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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 Statistically significant ways to improve staff behaviour, is through participation in activity programmes (Salmon 1993), through treatment of resident behaviour (Ingstad & Götestam 1987; Åkerlund and Norberg 1983) and through working after principles of “interacting” and “self-determination” ( Korremann, Meldgaard & Skrubbeltrang 1985). 3. Physical environment solely is not a guarantee for well-being and social interaction in dementia residential settings (Ingstad & Götestam 1987; Morgan & Stewart 1997; Perrin 1997). Concurrently with environmental changes, a higher emphasis should be stressed on psychosocial factors. Stimulation and meaningful activity, human contact, safety and supervision, individualised care, and flexibility are elements mentioned in a positive social environment (Morgan & Stewart 1997). Occupational space The studies reflect a connection between a working strategy of ‘activating care’ and improved behaviour of residents, increased social interaction and positive staff-attitudes. Staffs that succeed to reflect and act upon the occupational needs of residents seems to be correlated to two areas: Good working conditions such as positive expectations and support creates impetus to try out new ways of working Improved resident behaviour 12

Assignment on Evidence Based Practice in OT - December 2000 Staff attitudes, social interaction and people with dementia in residential settings These findings correlate closely to a study conducted by Betty Hasselkus (1998) based on the theories of occupational science. Residents expressing well-being seems to be a primary source of satisfaction and reward for staff members. Indicators of well-being such as humour, helpfulness and initiative in social contacts are closely connected to occupation. The more often staffs and residents experience moments of joint engagement in an activity or occupation, the more often both residents and staff will percieve well being. Betty Hasselkus (1998) names it an occupational space, when ‘meeting of minds’, ‘ engagement in occupation’ and a ‘positive resident-feed back cyclus’ occurs between caregiver and person with dementia. Securing quality of care Several proposals are given in the study of how to enable nursing staff to improve positive communication with the residents. Instead of attitude-campaigns solely addressed to change specific negative staff-attitudes, a more effective way to change attitude seems to be that staffs are actually involved in activities related to certain sets of attitudes. 1. Activity with residents must be scheduled and staff obliged to carrying it into effect. 2. Explicit expectations of staffs spending more time together with patients in eating, dressing, bathing or activity sessions such as walking or talking. The findings on staff attitudes and behaviour derives mostly from specific nurse studies (Armstrong, Browne and McAfee 1994; Salmon P 1993; Sandman P O and Norberg A 1988), and therefore recommendations concentrate on giving nurse-staff a repertoire of 13

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