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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 1. Exploration of daily life for residents / patients in psychogeriatric or residential settings (Two studies) 2. Connection between staff –resident interactions and staff attitudes (Three studies) 3. Exploration of change in social interaction as part of changing treatment or environment (Four studies) Daily life for residents / patients in psychogeriatric or residential settings There were two research studies of valuable evidence (see Table 1) in this section. One Randomised Control Study (Hallberg et al 1990) and one descriptive study carried out by an occupational therapist (Perrin 1997). Although they are from two different countries (Sweden & the UK), the results present similar findings in that people with dementia living in residential settings still live a life deprived from occupation and social interaction. Both studies are relatively recent and it is likely that the physical environments would be appropriate. Nevertheless the studies paint a very depressing picture of the lifes of persons with cognitive problems and difficulties in communication. These people, truly the most frail of old persons, are spending a life in extreme lassitude and passivity marked with occupational poverty. Assessments (Perrin T 1997) show more often ill-being than well-being and the staff seem in both studies not able to meet the occupational needs of the residents. In the Swedish study (Hallberg I R, Norberg A & Eriksson S 1990) it was measured, that the most vocally disruptive residents had the least offers of activities. Tessa Perrin (1997 p 6

Assignment on Evidence Based Practice in OT - December 2000 Staff attitudes, social interaction and people with dementia in residential settings 940) tries an explanation: ‘the clients with little language or comprehension are difficult to engage in social interaction or activities and many staff feel hopeless impotent in face of such devastating disability and need’. These observations and trials of high research-value must give rise to worry. In great part, patients with verbally disruptive behaviour suffer from stimulus and social deprivation, although they evidently would have had benefit of stimulation, activities and a richer environment (Cohen-Mansfield J & Werner P 1997). Social interactions connected to staff attitudes (three studies) The methodology of these researches, were all quantitative, but drew on different approaches: 2 surveys and a clinical controlled trial (see Table 2). The passive and isolated daily lives of residents in residential settings described earlier are also repeated in the three studies from this area. In these studies staff-attitude, staff behaviour and actual working philosophy are investigated as a possible key to secure social interactions and a better daily life for residents . Evidently there is a discrepancy between nurse behaviour and nurse statements. Staffs seem to be unconscious on how they actually practice. Even though nurses from the study give ‘talking to patients’ high priority, observations of their actual behaviour shows recurrently a notable reluctance or inability to engage for any length of time with a client in anything other than a task –oriented activity. Armstrong, Browne & McAfee (1994 p.270) states that ‘despite the advances that have been made in nurse education over the last two decades, 7

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