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The purpose was to compare selection, use and outcomes of assistive products among older home care clients with and without dementia in Sweden, and to explore the relations between the use of assistive products and perceptions of home care, loneliness and safety. Self-reported data from 89,811 home care clients aged 65 years or more, of whom 8.9% had dementia, were analysed using regression models. Excluding spectacles, 88.2% of them used assistive products. Respondents without dementia were more likely to use at least one assistive product but less likely to use assistive products for remembering. Respondents with dementia participated less in the selection of assistive products, used less assistive products, and benefited less from them. Users of assistive products were more likely to be anxious and bothered by loneliness, to feel unsafe at home with home care, to experience that their opinions and wishes regarding assistance were disregarded by home care personnel, and to be treated worse by home care personnel. The findings raise concerns about whether the needs for assistive products among home care clients with dementia are adequately provided for. They also indicate a need to strengthen a person-centred approach to providing home care to users of assistive products.

BACKGROUND: Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge.

AIM: The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care.

METHODS: Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis.

RESULTS: According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality.

CONCLUSIONS: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients.

IMPLICATIONS FOR PRACTICE: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care.

AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care.

DESIGN: A qualitative descriptive study.

METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used.

FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process.

CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine.

RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

Persons with dementia (PWDs) have a major cognitive decline in the ability to meet universal self-care needs, including self-feeding and maintaining a sufficient intake of fluids and food. The aim was to describe whether caregivers’ humming during lunch situations affected eating and feeding problems in PWDs. An experimental single-case design was used, involving video observation. At baseline, PWDs were fed by their caregivers in the usual way and at intervention the PWDs were fed while a caregiver hummed. Analysis using the Edinburgh Feeding Evaluation (EdFED) showed that for Mrs Smith, the EdFED score decreased from a mean score of 14 at baseline to a mean score of 8.5 during the intervention. Mrs Green experienced a decrease in mean score from 12 at baseline to 8.5 during the intervention. This pilot study suggests that humming during lunch situations might enhance eating and feeding abilities for PWD and should be further studied

The number of persons with dementia (PWD) is increasing rapidly worldwide. Cognitive impairments and communication difficulties are common among PWD. Therefore, gaining mutual togetherness in caring relation between PWD and their caregivers is important. This study was to investigate the effects of music therapeutic care (MTC) during morning care situations on improving verbal and nonverbal communication behaviors in people with dementia. An observation study with 10 PWD participating. Videotaped interactions (VIO) between PWD and their caregivers were conducted during eight weekly sessions, four recordings consisted of usual morning care and four recordings were of morning care with MTC intervention. The Verbal and Nonverbal Interaction Scale was used to analyze the recorded interactions at a later time. The unsociable verbal variable Cursing decreased significantly (P=.037) during MTC when compared with the baseline measurement. A significant (P=.000) reduction was observed for the unsociable nonverbal variable Does not respond to question. MTC significantly (P=.01) increased the mean score for the sociable nonverbal variable – Calm – relaxed. For sociable verbal communication, significant differences were observed for the variables Use coherent communication (P=.012), Use relevant communication (P=.009), Responds to questions (P=.000), Humming (P=.004), Singing (P=.000). MTC during morning care situations can be an effective non-pharmacological treatment, as well as nursing intervention in order to improve sociable communication behaviors, as well as reduce unsociable communication behaviors of PWDs

As welfare providers struggle to meet the care needs of persons with dementia (PwDs), most of their needs are being met by a family carers, most often a spouse. The situation for spouse carers is unique, e.g., with grief, loneliness and loss of intimacy combining with stress and poor health. Research is needed to develop adequate support for spouse carers based on evidence of what influences negative and positive outcomes of care. The present study investigated psychosocial correlates of spouse carers’ (i) negative impact and (ii) positive value of caring. Data from a cross-sectional survey of 165 spouse carers community-resident in Sweden was analysed in two hierarchical regression models to predict negative impact and positive value of caring. Results found that negative impact and positive value were explained by different variables, significant predictors for negative impact included carer stress, health, and emotional loneliness, and change in intimacy with the care-recipient, while positive value was predicted by mutuality, change in closeness to the care-recipient and quality of support. Negative impact and positive value shared variance of only 17.2%. Thus, negative impact and positive value represent different aspects of the carer situation. Consequently, support needs to target several aspects in carers’ life, aiming to; facilitate for spouses to manage PwD’s impairment, increase emotional support while also strengthening the relationship between carer and PwD to reduce negative impact while increasing positive value.

(1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse carers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer–care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.

Introduction. Caring for a person with dementia (PWD) can negatively affect the quality of life of informal carers, and research suggests spouse carers, often being older, are particularly vulnerable and requiring of support. Yet the formal support offered is rarely tailored to meet the needs of spouse carers of PWDs. The aim of the present study was to compare spouse carers to other carers of PWDs on a range of factors, as a foundation for a better understanding of their support needs. 

Material and methods. Cross-sectional survey. In late 2018 a random stratified sample was taken of the Swedish population aged 18 and older. Of 30,009 people contacted, 11,168 completed and returned a questionnaire or completed a web-based version, a response rate of 37.3%. The questionnaire contained questions on whether the respondent was an informal carer for another person, the extent of care provided, contact with and support received from formal services, and impacts of care.

Results. Of the respondents, 378 (3.38%) were carers of PWDs, of whom 107 (28.3%) were spouse carers. Spouse carers compared to other carers of PWD provide care more intenselyand are more informed on their right to support from local authorities. While more often being offered formal support in their carer role, they are less supported in providing care and report a higher negative impact (for all p<.05). 

Conclusions. Formal support is offered to spouse carers in their carer role, but might not be tailored to their specific needs of support.

Being an informal carer of a person with dementia (PwD) can have a negative effect on the carer’s health and quality of life, and spouse carers have been found to be especially vulnerable. Yet relatively little is known about the care provided and support received by spouse carers. This study compares spouse carers to other informal carers of PwDs regarding their care provision, the support received and the psychosocial impact of care.

Aim: Empathy is a crucial component of the nurse-patient relationship, but knowledge is lacking as to when empathy develops during nursing education. The aim of the present study was to compare empathy levels at different stages of undergraduate nursing education and different master's nursing programmes.

Design: The design was a comparative cross-sectional study.

Methods: A total of 329 participants in Sweden, comprised of nursing students in their second and sixth semesters in an undergraduate nursing programme as well as master's nursing students, rated their own empathy using the Jefferson Scale of Physician Empathy.

Results: Students in their sixth semester in an undergraduate nursing programme expressed more empathy than did students in their second semester and master's nursing students. Among the five master's programmes, public-health nursing students expressed the most empathy and intensive-care nursing students the least.

BACKGROUND: Older people were subjected to significant restrictions on physical contacts with others during the COVID-19 pandemic. Social distancing impacts older people's experiences of anxiety and loneliness. Despite a large body of research on the pandemic, there is little research on its effects on older people in residential care facilities (RCF) and in home care services (HCS), who are the frailest of the older population. We aimed to investigate the effect of the first wave of the COVID-19 pandemic in March-May 2020 on experiences of anxiety and loneliness among older people living in RCF or receiving HCS and the impact of the progression of the pandemic on these experiences.

METHODS: A retrospective cross-sectional design using data from the national user satisfaction survey (March - May 2020) by the Swedish National Board of Health and Welfare. Survey responses were retrieved from 27,872 older people in RCF (mean age 87 years) and 82,834 older people receiving HCS (mean age 84 years). Proportional-odds (cumulative logit) model was used to estimate the degree of association between dependent and independent variables.

RESULTS: Loneliness and anxiety were more prevalent among the older persons living in RCF (loneliness: 69%, anxiety: 63%) than those receiving HCS (53% and 47%, respectively). Proportional odds models revealed that among the RCF and HCS respondents, the cumulative odds ratio of experiencing higher degree of anxiety increased by 1.06% and 1.04%, respectively, and loneliness by 1.13% and 1.16%, respectively, for 1% increase in the COVID-19 infection rate. Poor self-rated health was the most influential factor for anxiety in both RCF and HCS. Living alone (with HCS) was the most influential factor affecting loneliness. Experiences of disrespect from staff were more strongly associated with anxiety and loneliness in RCF than in HCS.

CONCLUSION: Older people in RCF or receiving HCS experienced increasing levels of anxiety and loneliness as the first wave of the pandemic progressed. Older people' mental and social wellbeing should be recognized to a greater extent, such as by providing opportunities for social activities. Better preparedness for future similar events is needed, where restrictions on social interaction are balanced against the public health directives.

AIM: Older adults are increasingly encouraged to continue living in their own homes with support from home care services. However, few studies have focused on older adults' safety in home care. This study explored associations between the sense of security and factors related to demographic characteristics and home care services.

METHODS: The mixed longitudinal design was based on a retrospective national survey. The study population consisted of individuals in Sweden (aged 65+ years) granted home care services at any time between 2016 and 2020 (n=82,834-94,714). Multiple ordinal logistic regression models were fitted using the generalised estimation equation method to assess the strength of relationship between the dependent (sense of security) and independent (demographics, health and care-related factors) variables.

RESULTS: The sense of security tended to increase between 2016 and 2020, and was significantly associated with being a woman, living outside big cities, being granted more home care services hours or being diagnosed/treated for depression (cumulative odds ratio 2-9% higher). Anxiety, poor health and living alone were most strongly associated with insecurity (cumulative odds ratio 17-64% lower). Aside from overall satisfaction with home care services, accessibility and confidence in staff influenced the sense of security most.

CONCLUSIONS: We stress the need to promote older adults' sense of security for safe ageing in place, as mandated by Swedish law. Home care services profoundly influence older adults' sense of security. Therefore, it is vital to prioritise continuity in care, establish trust and build relationships with older adults. Given the increasing shortage of staff, integrating complementary measures, such as welfare technologies, is crucial to promoting this sense of security.

This study describes nurses' experiences in identifying mental ill-health in older men in primary care. The aging population is growing in Sweden and life expectancy is increasing. Age is a risk factor for mental ill-health. Older men are over-represented in deaths from suicide. When older men seek primary care, it is often because of somatic symptoms and rarely for mental health issues. A questionnaire with five open questions was answered by 39 nurses from 10 primary care centres and subjected to inductive qualitative content analysis. The results revealed a main theme-capturing the unsaid-and two categories: (1) feeling secure in the role, with three subcategories (building trust, daring to ask and interpreting signs); and (2) the need for resources, with two subcategories (time and continuity, and finding support in collaboration). The results confirm that nurses in primary care play a key role in identifying mental ill-health in older men. There is a need for resources in the form of time, competence and collaboration with other professionals and patients' relatives. This strategy will establish best practice and provide evidence-based care to facilitate improvements in older men's mental health and prevent suicide.

Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.

The spouses of people suffering from dementia are commonly first-in-line caregivers. This can have a considerable effect on their own lives, health and marriages. Several studies have focused on spouses' experiences, but very few have focused in any depth on their descriptions of themselves as subjects. Therefore, the aim of this study is to describe how spouse caregivers can express themselves when living with and caring for their partners with dementia. The study has a qualitative approach with a discourse analysis design and uses analytical tools such as rhetoric, subject positions and categorization. The results reveal three subject positions: as an actor, as a parent and as a survivor. The results show that as spouses struggle with external and internal clashes as subjects, they therefore need to develop coping strategies. They also experience pronounced loneliness and a risk to their own health. There is thus a need to support these spouses as individuals in their differing and changing needs.

BAKGROUND: Worldwide, older people were more severely affected during the COVID-19 pandemic than others. In Sweden, those living in residential care facilities had the highest mortality rate, followed by those receiving home care services. The Swedish and international literature on the working environment for assistant nurses and care aides during the pandemic shows an increase in stress, anxiety, depression and post-traumatic stress syndromes. Care organisations were badly prepared to prevent the virus from spreading and to protect the staff from stress. In order to be better prepared for possible future pandemics, the health and well-being of the staff, the care of older people and the experiences of the staff both during and after a pandemic are important aspects to take into account. Therefore, this study aims to describe the experiences of assistant nurses and care aides working in the care of older people during the COVID-19 pandemic in Sweden, their working conditions and the impact all this had on their lives.

METHODOLOGY: The study has a qualitative, descriptive design. The data was collected in four focus group interviews with 21 participants and analysed using qualitative content analysis.

RESULTS: The results revealed the theme, Being used for the greater good while fighting on the frontline, which was then divided into three categories: portrayed as a risk for older people, not being valued and being burnt out. The worsening working conditions that the pandemic contributed to resulted in a high degree of stress and risk of burnout, with staff members both wanting to and actually leaving their employment. After the pandemic they felt forgotten again and left to cope in an even worse situation than before.

CONCLUSIONS: The pandemic had a major effect on assistant nurses and care aides in terms of their working environment and their private lives. To be better prepared for future pandemics or disasters, organisations with responsibility for the care of older people will need to ensure that their staff have the necessary competencies and that there is adequate staffing in place. This also means that adequate government funding and multiple interventions will be needed.

INTRODUCTION: During the COVID-19 pandemic, older people in Sweden's residential care facilities and home care services experienced high mortality rates. Prior to the pandemic, the care of older people in Sweden was challenged by organisational and regulatory changes, an ageing population and insufficient increases in staff numbers. These issues led to high staff turnover, increased workloads, stress, burnout and a perceived inability to provide satisfactory care. The pandemic brought about increased job strain, stress, anxiety, depression and post-traumatic stress disorder among the staff who cared for older people. The aim of this study was therefore to focus on assistant nurses and care aides' experiences of their work environments when caring for older people during the pandemic in Sweden.

METHODS: The data were collected through four focus groups interviews and analysed using qualitative content analysis.

RESULTS: The results showed that the care staff had to navigate organisational and ethical challenges in poor and unsafe work environments. They lacked supportive leadership in their respective organisations, were neither valued, seen nor heard and were treated as 'plain doers'. During the pandemic, they were unable to protect or communicate easily with the older people in their care, which had harsh consequences.

CONCLUSION: According to the participants, the pandemic left them, their working conditions and this part of the care system in a worse situation than before the pandemic. The pandemic thus revealed more unsustainable and unethical working conditions for the staff than before it, including the vulnerability of the older people in their care.

IMPLICATIONS FOR PRACTICE: The findings highlights the need of policies that ensure adequate training and instruction on medical issues, for managers responsible for overseeing the care of older people. There are also a need of provision of sufficient support for care staff and health care professionals during crises. The findings also underscore the need of feasible and efficient strategies do disseminate care information and address the psychosocial needs of older people.

Background. ‘Music Therapeutic Caregiving’, defined as when caregivers’ sing for or together with persons with dementia care situations, has been shown to facilitate the caring situation, and enhance positive and decrease negative expressions in persons with dementia. No studies about singing during mealtimes have been conducted, and this project was designed to elucidate this. However, since previous studies have shown that there is a risk that persons with dementia will start to sing along with the caregiver, the caregiver in this study hummed such that the person with dementia did not sing instead of eat. Aim. To describe professional caregivers’ experiences of humming during meal time while feeding persons with dementia. Method. An intervention with caregivers humming was implemented during lunch time. Focus group interviews were conducted to fetch the caregivers experiences. Qualitative content analysis was used to analyse the interviews. Results. The caregivers described that humming disseminated relaxation and joy, and awakened memories about the songs hummed which encouraged the persons with the dementia to join in the songs. They also described that humming seemed to make the persons with dementia associate with mealtime and could make them eat more. However it also revealed suspiciousness and agitation from the persons with dementia. Conclusion. Humming during mealtime revealed mainly positive as well as some negative influences. More and larger studies are needed to be able to draw general conclusions.

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 the encounter 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 thereby 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 how interventions 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 the experiences of professional caregivers while caring for persons with dementia. The second study (II) aimed to present professional caregivers´ impressions of the persons with dementia. 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’. The fourth study (IV) focused on a single case and was designed to describe the expressions of emotion and of resistiveness to care of two nursing home residents with severe dementia, during morning care situations without and with music therapeutic caregiving. The final study (V) aimed to describe expressions of emotions and resistiveness to care among two groups of persons with dementia.

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 with 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 different data collection and analysis methods, as well as different care situations.

The impact of caregivers’ singing on expressions of emotion and communication during morning care situations in persons with dementia

The number of persons with dementia (PWD) is increasing rapidly worldwide. Emotions and communication difficulties are common and non-pharmacological interventions should be considered.  The inclusion criteria were diagnosed with severe dementia, living at nursing homes and a Mini–Mental State Examination (MMSE) score > 12. Music Therapeutic Caregiving (MTC), when a caregiver sings for or together with the PWD was conducted during morning care. Baseline and intervention sessions were videotaped during eight weeks. The PWDs’ expressions of resistant behavior were significantly reduced under the intervention situation[Gabriella2] . A significant (P=.000) reduction was observed for the unsociable nonverbal variable Does not respond to question. MTC significantly (P=.01) increased the mean score for the sociable nonverbal variable – Calm –Relaxed. For sociable verbal communication, significant differences were observed for the variables Use coherent communication (P=.012), Use relevant communication (P=.009), Responds to questions (P=.000), Humming (P=.004) and Singing (P=.000).

BACKGROUND: In Sweden, older people in residential care had the highest mortality rates, followed by those who received home care, during the coronavirus disease 2019 (COVID-19) pandemic. Staff working in the care of older people assumed responsibility for preventing the spread of the virus despite lacking the prerequisites and training. This study aimed to investigate the psychosocial work environment during the COVID-19 pandemic among staff in the care of older people and examine the factors associated with staff's perceptions of the clarity of instructions and the ability to follow them.

METHODS: A cross-sectional study design was employed using a web survey. The staff's perceptions of their psychosocial environment were analysed using descriptive statistics. The association between organisational and individual factors, as well as the degree of clarity of the instructions and the staff's ability to follow them, were assessed using multivariate (ordinal) regression analysis.

RESULTS: The main findings show that perceptions of the clarity and adaptability of the instructions were primarily correlated with organisational factors, as higher responses (positive) for the subscales focusing on role clarity, support and encouragement in leadership at work were associated with the belief that the instructions were clear. Similarly, those indicating high job demands and high individual learning demands were less likely to report that the instructions were clear. Regarding adaptability, high scores for demands on learning and psychological demands were correlated with lower adaptability, while high scores for role clarity, encouraging leadership and social support, were associated with higher adaptability.

CONCLUSIONS: High job demands and individual learning demands were demonstrated to decrease the staff's understanding and adoption of instructions. These findings are significant on an organisational level since the work environment must be prepared for potential future pandemics to promote quality improvement and generally increase patient safety and staff health.

It is well known that persons with dementia (PWD) have problems expressing and interpreting communication, making interaction with others difficult. Interaction between PWD and their caregivers is crucial, and several strategies have been investigated to facilitate communication during caregiving. Music therapeutic caregiving (MTC) - when caregivers sing for or together with PWD during caregiving activities - has been shown to enhance communication for PWD, evoking more vitality and positive emotions. The aim of this study was to describe how PWD and their caregivers express verbal and nonverbal communication and make eye contact during the care activity 'getting dressed', during morning care situations without and with MTC. Findings revealed that during the situations without MTC, the caregivers led the dressing procedure with verbal instructions and body movements and seldom invited the PWD to communicate or participate in getting dressed. Patterns in responses to caregivers' instructions included both active and compliant responses and reactions that were resistant and aggressive, confused, and disruptive. In contrast to the 'ordinary' morning care situation, during MTC, the caregivers seemed interested in communicating with the PWD and solicited their mutual engagement. Although verbal communication consisted of singing about things other than getting dressed, e.g. dancing, love, sailing, God, the PWD mostly responded to caregivers in a composed manner, by being active, compliant, and relaxed, though some were also resistant or incongruent. The authors conclude that MTC could be a way for PWD and their caregivers to successfully interact and co-operate during caring situations, as it seems to evoke enhanced communication for both partners in this context

‘Music therapeutic caregiving’ (MTC), when caregivers sing for or together with persons with dementia (PWDs) during caring situations, has been suggested as a way to reduce PWDs’ behavioral and psychological symptoms of dementia (BPSD). An intervention was designed to elucidate what influences MTC might have on PWDs and their caregivers. The aim was to describe professional caregiverś experiences of caring for PWDs during morning care situations without and with MTC. Group interviews were conducted, and a qualitative content analysis was performed. Two themes were revealed. The first (without MTC), Struggling for care in communion, encompassed four sub-themes: Hampered communication; Physical and mental struggle with aggression; Struggling with ethical demands; and The reward — consolation and love. The second theme (with MTC), Consolidating care in communion, encompassed two sub-themes: awakening cooperation, and feeling of well-being. The authors conclude that MTC could be used to help caregivers provide improved care.

Music therapeutic caregiving', when caregivers sing for or together with persons with severe dementia during care situations, has been suggested as a way to reduce problematic behaviors in dementia care. The present study implemented this technique as an intervention in dementia care. Six caregivers participated in group interviews about their experiences of morning care situations without and with'Music therapeutic caregiving'. Through a qualitative content analysis two themes emerged.'Being in a different reality' was based on'usual' morning care situations. The caregivers' experienced the persons with dementia as absent-minded; communication and cooperation were difficult. The second theme,'Being present', was based on morning care situations with the intervention. The caregivers described communication as enhanced; the persons with dementia expressed themselves more appropriately, making cooperation possible. The results indicate that'Music therapeutic caregiving' might lead to a more positive experience of the person with dementia and seems to increase receptivity to caregiving.

AIMS AND OBJECTIVES: The aim was to describe expressions of emotions and resistiveness to care among persons with dementia (PWD), during morning care situations without and with music therapeutic caregiving (MTC). BACKGROUND: Effective caregiving is dependent on the interpersonal relationship between nurse and patient. PWD suffer from major cognitive impairment, making interaction with others problematic. Such patients often react with problematic behaviours such as resistance and anger towards the care activity and the caregiver. Earlier research suggests that MTC - when caregivers sing for or together with PWD during caregiving - can reduce resistance and evoke positive emotions in PWD. DESIGN: This was an intervention study whereby MTC was implemented during morning care situations while PWD were being cared for. METHOD: The study included ten, 66-92-year-old men and women with severe dementia living in a nursing home in Sweden. Video observations of eight weekly sessions, consisting of four recordings of usual morning care and four recordings of morning care with MTC, provided data. The resistiveness to care scale and the observed emotion rating scale were used for analysis. RESULTS: Pull away was the most common resistant behaviour under both conditions. The PWDs' expressions of resistant behaviour, such as pull away, grab object and adduction, were significantly reduced under the intervention situation. Positively expressed emotions, specifically pleasure and general alertness, significantly increased under the MTC intervention compared with the 'usual' morning care sessions. CONCLUSIONS: MTC can be an effective nursing intervention to provide PWD a more pleasant experience of morning care situations as it decreases resistant behaviour and increases positive emotions. RELEVANCE TO CLINICAL PRACTICE: MTC offers a potential non-pharmacologic treatment that can be used in caring for PWD.

Even before the Covid-19 pandemic, spouse carers of persons with dementia (PwDs) found their care responsibilities overwhelming and had little time to focus on their own lives. To minimize the risk of being infected with Covid-19, older persons are recommended to self-isolate in their homes, while formal support such as respite care and day care centers are withdrawn. This study involved semi-structured interviews with 24 spouse carers of community-living PwDs, with the aim of describing their situation during the pandemic. The interviews were analyzed with qualitative content analysis. Results revealed that they commonly declined help because of the perceived risk of their spouse being infected with Covid-19 and thus also possibly causing their death. They described feelings of being trapped in their situation, as they experienced having no choice than take all responsibility for the care of their partner themselves, with cost of being unable to take necessary breaks. This was described as making an already strained situation almost unbearable, which led to conflicts with their partner. However, the spouses also described positive aspects due to strategic changes in health and social care provision to prevent the spread of the virus, such as greater staff continuity in home care services, and patient transportation service. These made the PwD less stressed and influenced their everyday life positively. It could be concluded that the extent burden during the Covid-19 pandemic calls for extensive development of tailored support to better tackle the rapid changes that can occur in a society.

Persons with dementia (PWDs) can suffer from major cognitive impairment, but are known to retain an ability to express both negative and positive emotions. Negative expressed emotions and resistance make caregiving problematic. Music Therapeutic Caregiving (MTC) – when caregivers sing for or together with PWDs during care – has been shown to decrease PWDs' negative expressed emotions and resistance, and increase positive expressed emotions. This single case study included two cases, two women with severe dementia, and measures expressed emotions and expressions of resistiveness to care during “usual” morning care situations and morning care situations with MTC. Video observations were conducted resulting in four recordings of usual morning care and four recordings of morning care with MTC. For analysis, the Observed Emotion Rating Scale and Resistiveness to Care Scale were used. Results revealed that in both cases, expressions of resistant behavior and negative emotions decreased, while expressions of positive emotions increased during morning care situations with MTC. The authors conclude that MTC may be an effective method for caregivers to use to facilitate care situations with PWDs, and also a way for PWDs to experience care situations as less unpleasant, and more joyful.

BACKGROUND: Undergraduate nurse education needs to prepare student nurses to meet the demands and to have the necessary communication skills for caring for an increasing older population. The challenges involve how best to support and empower student nurses to learn the communication skills needed to care for older people.

OBJECTIVE: The aim of this study was to investigate student nurses' views on the care of and communication with older people.

DESIGN: A descriptive study with a mixed-method approach was conducted.

METHODS: Quantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015.

RESULTS: The student nurses reported positive attitudes to the care of and communication with older people. The findings focus on the central aspects related to relationship building, techniques for communication and external prerequisites.

CONCLUSIONS: Despite positive attitudes, student nurses had a limited view of communication with older people. Educators need to increase student nurses' capacity to communicate effectively with older people. Educational interventions to improve and evaluate the communication competency of nurses and student nurses are needed.

BACKGROUND: For persons with dementia, receptive music may reduce negative expressions and increase positive ones. Caregiver singing (CS) is an intervention aimed at facilitating care situations and involves caregivers singing for or together with persons with dementia during care activities. In the literature, CS is commonly addressed as a music activity rather than a care intervention. The aim was to describe caregivers' experiences of the reactions of persons with dementia when using CS and receptive music in dementia care.

METHOD: The data comprised three focus group interviews with 12 professional caregivers in dementia care, analysed using qualitative content analysis.

RESULTS: the analysis resulted in two themes: "CS increases interaction and builds companionship" and "Receptive music soothes, awakens memories and reflects the person's self".

CONCLUSION: Both CS and receptive music was shown to have positive influences, and while the results were sometimes intertwined, CS was shown to better facilitate problematic care situations.

BACKGROUND: Persons with dementia are at risk of malnutrition and thus in need of assistance during mealtimes. Research suggest interventions for caregivers to learn how to facilitate mealtimes and eating, while other suggest a working environment enabling the encounter needed to provide high-quality care. However, the phenomenon of caring for this unique population needs to be elucidated from several perspectives before suggesting suitable implications that ensure their optimal health.

OBJECTIVES: To illustrate the meanings within caregivers' experiences of caring for persons with dementia during mealtime situations. We also measured weight and food intake among individuals with dementia to explain better the phenomenon of caring for them during mealtimes.

METHODS: Mixed method including focus group interviews with seven caregivers analyzed using phenomenological hermeneutics. In addition, for nine persons with dementia, weight and food intake were collected and descriptive statistics were calculated.

ETHICAL CONSIDERATIONS: Ethical review was obtained from an ethics committee, and all caregivers signed a consent form after being informed on the issue of research ethics. Relatives for persons with dementia were informed and signed the consent. In addition, throughout the study, the persons' expressions were observed aiming to respect their vulnerability, integrity, and dignity.

FINDINGS: One theme emerged from interviews (struggling between having the knowledge and not the opportunity), which was built upon three subthemes (being engaged and trying; feeling abandoned and insufficient; being concerned and feeling guilty). Seven of nine persons with dementia lost a minimum of 1.3 kg of weight and ate a maximum of 49.7% of the food served.

CONCLUSION: Caregivers struggle because they have knowledge about how to provide high-quality care but are unable to provide this care due to organizational structures. The weight loss and insufficient eating among the persons with dementia may support this conclusion. Sufficient time for adequate care should be provided.

Background: The music intervention caregiver singing (CS) has been shown to be beneficial in facilitating care of persons with dementia in residential care, but no studies have focused on possible differences with respect to dementia diagnosis, which might be important due to possible different symptoms. Aim: To describe expressed emotions and resistiveness to care among persons with vascular dementia or Alzheimer’s disease during CS. Method: The study is a pilot intervention of CS which contains pre- and intervention measurements. Participants were persons with vascular dementia or Alzheimer’s disease. Measures were the Resistiveness to Care Scale and the Observed Emotion Rating Scale. Care situations without and with CS were compared of persons with vascular dementia and Alzheimer’s disease. The data are described with descriptive statistics. Results: During CS, positive emotion increased for persons with Alzheimer’s disease and vascular disease, with far longer intervals observed among persons with Alzheimer’s disease. Conclusion: CS may have positive influences regardless of diagnosis, but when targeting different emotional expressions, diagnosis may play an important role. However, larger studies need to be undertaken to confirm the results of this pilot study. © The Author(s) 2022.

Objective:

‘Music Therapeutic Caregiving’, when caregivers sing for or together with persons with dementia during morning care situations, has been shown to increase verbal and nonverbal communication between persons with dementia and their caregivers, as well as enhance positive and decrease negative emotions in persons with dementia. No studies about singing during mealtimes have been conducted, and this pilot project was designed to elucidate this. However, since previous studies have shown that there is a risk that persons with dementia will start to sing along with the caregiver, the caregiver in this study hummed such that the person with dementia did not sing instead of eat. The aim of this pilot project was threefold: to describe expressed emotions in a woman with severe dementia, and describe communication between her and her caregivers without and with the caregiver humming. The aim was also to measure food and liquid intake without and with humming.

Method: The study was constructed as a Single Case ABA design in which the ordinary mealtime constituted a baseline which comprised a woman with severe dementia being fed by her caregivers in the usual way. The intervention included the same woman being fed by the same caregiver who hummed while feeding her. Data comprised video observations that were collected once per week over 5 consecutive weeks. The Verbal and Nonverbal Interaction Scale and Observed Emotion Rating Scale were used to analyze the recorded interactions.

Results:

A slightly positive influence of communication was shown for the woman with dementia, as well as for the caregiver. Further, the women with dementia showed a slight increase in expressions of positive emotions, and she ate more during the intervention.

Conclusion:

Based on this pilot study no general conclusions can be drawn. It can be concluded, however, that humming while feeding persons with dementia might slightly enhance communication, and positive expressed emotions in persons with dementia. To confirm this, more studies on group levels are needed. Because previous studies have found that caregiver singing during caring situations influences persons with dementia positively it might be desirable to test the same during mealtime.

Background and aim: Spouse carers of a person with dementia report feeling lonely and trapped in their role, lacking support and having no time to take care of their own health. In Sweden, the support available for family carers is not specialised to meet the needs of spouse carers of people with dementia. The aim of the study described in this paper was to explore spouse carers’ experiences of caring for a partner with dementia, their everyday life as a couple and their support needs.

Methods: Nine spouse carers of a partner with dementia living at home were recruited through a memory clinic and a dementia organisation. Semi-structured interviews were conducted with the participants, focusing on their experiences of providing care, their support needs in relation to their caring situation, their personal well-being and their marital relationship. The interviews were transcribed and underwent qualitative content analysis.

Results: The analysis resulted in one overall theme Being   ‘alone’   striving   for   belonging   and adaption  in  a  new  reality, synthesized from four sub-themes: (1) Being  in  an  unknown  country; (2) Longing  for a  place  for  me  and  us; (3) Being  a  carer  first  and  a  person  second; and (4) Being  alone  in  a relationship.

Conclusions: The training of care professionals regarding the unique needs of spouse carers of people with dementia needs improvement, with education, in particular, focusing on their need to be considered as a person separate from being a carer and on the significance of the couple’s relationship for their mutual well-being.

AIM: To examine the interplay of social support, pain intensity and ethnicity as moderators and covariates of relationship on depressive symptomatology.

METHODS: Racially and ethnically diverse elders responded to measures of depressive symptomatology and social support.

RESULTS: Hispanics reported significantly higher prevalence of moderate pain intensity and depressive symptomology, and lower prevalence of high social support compared with other ethnic groups. Although social support showed reduced depressive symptomatology among those with high pain intensity, it did not play a significant role in decreasing depressive symptomatology among those with low/moderate pain intensity.

CONCLUSION: Social support in decreasing depressive symptomatology is more effective in older adults with high pain intensity than those with moderate or low levels of pain intensity.

Information and communication technology (ICT) has increased in importance and facilitates participation in several life areas throughout society. However, young adults with mild to moderate intellectual disability make less use ICT than the general population. Disability services staff play a central role in supporting and enabling service users in daily life, and their perceptions of ICT are important to their role in service provision. The aim of the study is to describe staff perceptions of the role of ICT and how it affects daily life in young adults with mild to moderate intellectual disability living in residential homes. Focus group interviews and individual interviews were conducted with staff working in residential homes in which young adults with mild to moderate intellectual disability live. All materials were transcribed verbatim and analyzed using latent content analysis. Staff perceived ICT and, more specifically, the Internet as being supportive of both daily life and social relationships of these young adults, but they also viewed ICT as posing social risks. Perceptions of and support for ICT were related to staff perceptions about what is appropriate and manageable in relation to an individual resident's functioning level. Staff members also considered the views of parents about appropriate content when providing support. Staff in residential homes for young adults with mild to moderate intellectual disability use their implicit moral judgment about the use of ICT by residents. Their enablement of and support for ICT are not primarily based on the service user's wishes or interests. This finding implies a risk that the organization of a conflict-free service provision is a higher priority than service users' participation in social life.

BACKGROUND:

Information and communication technology (ICT) increases participation in life activities, and young adults are frequent users. Young adults with intellectual disability (ID) do not use ICT as much as their peers, and little is known about how ICT is used by young adults with ID. This study describes the use of ICT from the perspective of young adults with mild to moderate ID in a municipal social care context.

METHOD:

Semi-structured interviews were used to collect information from 11 young adults with mild-to-moderate ID living in residential care and analysed using a content analysis.

RESULTS:

ICT was used for family relationships, daily support, interactions based on interests and amusement, and as support for offline activities. Family members were important providers of support for ICT use.

CONCLUSION:

Young adults with mild-to-moderate ID use ICT in their daily life. The social care context needs to be further investigated due to its influence on the young adults' access to ICT and need of support.

Background

Young adults today have grown up in a society where information and communication technology (ICT) support empowerment and social participation. Young adults with mild-to-moderate intellectual disability are at risk for marginalization by the digital divide. The aim was to map and describe how municipal organizations in Sweden organize support in terms of policy and strategies to enable the use of ICT in social care for adults with a mild-to-moderate intellectual disability.

Methods

A quantitative, cross-sectional survey including all municipalities in Sweden (n = 290) was conducted (response rate: 51%, n = 147). Descriptive statistics were used.

Results

Findings indicate a lack of organizational support for staff as well as for young adults with mild-to-moderate intellectual disability.

Conclusion

Municipalities request more knowledge about strategies for making ICT available. Despite the lack of comprehensive strategies for ICT, some Swedish municipalities have taken the initiative in this are

Background: Dignity and well-being are central concepts in the care of older people, 65 years and older, world‑wide. The person-centred practice framework identifes dignity and well-being as person-centred outcomes. Older persons living in residential care facilities, residents, have described that they sometimes lack a sense of dignity and well-being, and there is a need to understand which modifable factors to target to improve this. The aim of this study was to examine the associations between perceptions of dignity and wellbeing and the independent variables of the attitudes of staf, the indoor-outdoor-mealtime environments, and individual factors for residents over a three-year period.

Methods: A national retrospective longitudinal mixed cohort study was conducted in all residential care facilities within 290 municipalities in Sweden. All residents aged 65 years and older in 2016, 2017 and 2018 were invited to responded to a survey; including questions regarding self-rated health and mobility, the attitudes of staf, the indooroutdoor-mealtime environments, safety, and social activities. Data regarding age, sex and diagnosed dementia/pre‑scribed medication for dementia were collected from two national databases. Descriptive statistics and ordinal logistic regression models were used to analyse the data.

Results: A total of 13 763 (2016), 13 251 (2017) and 12 620 (2018) residents answered the survey. Most of them (69%) were women and the median age was 88 years. The odds for satisfaction with dignity did not difer over the three-year period, but the odds for satisfaction with well-being decreased over time. Residents who rated their health as good, who were not diagnosed with dementia/had no prescribed medication for dementia, who had not experienced disrespectful attitudes of staf and who found the indoor-outdoor-mealtime environments to be pleasant had higher odds of being satisfed with aspects of dignity and well-being over the three-year period.

Conclusions: The person-centred practice framework, which targets the attitudes of staf and the care environment, can be used as a theoretical framework when designing improvement strategies to promote dignity and well-being. Registered nurses, due to their core competencies, focusing on person-centred care and quality improvement work, should be given an active role as facilitators in such improvement strategies.