Female | Economist and rehabilitation manager | retired |
Rel08 | 00:37:51 | Spouse | 71 | Male | Engineer | retired |
Rel09 | 01:13:51 | Spouse | 80 | Female | Office clerk | retired |
Rel10 | 01:05:52 | Spouse | 64 | Female | Sales woman | retired |
Mean: | 00:47:30 | 7 spouses/3 children | 69.9 | 4 male/6 female | 7 retired/3 working |
Healthcare professionals | ||||||
---|---|---|---|---|---|---|
ID | Duration audiofile (hours) | Group of interviewees | Age (years) | Sex | Occupation | Work experience (years) |
HcpHo01 | 00:21:55 | Healthcare Hospital | 26 | Male | Nursing assistant | 9 |
HcpHo02 | 00:18:06 | Healthcare Hospital | 39 | Female | Nurse | 19 |
HcpHo03 | 00:19:54 | Healthcare Hospital | 32 | Female | Occupational therapist | 12 |
HcpHo04 | 00:29:51 | Healthcare Hospital | 44 | Female | Occupational therapist | 19 |
HcpHo05 | 00:48:22 | Healthcare Hospital | 54 | Female | Physiotherapist | 24 |
HcpNh01 | 00:24:47 | Healthcare Nursing Home | 36 | Female | Nurse | 15 |
HcpNh02 | 00:12:43 | Healthcare Nursing Home | 33 | Female | Nurse | 17 |
HcpNh03 | 00:50:13 | Healthcare Nursing Home | 32 | Male | Occupational therapist assistant | 5 |
HcpNh04 | 00:46:35 | Healthcare Nursing Home | 56 | Female | Occupational therapist | 20 |
HcpNh05 | 00:35:52 | Healthcare Nursing Home | 36 | Female | Nursing assistant | 9 |
Mean | 00:30:50 | 5 hospital/5 nursing home | 38.8 | 2 male/8female | 5 therapists/5 nurses (nursing assistants) | 14.9 |
Creation of the interview guideline
Category | Domain | People with dementia | Relatives | Healthcare professionals |
---|---|---|---|---|
1 | Socio-demographic data | Socio-demographic and personal data | ||
2 | Daily activities | Daily living | Daily work | |
Need for assistance | ||||
3 | Behavior | Behavior on inpatient admission | Challenging behaviors | |
4 | Characteristics of technology | Potential areas of application of technological assistance Design ideas Acceptance and adoption of technology |
Procedure
Analysis
Main category: behavior during hospitalization/in nursing home |
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Sub-category 1 |
Behavior during stay\Problems with adaptation of people with cognitive impairment |
Definition |
Describes the adaptation to the unfamiliar environment from the perspective of the people with cognitive impairment or relatives |
Anchor example |
“Yeah, some things are different, for example it’s [the place] so small. It’s 2 × 4 m and I had a whole house.” Female participant, Res6 #00:04:07-4# |
Coding rules |
Barriers and difficulties due to admission as well as resources for a successful adaptation of people with cognitive impairment to unfamiliar environments are captured (e.g. multi-bedroom, day structure, lifestyle) |
Results
General data
Everyday living and need for assistance and potential action fields for an AT
Action field | Need for assistance |
---|---|
Activity | Activation/sports (Rel, Hcp) Assisting /initializing activity (puzzles, gaming, handcraft, music, celebrating, singing, dancing, and reading out) Bringing patient/resident visitors or things to the hospital/nursing home (such as visitors, the patient’s dog, or favorite things) (Rel) Practicing ways together (Rel) Conversation (including in low German) |
Care | (Permanent) Accompaniment (meal, activity, toilet, or bed) (Rel, Hcp) Being a contact person Pushing someone with a wheelchair (Rel) Excursion/go for a walk (city, fair, dancing, café, group meetings for people with dementia) Interrupting wandering tendencies, searching for residents (Hcp) Mediating between nursing home and residents (Rel, Pwd) Picking up dropped things (Pwd) Promoting residents’/patients’ independence (Rel, Hcp) Supplying individualized or group-based interventions (Hcp) Keep company (incl. assistance settling in and explaining the new living-situation) (Rel, Pwd) Wayfinding outdoor (Rel) |
Management/administration | Banking/dealing with authorities (Rel, Pwd) Cleaning up operations (reporting cleaning needs, house cleaning) (Hcp, Pwd) Dissolution or furnishing of the apartment (Rel, Pwd) Driving service (to emergency room, group care, physiotherapy, game afternoon) (Rel) Organization (appointments, treatments, nursing home places/moves/aids) (Rel, Hcp) Reminder (appointments, dates, drinking, washing) (Hcp) Shopping (Rel, Pwd) Taking over the correspondence (including making or assisting calls) (Rel, Pwd) Visiting a doctor (discussion of findings and medical treatments) (Rel, Pwd) |
Nursing | At night: putting on fresh bed linen, dressing, waking up someone to getting him to toilet (Rel) Checking on residents (Hcp) Doing laundry Dressing (shoes, compression stockings) Food intake/processing (Rel, Pwd) Guiding at ADLs (verbal instruction) (Rel, Hcp) Help with medication intake (Rel, Hcp) Patient positioning and mobilization (Hcp) Personal hygiene Prepare items for clothing (Rel) Assisting healthcare professionals (Rel) |
Values associated with caring for people with dementia
Adaptability Adaptability (Zwetsloot et al., 2013, p. 191) | Authenticity |
Autonomy | Caring and empathy |
Community Community (Zwetsloot et al., 2013, p. 189) | Individuality |
Justice/fairness | Knowledge |
Management Structure and continuity (McNeese-Smith & Crook, 2003, p. 262) | Participation |
Peace | Privacy |
Respect | Safety |
Assistance | Trust |
“So, it [the work] is always very focused on this one resident or on these two residents. That is often difficult (...) to find a middle ground.” (female occupational therapist, HcpNh04, p. 30)
“Because every personality is different, you have to get to know people for a day or two to know how to deal with them.” (male nursing assistant, HcpHo01, p. 12).
“And then you think “yes”, you can do it. You can do it, as a doctor you have to manage to look after your own husband until the end of life, no matter when/. That is/the theory and in practice, it is completely different.” (resident’s wife, Rel02, p. 12).
“(...) and now we get a lot of unskilled workers, always only assistants, so that tomorrow we don't even know who is responsible (.) for us or who is coming, that we sometimes have to wait a long time until someone comes.” (female resident, Res08, p. 76) or“We also have our workload, the other patients also want to be looked after, other things also have to be done. And we only have a certain amount of time available. And that then puts us under pressure.” (female physiotherapist, HcpHo05, p. 36).
“We don't even know what's going on in the world. Every now and then we steal a newspaper so that we know whether the Federal Chancellor still exists.” (female resident, Res06, p. 113).
“The integration of demented residents with non-demented residents, cognitively clear residents. I also find creating acceptance very difficult.” (female nurse, HcpNh02, p. 4).
“I: Was that also a change factor? Female resident: Yes, at first yes. First of all, having meals, with strangers” (female resident, Res08, p. 86)“Yes, but they are in a completely new environment and if you imagine being torn out of, at home they could (…). These were processes that are stored in memory and everything is new in the hospital, whether it's the noises (...) And that scares them and then they become aggressive, not always, but they are scared.” (female physiotherapist, HcpHo05, p. 20)