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Exploring dementia care dyads' person transfer situations from a behavioral medicine perspective in physiotherapy: development of an assessment scale
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Individuals who suffer from severe dementia require assistance when performing activities of daily living. The highly important person transfer situation is influenced by complex, intertwined biopsychosocial factors that are related to the expression of personal, environmental and behavioral variables, which can interfere with the performance of dementia-care dyads' transfer situations.

The overall aim of this study was to leverage a behavioral medicine perspective in physiotherapy to explore, intervene in, and develop an assessment scale for problematic person transfer situations including persons with dementia and the interaction with the caregiver in these transfer situations.

Interviews were performed with ten caregivers who were recruited to two focus groups and worked in a special care unit for persons with dementia; interviewees described their experiences pursuant to assisting persons with dementia in transfer situations (I).

Literature review and video recordings elicited 93 possible items for the new scale. Expert opinions and item-content validity index reduced the number of items to 17 that spanned two areas. Eight items related to the actions of persons with dementias, whereas nine related to caregiver actions. The feasibility testing of the scale in eight person transfer situations showed that the scale was ready for inter- and intra-rated reliability testing (II). Inter- and intra- rater reliability was good (III). In two single-case experimental design studies, the new scale was shown to contribute to a substantial gathering of data on behaviors in care dyads' person transfer situations (IV). In summary, the results of the thesis show that person transfer situations in dementia special care units are influenced by different biopsychosocial factors and that the new assessment scale can support decision-making about treatment strategies. These findings are important in promoting evidence-based behavior change strategies that can facilitate both sets of individuals—i.e., both persons with dementia and caregivers—in transfer situations. The results highlight important research issues that merit attention in future studies.

Place, publisher, year, edition, pages
Örebro: Örebro university , 2015. , 97 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 126
Keyword [en]
Behavioral medicine in physiotherapy, Care dyad, Dementia, Intervention, Scale development, Transfer problems
National Category
Geriatrics
Research subject
Nursing Science; Geriatrics
Identifiers
URN: urn:nbn:se:oru:diva-45277ISBN: 978-91-7529-090-4 (print)OAI: oai:DiVA.org:oru-45277DiVA: diva2:842386
Public defence
2015-10-02, Prismahuset, Hörsal 2, Örebro universitet, Fakultetsgatan 1, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-07-20 Created: 2015-07-20 Last updated: 2015-12-21Bibliographically approved
List of papers
1. Reciprocal struggling in person transfer tasks - Caregivers’ experiences in dementia care
Open this publication in new window or tab >>Reciprocal struggling in person transfer tasks - Caregivers’ experiences in dementia care
2012 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 14, no 4, 175-182 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: This study describes caregivers’ experiences of person transfer situations involving people with dementia.

Method: Qualitative focus group interviews were conducted with a total of 10 caregivers; two groups with five persons each, including two men and eight women. The resulting data were extracted and condensed into meaning units and codes using content analysis.

Findings: One main theme was formulated that represents the caregivers’ experiences of person transfer situations involving people with dementia: "Reciprocal struggle in person transfer tasks". Five categories were formulated: "Becoming familiar and making contact", "Risking one’s own body to protect the resident from injury", "Focused yet aware of the surroundings", "Identifying needs to facilitate the person transfer" and "Struggling to be understood".

Conclusion: Person transfer situations involving people with dementia are subject to sudden changes. The ongoing challenge is to ensure a dynamic approach that can be adapted to the needs of the person with dementia at any given time. There is a need for more studies within the field about care and rehabilitation among people with dementia. We suggest that assessment of person transfer situations involving people with dementia and their caregivers is an important issue for further investigation and physiotherapeutic interventions.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
Keyword
article; caregiver; caregiver support; cognition; dementia; health care quality; human; nonverbal communication; patient care; patient mobility; physiotherapist; physiotherapy; verbal communication
National Category
Geriatrics
Identifiers
urn:nbn:se:oru:diva-45733 (URN)10.3109/14038196.2012.725184 (DOI)2-s2.0-84870533043 (Scopus ID)
Available from: 2015-09-08 Created: 2015-09-08 Last updated: 2015-09-08Bibliographically approved
2. Development of a new assessment scale for measuring interaction during staff-assisted transfer of residents in dementia special care units
Open this publication in new window or tab >>Development of a new assessment scale for measuring interaction during staff-assisted transfer of residents in dementia special care units
Show others...
2015 (English)In: BMC Geriatrics, ISSN 1471-2318, Vol. 15, 6Article in journal (Refereed) Published
Abstract [en]

Background: Mobility problems and cognitive deficits related to transferring or moving persons suffering from dementia are associated with dependency. Physical assistance provided by staff is an important component of residents' maintenance of mobility in dementia care facilities. Unfortunately, hands-on assistance during transfers is also a source of confusion in persons with dementia, as well as a source of strain in the caregiver. The bidirectional effect of actions in a dementia care dyad involved in transfer is complicated to evaluate. This study aimed to develop an assessment scale for measuring actions related to transferring persons with dementia by dementia care dyads.

Methods: This study was performed in four phases and guided by the framework of the biopsychosocial model and the approach presented by Social Cognitive Theory. These frameworks provided a starting point for understanding reciprocal effects in dyadic interaction. The four phases were 1) a literature review identifying existing assessment scales; 2) analyses of video-recorded transfer of persons with dementia for further generation of items, 3) computing the item content validity index of the 93 proposed items by 15 experts; and 4) expert opinion on the response scale and feasibility testing of the new assessment scale by video observation of the transfer situations.

Results: The development process resulted in a 17-item scale with a seven-point response scale. The scale consists of two sections. One section is related to transfer-related actions (e.g., capability of communication, motor skills performance, and cognitive functioning) of the person with dementia. The other section addresses the caregivers' facilitative actions (e.g., preparedness of transfer aids, interactional skills, and means of communication and interaction). The literature review and video recordings provided ideas for the item pool. Expert opinion decreased the number of items by relevance ratings and qualitative feedback. No further development of items was performed after feasibility testing of the scale.

Conclusions: To enable assessment of transfer-related actions in dementia care dyads, our new scale shows potential for bridging the gap in this area. Results from this study could provide health care professionals working in dementia care facilities with a useful tool for assessing transfer-related actions.

Keyword
Caregiver, Dementia, Dyadic interaction, Observation scale, Scale construction, Special care unit
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:oru:diva-43938 (URN)10.1186/s12877-015-0003-6 (DOI)000349862200001 ()2-s2.0-84923859656 (Scopus ID)
Available from: 2015-03-30 Created: 2015-03-30 Last updated: 2015-09-08Bibliographically approved
3. Inter- and intra-rater reliability of a newly developed assessment scale: the Dyadic Interaction in Dementia Transfer Assessment Scale (DIDTAS)
Open this publication in new window or tab >>Inter- and intra-rater reliability of a newly developed assessment scale: the Dyadic Interaction in Dementia Transfer Assessment Scale (DIDTAS)
(English)In: Physical & Occupational Therapy in Geriatrics, ISSN 0270-3181, E-ISSN 1541-3152Article in journal (Refereed) Accepted
Place, publisher, year, edition, pages
Taylor & Francis
National Category
Geriatrics
Identifiers
urn:nbn:se:oru:diva-45734 (URN)
Available from: 2015-09-08 Created: 2015-09-08 Last updated: 2015-09-08Bibliographically approved
4. Functional Behavior Analysis-Guided Interventions for Improving Transfer-Related Behavior in Dementia Care Dyads: Two Experimental Single Cases
Open this publication in new window or tab >>Functional Behavior Analysis-Guided Interventions for Improving Transfer-Related Behavior in Dementia Care Dyads: Two Experimental Single Cases
(English)Manuscript (preprint) (Other academic)
National Category
Geriatrics
Identifiers
urn:nbn:se:oru:diva-45735 (URN)
Available from: 2015-09-08 Created: 2015-09-08 Last updated: 2015-09-08Bibliographically approved

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