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Assignment on Evidence

Assignment on Evidence Based Practice in OT - December 2000 Staff attitudes, social interaction and people with dementia in residential settings The findings of this critical review about daily life and quality of care for residents with dementia in residential settings indicates, that there is a serious need for enlightening the problems of this area. In the review, it was basically questioned, if the ideas of the modern dementia environments are successfully practised. According to evidence from the reviewed studies the question must be answered with a “no”. Subsequently in the review, it was investigated if there is evidence to find that staff attitude influence on the social interaction of residents with dementia, and this has been confirmed. Daily life for residents with dementia in residential settings is evidently still very depressing: a picture of days spent in extreme lassitude, passivity and solitude (Armstrong, Browne and McAfee1994; Hallberg, Norberg & Eriksson 1990; Morgan & Stewart 1997; Perrin 1997). It seems as if a shift of focus has occurred away from the original ideas. Tessa Perrin (1997), the only occupational therapist included in the nine studies states, that the modern, physical and social environments in which demented residents live, may have less bearing upon psychological state than has commonly been imaged in the past Ideologically, the background of modern small group environments are evidence from trials and studies performed in the early 1980ths, where the predominant idea was to change from a medical towards a more behaviour orientated treatment. The key strands were often a combination of group techniques with treatment methods such as behaviour modification 10

Assignment on Evidence Based Practice in OT - December 2000 Staff attitudes, social interaction and people with dementia in residential settings through reinforcements (Vaccaro F J 1988), Reality Orientation (Spector A, Orrell M, Davies S, Wood B 2000) or Activity Programmes (Law M et al 2000). Treatment strategies that as mean did require especially skilled staff. The possible calming effect due to the physical small group environment was at that time regarded as positive side effect. Nevertheless today, as Perrin (1997) states: ‘.. most of us attach considerable importance to decor, furnishings and congenial company..’ and ‘.. sets standards on room size, equipment for disability and staffing level ..’ rather than to the more complex demand of staff behaviour and attitudes and a stimulating daily life for the residents. Out of the review and key strands three key results were identified: 1. Evidence from the studies favoured an increasing recognition of the importance of a stimulating environment, activity and social interaction in residential settings for persons with dementia (Morgan & Stewart 1997; Sandman and Norberg 1988). More ill-being than well-being is seen in the daily life of residents with dementia due to the fact that staff are unable to meet the occupational needs of the residents with severe dementia (Hallberg, Norberg & Eriksson 1990, Perrin 1997). 2. According to the findings of the studies, staff – resident interaction is largely restricted to physical care, despite the fact, that nurses stated ‘talking to patients’ as very important (Armstrong, Browne and McAfee 1994; Salmon 1993). Staffs seem to be unconscious on how they actually practise, and attention is called to the need for developing staff attitude (Armstrong, Browne and McAfee 1994; Salmon 1993). 11

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