Balancing between Contradictions: The Meaning of Interaction with People Suffering from Dementia and “Behavioral Disturbances”

2005 ◽  
Vol 60 (2) ◽  
pp. 145-157 ◽  
Author(s):  
Ulla H. Graneheim ◽  
Ulf Isaksson ◽  
Inga-Maj Persson Ljung ◽  
Lilian Jansson
Keyword(s):  
Ethical Dilemmas ◽  
Care Providers ◽  
Narrative Interviews ◽  
Behavioral Disturbances ◽  
People With Dementia ◽  
Good For ◽  
The Individual

Interacting with people who suffer from dementia poses a challenge for care providers, and the presence of behavioral disturbances adds a further complication. Our article is based on the assumption that behavioral disturbances are meaningful expressions of experiences. Six narrative interviews were conducted with care providers with the aim of illuminating the meaning of interaction with people suffering from dementia and behavioral disturbances. The interviews were tape-recorded, transcribed into text, and interpreted using a phenomenological hermeneutic methodology. The findings indicate that interacting with people with dementia and behavioral disturbances, as narrated by care providers, means balancing between contradictions concerning meeting the person in my versus her/his world, feeling powerless versus capable, and feeling rejected versus accepted. Interaction involves being at various positions along these continua at different points in time. Furthermore, it means facing ethical dilemmas concerning doing good for the individual or the collective. This is interpreted as a dialectic process and is reflected on in light of Hegel's reasoning about the struggle between the master and the slave.

Clinical ethics and law in health care system

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Abhinav Gorea
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Providers ◽  
Clinical Ethics ◽  
Ethical Dilemmas ◽  
Care Providers ◽  
Complete Cure ◽  
Law And Ethics ◽  
Good For ◽  
The Right

Different situations arise while treating the patients when there are ethical dilemmas to give one or other type of treatment or not to do anything. Sometimes doctors and nurses consider that what is good for the patient must be done because the patient does not understand the situation and consequences. This may lead to complete cure and patient usually goes back to home happily but sometimes a complication may occur and the patient may sue the health care providers. When such situations are analyzed then principles of ethics and law are considered to see if any of these have been violated or not to reach the conclusion. In this study principles of law and ethics of treatment have been discussed to reach the right conclusion; which will be helpful in situations where there are ethical dilemmas during the treatment.

Dementia Friendly Memory Institutions

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Lynne C Howarth
Keyword(s):  
Cultural Heritage ◽  
Health Care Providers ◽  
Life Experience ◽  
Severe Disease ◽  
Disease Process ◽  
Care Providers ◽  
Persons With Disabilities ◽  
People With Dementia ◽  
Centered Care ◽  
The Individual

On November 3, 1906, at the 37th Meeting of South-West German Psychiatrists, Dr. Alois Alzheimer, reported on “a peculiar severe disease process of the cerebral cortex”. The disease with which he is associated has continued to elude a cure and is forecast to afflict one in eighty-five persons globally by 2050. Health care providers, researchers, and governments are on notice to explore different ways of understanding and addressing Alzheimer’s Disease and Related Dementias (ADRD) as demands for resources and funding escalate. One of those approaches, person-centered care (PCC), puts a focus on the individual, not the disease, emphasizing ability and enablement, and recognizing people with dementia as having rights of choice, personal empowerment, and self-determination. We expand on the concept of “dementia friendly communities,” embodying PCC, to envision how spaces, programs, and services within cultural heritage institutions such as galleries, libraries, archives, and museums (GLAM), could be re-thought and designed to enhance the everyday life experience of persons with ADRD. Impetus for such initiatives is provided further through the articulation, acceptance, adoption, and promotion of the rights of those with dementia as the rights of persons with disabilities. This emphasis on rights is important as it has behind it the force of international agreement and legally-binding United Nations’ Convention on the Rights of Persons with Disabilities (2008). We argue that cultural heritage institutions have a responsibility and a rationale for servicing those who have been marginalized across time by what they have rather than who they are.

scholarly journals Modifiable Risk Factors of Behavioral and Psychological Symptoms in People with Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 648-649
Author(s):  
Shinae Seo ◽  
Meghan Mattos
Keyword(s):  
Risk Factors ◽  
Psychological Symptoms ◽  
Community Dwelling ◽  
Modifiable Risk Factors ◽  
Care Providers ◽  
Dyadic Relationship ◽  
People With Dementia ◽  
The Individual ◽  
Behavioral And Psychological Symptoms

Abstract Over ninety percent of people with dementia (PWD) experience behavioral and psychological symptoms, known to increase burden on care providers and healthcare systems. The purpose of this integrative review was to examine the modifiable risk factors of behavioral and psychological symptoms of dementia (BPSD) at the individual, caregiver, and environmental levels. An electronic database search was performed using PubMed, CINAHL[EBSCO], Web of Science, and PsycINFO from 2010-2020. Search terms included “dementia” AND (“Behavioral” OR “Behavioural” OR “Psychological” OR “Neuropsychiatric”) AND “symptoms” AND (“Independent Living” OR “Community Dwelling” OR “Community Living” OR “Living at Home” OR “Ageing in Place.” The search yielded 1,121 articles, and 14 articles were included in this review. Among the 14 articles, there were 11 modifiable risk factors presented across the individual, caregiver, and environmental levels. Individual-level factors included the presence of affective disorder, low quality of life, and leisure dysfunction. The modifiable caregiver-level factors included relationship with PWD, frequency of contact, caregiver burden, distress, frustration level, caregiver as a resource for PWD, and quality of dyadic relationship. One environmental factor, the presence of pandemic disease (e.g., COVID 19), was identified. This review presents the modifiable factors that contribute to the varied symptoms and multi domains of BPSD. Further research is necessary to determine whether, and to what degree, interventions targeting individual, caregiver, or environmental risk factors may reduce BPSD for PWD, caregivers, and providers within the community setting.

scholarly journals Using the Age-Friendly 4Ms Framework to Redesign a Community Clinical Experience

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 9-9
Author(s):  
Margaret Avallone ◽  
Staci Pacetti
Keyword(s):  
Nursing Students ◽  
Social Workers ◽  
Clinical Experience ◽  
Affordable Housing ◽  
Fall Risk ◽  
Primary Care Providers ◽  
Care Providers ◽  
Undergraduate Nursing ◽  
Experience Teaching ◽  
The Individual

Abstract The Age-Friendly 4Ms Framework (IHI/Hartford Foundation) was used to redesign an existing undergraduate nursing community experience, teaching students how to evaluate what matters to the individual, medications, mentation, and mobility. As part of the NJ Geriatric Workforce Enhancement Program (NJGWEP), a 5-year grant supported by DHHS-HRSA, ten senior nursing students joined a team of bilingual social workers, APNs, and a PharmD in an affordable housing urban highrise. This paper will describe the implementation and evaluation of a redesigned clinical experience using the 4Ms framework. Students visited older residents with bilingual social workers, performed health assessments and developed person-centered plans of care. Students presented resident cases during weekly interprofessional conferences to promote team collaboration and planning. Residents who screened positive for dementia were referred to an interprofessional Memory Assessment Program. Medications were reviewed using the Beers criteria, reconciled, and referred to primary care providers if appropriate. Fall risk was assessed and managed using the STEADI toolkit (CDC). Students were evaluated on attainment of geriatric-specific competencies, including medication review, cognition and depression screening, and fall risk assessments, by direct observations and interview. Following the semester-long experience, students completed a retrospective pretest/posttest survey to evaluate achievement of objectives based on the 4Ms. Mean scores for achievement of learning objectives ranged from 4.7-4.9 on a Likert scale of 1-5. Students identified barriers that older diverse individuals face when managing chronic health problems in the community. Students also valued the partnership with the social workers, stating, “We learned from each other.”

scholarly journals The Role of Rehabilitation in Reducing Resource Use and Lowering Hospital Readmission Through Discharge Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 804-804
Author(s):  
Kenneth Miller
Keyword(s):  
Health Care Providers ◽  
Resource Use ◽  
Hospital Readmission ◽  
Discharge Planning ◽  
Care Transitions ◽  
Healthcare Team ◽  
Transition Management ◽  
Care Providers ◽  
Initial Examination ◽  
The Individual

Abstract The transitions between medical settings, the community and back again is a complex and intimidating process for patients, families and caregivers. These transitions are vulnerable points where planning is key and must begin at the initial examination with rehabilitation providers (PTs/OTs,SLPs). These providers are key members of the healthcare team to facilitate effective transition management. In this session, attendees will learn the critical factors rehabilitation providers use to evaluate patients in order to facilitate successful care transitions. An overview of the indications for rehabilitation referral will be presented, as well as evidence for effective rehabilitation strategies. The speaker will present tools from the American Physical Therapy Association Home Health Toolbox and outline a decision-making process for care transitions based on the individual, caregivers, and health care providers to achieve successful transitions that reduce resource use and hospital readmission rates. Attendees will learn strategies to facilitate inter-professional collaboration, communication, and advocacy.

scholarly journals A Multiple Stakeholder Perspective for Evaluating Community-Based Dementia Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 60-61
Author(s):  
Johan Suen
Keyword(s):  
Dementia Care ◽  
Structural Constraints ◽  
Care Provision ◽  
Care Providers ◽  
Structured Interviews ◽  
Community Based ◽  
Relational Factors ◽  
Care Relationships ◽  
The Individual ◽  
The Impact

Abstract For holistic interventions and research on dementia, it is fundamental to understand care experiences from the perspectives of carers, care recipients, and care professionals. While research on care dyads and triads have highlighted the effects of communication and interactional aspects on care relationships, there is a lack of knowledge on how individual-contextual and relational factors shape the provision and receipt of care in terms of decision-making processes, resource allocation, and expectations of care outcomes. Thus, this paper sheds light on (i) how carers negotiate care provision with other important life domains such as employment, household/family roles and conflicts, as well as their own health problems, life goals, values, and aspirations for ageing; (ii) how older adults with dementia perceive support and those who provide it; (iii) the structural constraints faced by care professionals in delivering a team-based mode of dementia care; and, taken together, (iv) how community-based dementia care is impeded by barriers at the individual, relational, and institutional levels. Findings were derived from semi-structured interviews and observational data from fieldwork conducted with 20 persons with dementia (median age = 82), 20 of their carers (median age = 60), and 4 professional care providers. All respondents were clients and staff of a multidisciplinary and community-based dementia care system in Singapore. Our analysis indicates the impact of dementia care is strongly mediated by the interplay between institutional/familial contexts of care provision and the various ‘orientations’ to cognitive impairment and seeking support, which we characterised as ‘denial/acceptance’, ‘obligated’, ‘overprotective’, and ‘precariously vulnerable’.

scholarly journals Caregiver-Centered Care Health Workforce Competencies: Developing Consistent Support for Family Caregivers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 15-15
Author(s):  
Jasneet Parmar ◽  
Sharon Anderson ◽  
Lisa Poole ◽  
Wendy Duggleby ◽  
Jayna Holyroyd-Leduc ◽  
...  
Keyword(s):  
Health System ◽  
Family Caregivers ◽  
Health Providers ◽  
Care Providers ◽  
Modified Delphi ◽  
Healthcare Settings ◽  
Delphi Approach ◽  
People With Dementia ◽  
Health And Social Care ◽  
Centered Care

Abstract Family caregivers [FCGs] are the backbone of the health system. They provide over 80% of the care for people with dementia, chronic illnesses and impairments. Despite evidence of their contributions and consequences of caregiving, support for FCGs has not been a health system priority. Education to prepare health providers to effectively identify, engage, assess, and support FCGs throughout the care trajectory is an innovative approach in addressing inconsistent system of supports for FCGs. We report on development and validation of the Caregiver-Centered Care Competency Framework to help with curricular design and subsequent evaluation of effectiveness of care providers working within healthcare settings to engage and support FCGs. We used a three round modified Delphi approach. An expert panel of 42 international, national, and provincial stakeholders agreed to participate. In the first 2 rounds, multi-level, interdisciplinary participants, rated the indicators in terms of importance and relevance. In the 3rd round consensus meeting, participants validated the six competency domains, including indicators in small group sessions. Thirty-four experts (81%) participated in the round 1, 36 (85.7%) in round 2, and 42 people (100%) in round 3. There was stable consensus across all three rounds, 96.07% of participants rated the indicators as essential or important (Round 1, 95.81%; Round 2, 94.15; Round 3, 98.23%). FCG research has been primarily focussed on educating FCGs to provide care. These competencies will shape the design of educational curricula and interdisciplinary training programs aimed at supporting the health and social care workforce to provide caregiver-centered care.

Can Communities Protect Autonomy? Ethical Dilemmas in HIV Preventative Drug Trials

1995 ◽  
Vol 4 (4) ◽  
pp. 516-523 ◽  
Author(s):  
Deborah Zion
Keyword(s):  
Advance Directive ◽  
Common Good ◽  
Ethical Dilemmas ◽  
Drug Trials ◽  
The Common Good ◽  
Gay Community ◽  
The Common ◽  
The Individual ◽  
Trial Participants

Before sailing past the sirens' “flowery meadow,” Ulysses instructed his sailors to lash him to the mast so that he would not succumb to the siren's singing. His advance directive demonstrated that he valued his dispositional or long-term autonomy over his unquestioned right to make decisions. He also indicated to his oarsmen that he understood the nature of temptation and his inability to resist it. Ideas of autonomy and sexual choice are central to this discussion of new AIDS treatments, especially the trials of preventative vaccines. Questions arise over the rights of individuals and the extent that these should be limited by concerns of the gay community. Should the gay community intervene in the risky decisions of individuals if no explicit advance directive exists? If so, how do they justify their paternalism? Could their aims not be better served through strengthening the individual dispositional autonomy of trial participants rather than making specific claims about the common good?

A younger onset dementia toolkit: Innovative practice

Dementia ◽  
2018 ◽  
Vol 19 (4) ◽  
pp. 1299-1307
Author(s):  
Caroline Vafeas ◽  
Elisabeth Jacob ◽  
Alycia Jacob
Keyword(s):  
Expert Panel ◽  
Aged Care ◽  
Dementia Care ◽  
Care Providers ◽  
Community Environment ◽  
Innovative Practice ◽  
Care Workers ◽  
The Family ◽  
Specific Care ◽  
The Individual

A diagnosis of younger onset dementia requires specific care tailored to the individual and the family. Dementia care workers often do not have the skills and experience necessary to offer this care within the residential and community environment. This article reports the development of an interactive resource to educate those employed to care for people living with younger onset dementia. Prescription for Life, a talking e-Flipbook was developed and piloted in two states of Australia. Feedback from the pilots was incorporated in the resource prior to a national rollout. The project was supported by an expert panel, including experts from national aged care providers.

Is natural openness or trade policy good for the environment?

2011 ◽  
Vol 16 (6) ◽  
pp. 657-684 ◽  
Author(s):  
Steven Yamarik ◽  
Sucharita Ghosh
Keyword(s):  
Air Pollution ◽  
Trade Policy ◽  
Factor Endowment ◽  
Trade And Environment ◽  
Population Geography ◽  
Limited Impact ◽  
Individual Effects ◽  
Good For ◽  
The Individual ◽  
Trade Share

AbstractIn this paper, we estimate the individual effects of natural openness and trade policy on air pollution. Natural openness is the component of the trade share (imports and exports as a percentage of GDP) attributable to population, geography and factor endowment differences. We find that natural openness reduces air pollution, while trade policy has a limited impact. The implication is that ‘natural’ geographic and endowment differences play a more important role than deliberate trade policy decisions in explaining the trade and environment link.

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