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Melander, C., Sävenstedt, S., Olsson, M. & Välivaara, B.-M. (2018). Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning. International psychogeriatrics, 30(4), 581-589
Open this publication in new window or tab >>Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning
2018 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 30, no 4, p. 581-589Article in journal (Refereed) Published
Abstract [en]

The ability of nursing staff to assess and evaluate behavioral and psychological symptoms of dementia (BPSD) to determine when intervention is needed is essential. In order to assist with the assessment process, the current use of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) is internationally accepted. Even though the NPI-NH is thoroughly validated and has several advantages, there are also various challenges when implementing this system in practice. Thus, the aim of this study was to explore clinical reasoning employed by assistant nurses when utilizing the NPI-NH as a tool to assess frequency and severity of BPSD in individuals with advanced dementia.

Twenty structured assessment sessions in which assistant nurses used the NPI-NH were audio recorded and analyzed with a discourse analysis focusing on the activities in the communication.

Four categories were identified to convey assistant nurses' clinical reasoning when assessing and evaluating BPSD using the NPI-NH: considering deteriorations in ability and awareness, incorporating individual and contextual factors, overcoming variations in behaviors and ambiguous formulations in the instrument, and sense-making interactions with colleagues.

The NPI-NH served as a supportive frame and structure for the clinical reasoning performed during the assessment. The clinical reasoning employed by assistant nurses became a way to reach a consensual and broader understanding of the individual with dementia, with the support of NPI-NH as an important framework.

Place, publisher, year, edition, pages
Cambridge University Press, 2018
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-65964 (URN)10.1017/S1041610217002009 (DOI)000431404300014 ()28965503 (PubMedID)
Note

Validerad;2018;Nivå 2;2018-05-17 (andbra)

Available from: 2017-10-04 Created: 2017-10-04 Last updated: 2018-09-12Bibliographically approved
Melander, C., Sävenstedt, S., Välivaara, B.-M. & Olsson, M. (2018). Human capabilities in advanced dementia: Nussbaum's approach. International Journal of Older People Nursing, 13(2), Article ID 12178.
Open this publication in new window or tab >>Human capabilities in advanced dementia: Nussbaum's approach
2018 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, no 2, article id 12178Article in journal (Refereed) Published
Abstract [en]

Aims and objectives

To explore how Martha Nussbaum's approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes.

Background

Challenges experienced when supporting people with advanced dementia who express problematic behaviours include understanding their needs and ensuring a dignified life for them.

Design and methods

Data were gathered using an ethnographic approach based on participatory observation. Nussbaum's capability approach was then used as a framework for the analysis. Four women diagnosed with advanced dementia who also expressed problematic behaviours were recruited from a nursing home in Northern Sweden. The data collection was performed during 2015.

Findings

Individuals with advanced dementia had difficulties in participating in the planning of their lives and achieving the human capability of practical reasoning. They were also at risk of being placed outside the social group, thus hindering them from attaining the human capability of affiliation. A dignified life for individuals with advanced dementia requires nursing staff to be present and to provide adapted support to ensure that the individual can actually pursue human capabilities.

Conclusion

Creating opportunities for the human capabilities of practical reasoning and affiliation is essential as they permeate all other human capabilities. For these individuals, it was crucial not only to create opportunities for human capabilities but also to attend to their expressions and needs and to guide and steer them towards a dignified life.

Implications for Practice

The normative structure of the capability approach described by Nussbaum can ensure that nursing staffs move beyond fulfilling patients’ basic needs to consider other capabilities vital for a dignified life.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-66049 (URN)10.1111/opn.12178 (DOI)000434118100002 ()28990351 (PubMedID)2-s2.0-85047906757 (Scopus ID)
Note

Validerad;2018;Nivå 2;2018-06-04 (svasva)

Available from: 2017-10-11 Created: 2017-10-11 Last updated: 2018-09-12Bibliographically approved
Melander, C. (2018). Piecing together a fragmented world: Structures to promote the understanding of people with advanced dementia. (Doctoral dissertation). Luleå: Luleå University of Technology
Open this publication in new window or tab >>Piecing together a fragmented world: Structures to promote the understanding of people with advanced dementia
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Föra samman fragment till en helhet : Strukturer för att öka förståelsen för personer med avancerad demens
Abstract [en]

Understanding people with dementia whose verbal ability has been impaired is a complex and challenging task, even for professional nursing staff. The aim of this PhD thesis was to explore structures that may promote the understanding of people with advanced dementia living in nursing homes. It focusses specifically on (I) the clinical reasoning employed by assistant nurses when utilizing the NPI-NH (Neuropsychiatric Inventory Nursing Home version) as a tool to assess frequency and severity of BPSD (behavioural and psychological symptoms in dementia, i.e. problematic behaviours) in people with advanced dementia, (II) whether a sensor measuring electrodermal activity (EDA) can improve the identification of agitation in individuals with dementia, (III) how an EDA sensor impacts assistant nurses’ structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions, and (IV) how Martha Nussbaum’s approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes. Study I used a method of discourse analysis that focussed on clinical reasoning utilized by assistant nurses when assessing problematic behaviours. In study II, a nonexperimental and correlational observation of the relationship between a sensor measuring EDA and assistant nurses’ structured observations of agitation in people with advanced dementia was applied. Study III used both quantitative and qualitative approaches; data were collected during structured assessments of problematic behaviours conducted by assistant nurses, as well as by focus group interviews with assistant nurses. Study IV took an ethnographic approach with participatory observations that were analyzed with a recursive analysis using a theoretical framework for the conditions necessary for a dignified human life. The structure of the NPI-NH provided a supportive framework that encouraged assistant nurses to discuss and broaden their understanding of the person with dementia (I). The EDA sensor provided continuous information regardless of staff presence and the potential to identify EDA prior to observing these behaviours (II, III), which supported the understanding of the person and when to introduce timely interventions to prevent the onset of problematic behaviours (III). The structure of Nussbaum’s approach to human capabilities illuminated that people with advanced dementia were at risk of living a life in which their opportunities for human capabilities were limited, and hence, the possibility to live a dignified life (IV). An overview of the findings in this thesis indicates that the studied structures were used to piece together fragments of information to create a comprehensive understanding of the needs of the person with dementia. For the structures to support the understanding of the person with dementia, it was crucial that nursing staff were present, attentive and engaged in each person’s situation in order for them to figure out how to piece together and integrate the structures into the overall understanding of the person and, based on that, formulate caring actions in daily life that are meaningful from the perspective of the person with advanced dementia.

Place, publisher, year, edition, pages
Luleå: Luleå University of Technology, 2018
Series
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
Keywords
dementia, nursing home, electrodermal activity, capability approach, clinical reasoning, assessment, behaviour
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-70847 (URN)978-91-7790-199-0 (ISBN)978-91-7790-200-3 (ISBN)
Public defence
2018-10-26, Deltasalen, D770, Luleå, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2018-09-13 Created: 2018-09-12 Last updated: 2018-09-27Bibliographically approved
Melander, C., Kikhia, B., Olsson, M., Wälivaara, B.-M. & Sävenstedt, S. (2018). The impact of using measurements of electrodermal activity in the assessment of problematic behaviour in dementia. Dementia and geriatric cognitive disorders extra, 8(3), 333-347
Open this publication in new window or tab >>The impact of using measurements of electrodermal activity in the assessment of problematic behaviour in dementia
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2018 (English)In: Dementia and geriatric cognitive disorders extra, E-ISSN 1664-5464, Vol. 8, no 3, p. 333-347Article in journal (Refereed) Published
Abstract [en]

Background: A major and complex challenge when trying to support individuals with dementia is meeting the needs of those who experience changes in behaviour and mood. Aim: To explore how a sensor measuring electrodermal activity (EDA) impacts assistant nurses' structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions. Methods: Fourteen individuals with dementia wore a sensor that measured EDA. The information from the sensor was presented to assistant nurses during structured assessments of problematic behaviours. The evaluation process included scorings with the instrument NPI-NH (Neuropsychiatric Inventory-Nursing Home version), the care interventions suggested by assistant nurses to decrease problematic behaviours, and the assistant nurses' experiences obtained by focus group interviews. Results: The information from the sensor measuring EDA was perceived to make behavioural patterns more visual and clear, which enhanced assistant nurses' understanding of time-related patterns of behaviours. In turn, this enhancement facilitated timely care interventions to prevent the patterns and decrease the levels of problematic behaviour. Conclusion: With the addition of information from the sensor, nursing staff could target causes and triggers in a better way, making care interventions more specific and directed towards certain times throughout the day to prevent patterns of problematic behaviours.

Place, publisher, year, edition, pages
Basel: S. Karger, 2018
National Category
Health Sciences Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-70846 (URN)10.1159/000493339 (DOI)000465207700004 ()30386370 (PubMedID)2-s2.0-85054876403 (Scopus ID)
Note

Validerad;2018;Nivå 2;2018-11-07 (johcin) 

Available from: 2018-09-12 Created: 2018-09-12 Last updated: 2019-05-02Bibliographically approved
Kikhia, B., Stavropoulos, T. G., Meditskos, G., Kompatsiaris, I., Hallberg, J., Sävenstedt, S. & Melander, C. (2018). Utilizing ambient and wearable sensors to monitor sleep and stress for people with BPSD in nursing homes (ed.). Journal of Ambient Intelligence and Humanized Computing, 9(2), 261-273
Open this publication in new window or tab >>Utilizing ambient and wearable sensors to monitor sleep and stress for people with BPSD in nursing homes
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2018 (English)In: Journal of Ambient Intelligence and Humanized Computing, ISSN 1868-5137, E-ISSN 1868-5145, Vol. 9, no 2, p. 261-273Article in journal (Refereed) Published
Abstract [en]

Clinical assessment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes is often based on staff member’s observations and the use of the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) instrument. This requires continuous observation of the person with BPSD, and a lot of effort and manual input from the nursing home staff. This article presents the DemaWare@NH monitoring framework system, which complements traditional methods in measuring patterns of behavior, namely sleep and stress, for people with BPSD in nursing homes. The framework relies on ambient and wearable sensors for observing the users and analytics to assess their conditions. In our proof-of-concept scenario, four residents from two nursing homes were equipped with sleep and skin sensors, whose data is retrieved, processed and analyzed by the framework, detecting and highlighting behavioral problems, and providing relevant, accurate information to clinicians on sleep and stress patterns. The results indicate that structured information from sensors can ease and improve the understanding of behavioral patterns, and, as a consequence, the efficiency of care interventions, yielding a positive impact on the quality of the clinical assessment process for people with BPSD in nursing homes.

Place, publisher, year, edition, pages
Springer, 2018
National Category
Media and Communication Technology Nursing
Research subject
Pervasive Mobile Computing; Nursing
Identifiers
urn:nbn:se:ltu:diva-9225 (URN)10.1007/s12652-015-0331-6 (DOI)000429249200005 ()7c97293a-e058-4224-b5bb-882faec2867e (Local ID)7c97293a-e058-4224-b5bb-882faec2867e (Archive number)7c97293a-e058-4224-b5bb-882faec2867e (OAI)
Note

Validerad;2018;Nivå 2;2018-04-04 (rokbeg)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-04-26Bibliographically approved
Kikhia, B., Stavropoulos, T. G., Andreadis, S., Karvonen, N., Kompatsiaris, I., Sävenstedt, S., . . . Melander, C. (2016). Utilizing a Wristband Sensor to Measure the Stress Level for People with Dementia. Sensors, 16(12), Article ID 1989.
Open this publication in new window or tab >>Utilizing a Wristband Sensor to Measure the Stress Level for People with Dementia
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2016 (English)In: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 16, no 12, article id 1989Article in journal (Refereed) Published
Abstract [en]

Stress is a common problem that affects most people with dementia and their caregivers. Stress symptoms for people with dementia are often measured by answering a checklist of questions by the clinical staff who work closely with the person with the dementia. This process requires a lot of effort with continuous observation of the person with dementia over the long term. This article investigates the effectiveness of using a straightforward method, based on a single wristband sensor to classify events of "Stressed" and "Not stressed" for people with dementia. The presented system calculates the stress level as an integer value from zero to five, providing clinical information of behavioral patterns to the clinical staff. Thirty staff members participated in this experiment, together with six residents suffering from dementia, from two nursing homes. The residents were equipped with the wristband sensor during the day, and the staff were writing observation notes during the experiment to serve as ground truth. Experimental evaluation showed relationships between staff observations and sensor analysis, while stress level thresholds adjusted to each individual can serve different scenarios.

National Category
Nursing Media and Communication Technology
Research subject
Nursing; Mobile and Pervasive Computing
Identifiers
urn:nbn:se:ltu:diva-60730 (URN)10.3390/s16121989 (DOI)000391303000009 ()27886155 (PubMedID)2-s2.0-84997328010 (Scopus ID)
Note

Validerad; 2016; Nivå 2; 2016-11-28 (andbra)

Available from: 2016-11-28 Created: 2016-11-28 Last updated: 2018-10-15Bibliographically approved
Melander, C., Kikhia, B., Olsson, M., Välivaara, B.-M. & Sävenstedt, S. (2015). Assessment and evaluation of interventions in bpsd with the help of a multiple sensor system (ed.). Paper presented at Alzheimer's Association International Conference : 18/07/2015 - 23/07/2015. Alzheimer's & Dementia, 11(7), P164-P165
Open this publication in new window or tab >>Assessment and evaluation of interventions in bpsd with the help of a multiple sensor system
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2015 (English)In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 11, no 7, p. P164-P165Article in journal, Meeting abstract (Refereed) Published
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-35233 (URN)10.1016/j.jalz.2015.07.110 (DOI)9af13c7b-344c-4000-a62d-5bed6c2e853a (Local ID)9af13c7b-344c-4000-a62d-5bed6c2e853a (Archive number)9af13c7b-344c-4000-a62d-5bed6c2e853a (OAI)
Conference
Alzheimer's Association International Conference : 18/07/2015 - 23/07/2015
Note
Godkänd; 2015; 20151215 (andbra)Available from: 2016-09-30 Created: 2016-09-30 Last updated: 2017-11-30Bibliographically approved
Kikhia, B., Bengtsson, J., Melander, C. & Sävenstedt, S. (2015). Life logging in the context of dementia care: My life story (ed.). Paper presented at Alzheimer's Association International Conference : 18/07/2015 - 23/07/2015. Alzheimer's & Dementia, 11(7), P165
Open this publication in new window or tab >>Life logging in the context of dementia care: My life story
2015 (English)In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 11, no 7, p. P165-Article in journal, Meeting abstract (Refereed) Published
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-36983 (URN)10.1016/j.jalz.2015.07.111 (DOI)ad78ac6e-1eae-403a-a4bd-f99c5fac621c (Local ID)ad78ac6e-1eae-403a-a4bd-f99c5fac621c (Archive number)ad78ac6e-1eae-403a-a4bd-f99c5fac621c (OAI)
Conference
Alzheimer's Association International Conference : 18/07/2015 - 23/07/2015
Note
Godkänd; 2015; 20151215 (andbra)Available from: 2016-10-03 Created: 2016-10-03 Last updated: 2017-11-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0313-6002

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