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here - Able - Annette Johannesen

here - Able - Annette Johannesen

Assignment on Evidence

Assignment on Evidence Based Practice in OT - December 2000 Staff attitudes, social interaction and people with dementia in residential settings there still appears to be a dichotomy between the ideals of what we learn and the reality of how we practice’. It is questioned how nurses should be trained to learn this. According to the study of Salmon (1993), scheduled activity programs seems to be a possibility, since a higher proportion of interactions, which were positive, were seen during activity periods, than at other times. This is congruent with the findings of Korremann, Meldgaard & Skrubbeltrang (1985) who discovered, that actual working attitude has significant importance on the functional level and well being of the residents. The staffing level and degree of impairment of residents do play a role for social interacting and activity level of the residents, but most important is the way staff regards their residents and actually co-operates with them. In institutions where staffs work after a ‘helping strategy’, residents become significantly more passive and with little social interaction compared to institutions where staffs work after an ‘interacting’ and ‘self determination’ strategy. Change in social interaction as part of changing treatment or environment (Four studies) Table 3 presents four studies of different interventions and again ‘social interaction’ is seen as a sensitive outcome measure. In all studies the social interaction were either enhanced or decreased, as a result of a change in environment or intervention and so was staff attitude. What differs in the studies seems to be the amount of support and guidance of staff while changing treatment or environment. The two most valid of the four studies are the CCT of Ingstad & Götestam (1987) and the qualitative study of Morgan and Stewart (1997) using grounded theory techniques. 8

Assignment on Evidence Based Practice in OT - December 2000 Staff attitudes, social interaction and people with dementia in residential settings The study trial of Ingstad P J & Götestam G (1987) depicts the logic of facts: 1. Environmental changes concurrently followed by activating treatment could improve residents’ behaviour. 2. The improved resident behaviour and /or the new activating way of caring changed the staff attitude significantly positive Staffs in the experiment-group were encouraged to prompt activity and to work in a constructive and positive way with the elderly concurrently with minor changes of the physical environment. Since there was awareness on the importance of staff attitude, staffs were instructed how to work in new ways, which resulted in significant improvements of resident-behaviour and staff attitude to the residents. Social interaction increased among residents, as examples is mentioned that staffs spent more time with residents on breakfast and supported residents to dress themselves. In comparison, the exact opposite development is seen in the study of Morgan D G and Stewart N J (1997): Concurrently with moving residents to modern special care units, the staff-resident ratio was decreased and the activity aide staff was eliminated. The social interactions and activity-level of residents decreased after moving. It is concluded, that the social environment have more impact on quality of life and functional ability than physical environment. Conclusions and recommendations 9

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