Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA.
Department of Family & Community Medicine, University of California, San Francisco, CA, USA.
Age Ageing. 2019 Sep 1;48(5):727-734. doi: 10.1093/ageing/afz030.
of the estimated 1.4 million residents of US nursing homes, over half have dementia. In the final stages of dementia, caregiving is complicated by the inability of care recipients to speak intelligibly or express their needs.
to examine the ways in which a nursing home end-stage dementia special care unit (SCU) functioned as a caring community for people near the end of life.
a qualitative, ethnographic case study was conducted in a highly-regarded SCU. Over 175 hours of scheduled activity observations were completed over 2 years, bolstered by 30 hours of caregiving observations on the end-stage dementia unit and 19 interviews with SCU carers. Inductive coding was completed independently by two researchers, emerging themes reconciled by consensus, and qualitative analysis conducted iteratively until the endpoint of thematic saturation.
on the SCU, employees and volunteers fostered relationships based upon a model of family. They formed a caring community that included professionals, volunteers, friends and family. Relationships were supported through (1) the use of reminiscence to evoke intact long-term memories, (2) the use of verbal communication long after care-recipients could no longer speak and (3) the use of intentional nonverbal communication, including daily music, pet visits, and sensory stimulation.
through detailed examination of daily life, this study identified articulated beliefs and observable behaviour through which to develop relationship-centred care in the context of end-stage dementia. The caring community offers primary source data for the development of mid-level theory and the generation of new hypotheses.
在美国养老院的估计 140 万居民中，超过一半患有痴呆症。在痴呆症的晚期阶段，由于护理对象无法清晰地说话或表达他们的需求，护理变得复杂。
研究养老院终末期痴呆症特别护理单元 (SCU) 如何作为生命末期人群的关怀社区运作。
在一个备受推崇的 SCU 中进行了定性、民族志案例研究。在 2 年期间完成了超过 175 小时的预定活动观察，通过在终末期痴呆病房进行 30 小时的护理观察和 19 次 SCU 护理人员访谈得到了补充。两位研究人员独立完成了归纳编码，通过共识解决了出现的主题，并通过迭代进行了定性分析，直到主题饱和的终点。
在 SCU 上，员工和志愿者基于家庭模式建立关系。他们形成了一个关怀社区，包括专业人员、志愿者、朋友和家人。关系通过以下方式得到支持：(1) 使用回忆唤起完整的长期记忆，(2) 在护理对象无法再说话后仍使用言语交流，以及 (3) 使用有意的非言语交流，包括日常音乐、宠物探访和感官刺激。
通过对日常生活的详细检查，本研究确定了表达清晰的信念和可观察的行为，以在终末期痴呆症的背景下发展以关系为中心的护理。关怀社区为中级理论的发展和新假设的产生提供了主要的原始数据。
