Caregivers´ singing facilitates mutual encounter : implementation and evaluation of music therapeutic caregiving in complex dementia care situations

Detta är en avhandling från Stockholm : Karolinska Institutet, Dept of Neurobiology, Care Sciences and Society

Sammanfattning: Persons with severe dementia suffer from major cognitive impairment, and are in need of considerable caring services. They commonly react with problematic behaviors, such as resistance and aggression in close care (e.g., morning care situations). Non-pharmacological treatments such as care interventions should be used to enhance mutuality in encounters and minimize problematic behaviors. Music Therapeutic Caregiving (MTC) is one such intervention and involves the caregiver singing for or together with the persons with dementia during caregiving. MTC is proposed to decrease expressions of aggressive behaviors and enhance communication between persons with dementia and their caregivers. In addition, it has been suggested that MTC can enhance the posture and sensory awareness of persons with dementia, as well as alter the characteristics of the emotions and moods of both the caregivers and the persons with dementia. This thesis was designed with the aim of demonstrating if and in that case how the intervention of using MTC impacted the participants in this study, which included patients with severe dementia and their caregivers. Five studies were included in this thesis, each of which focused on specific aspects of morning care situations with or without the use of MTC. The first study (I) aimed to describe professional caregivers’ experiences of caring for persons with dementia during morning care situations without and with MTC. The second study (II) aimed to present professional caregivers´ experiences of persons with dementia during morning care situations without and with MTC. The third study (III) aimed to describe how persons with dementia and their caregivers express verbal and non-verbal communication and make eye contact during the care activity ‘getting dressed’ during morning care situations without and with MTC. The fourth study (IV) was a single case study and described expressed emotions and expressions of resistiveness to care in two nursing home residents with severe dementia, during morning care situations without and with MTC. Study V aimed to describe expressions of emotions and resistiveness to care among persons with dementia during morning care situations without and with MTC. Study I revealed that during usual morning care situations (without the use of MTC), the caregivers often had problems reaching the persons with dementia and described a struggle when it was necessary to physically restrain some patients due to aggression and resistance. They found consolation when the persons with dementia showed them affection. In study II, the persons with dementia were described as not mentally present during usual morning care situations, and their resistance and aggression lead to difficulties in communicating and cooperating. Study III revealed that the caregivers communicated mainly with verbal instructions and body movements, and that they seldom invited the persons with dementia to participate in the communication. The responses of persons with dementia were at times active and compliant, and other times confused, disruptive, resistant and aggressive. During MTC, the caregivers described a feeling of well-being, as positive emotions seemed dominant for both the caregivers (study I) and the persons with dementia (study II). The caregivers sense of well-being led to a joyful and positive encounter with the persons with dementia (study I). In study II, caregivers found the persons with dementia better able to express themselves appropriately. Expressions of positive emotions were dominant amongst patients and they were mainly described as relaxed, self-confident, and pliable. Study III also showed that the persons with dementia commonly responded to caregivers’ communication in a composed manner, by being active, compliant and relaxed. Study III further revealed that the caregivers seemed more interested in communicating with the persons with dementia and solicited mutual engagement. In study IV, both residents increased positive expressed emotions, while the negative expressed emotions and resistance decreased. Study V also revealed that the positive emotions, such as pleasure and general alertness significantly increased during MTC, while resistant behaviors, such as pulling away, grabbing objects and adduction, were significantly reduced. From this thesis, it can be concluded that the use of MTC during morning care situations with persons with dementia can increase their positive expressed emotions, decrease their negative expressed emotions and resistance to care, and lead to a more positive interaction for both them and their caregivers. It can also be concluded that MTC can enhance communication between persons with dementia and their caregivers during caring and thus increase the mutuality in the encounter, thereby facilitating an interpersonal relation during morning care situations. More research concerning MTC is needed and should be conducted using larger samples, different data collection and analysis methods, as well as different care situations.

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