Dementia and interaction A qualitative exploratory study of Marte Meo counselling for staff in dementia-specific care units
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AbstractApproximately 70–80% of all persons who live in nursing homes have dementia. Enhancing communication and interactions that promote mutuality, dignity, and respect can be challenging because of the residents’ decreased abilities to understand and interact and the staff’s difficulties in understanding and interpreting vague communication from the residents. Positive interactions between persons with dementia and nurses are essential to promote dignity and avoid undesirable and conflicting situations. The manner in which nurses act in encounters with residents appears to greatly impact the well-being and behaviour of the residents. The main aims of this dissertation were to explore whether Marte Meo counselling (MMC) may contribute to positive changes in the daily interactions between persons with dementia and staff in dementia-specific care units (DSCUs) and to explore the nurses’ experiences of MMC. MMC is a video-supported counselling method that has been adopted in recent years to enable staff to recognise and improve communication and interactions when working with persons with dementia. It is based on the assumption that a heightened awareness of what comprises effective communication can facilitate greater contact and mutuality in interpersonal interactions between persons with dementia and their caregivers. This dissertation was based on three studies: Study I aimed to investigate whether changes could be identified in the interactions between persons with dementia and their nurses during morning care following MMC. An intervention study based on video recordings before and after MMC intervention was used. Thirteen nurses and 10 residents from six DSCUs at six different institutions in Norway participated. Data were collected through the video recording of six pairs (nurse and resident) during interactions before and after the staff received MMC. Four pairs were included in the comparison group. The findings suggest that nurses who received MMC succeeded, to a greater degree compared with the comparison nurses, in providing care consistent with promoting positive interactions. We identified clearer indications of increased positive interactions and a reduction in inappropriate interactions in the intervention group. In the comparison group, the variation was greater, with both good and poor interactions present in a given case. This study indicated that MMC can facilitate positive interactions and reduce inappropriate interactions. Study II sought to explore the staff members’ experiences of participating in MMC with a particular focus on their learning experiences in four DSCUs. This was a qualitative descriptive study. Data were collected through 12 individual and four focus group interviews (N=24). Findings emerged through manifest and latent content analyses. The nurses acquired new knowledge regarding the residents through MMC, which resulted in an improved capability to interpret the residents’ expressions and an increased awareness of the residents’ competence. New knowledge concerning themselves as nurses also emerged; they recognised how their actions affected the interactions, which consequently made them aware of the usefulness of taking time, pacing their interactions, maintaining eye contact, and describing the situation in words during interactions. This increased knowledge appeared to increase the resident’s perception of being able to cope. This study indicated that MMC helped nurses to learn how to improve interactions with residents with moderate and severe dementia. Study III sought to identify factors that affected the learning outcomes from MMC. Twelve individual interviews and four focus group interviews (N=24) with staff who had participated in MMC were analysed through a qualitative content analysis. The study found that the learning climate had significantly influenced the experienced advantages of MMC and indicated that the learning climate depended on three conditions: establishing a common understanding of the content and form of MMC, ensuring the staff’s willingness and opportunity to participate, and securing an arena in the unit for discussion and interactions. Clear leadership was essential to ensure a good learning climate. This dissertation suggests that MMC may contribute to positive changes in the daily interactions between persons with dementia and the staff of DSCUs. Further research is necessary to evaluate the effects of MMC.
List of papers
|I. Alnes, R.E. Kirkevold, M. & Skovdahl, K. (2011) Marte Meo counselling: a promising tool to support positive interactions between residents with dementia and nurses in nursing homes. Journal of Research in Nursing, 16 (5) 415-433. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1177/1744987111414848|
|II. Alnes, R.E. Kirkevold, M. & Skovdahl, K. (2011) Insight gained through Marte Meo counselling: experiences of nurses in dementia-specific care units. International Journal of Older People Nursing, 6 (2) 123-132. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1111/j.1748-3743.2010.00229.x|
|III. Alnes, R.E. Kirkevold, M. & Skovdahl, K. (2013) The influence of the learning climate on learning outcomes from Marte Meo counselling in dementia care, Journal of Nursing Management, 21, 130–140. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1111/j.1365-2834.2012.01436.x|