Department of Care Ethics, University of Humanistic Studies, Utrecht, Utrecht, The Netherlands.
Julius Center for Healthcare Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
PLoS One. 2024 Mar 27;19(3):e0298783. doi: 10.1371/journal.pone.0298783. eCollection 2024.
People with mild to moderate dementia and their loved ones may experience strong existential and spiritual challenges due to the disease. People with dementia could therefore benefit greatly from ongoing conversational support. Within the literature and in supportive practice, there are very few tools that help professionals provide this type of support. Professionals may therefore be unaware of, or uncertain of, how support can be given.
To develop and test support approaches that may enable professionals to better conduct conversations with attention for existential and spiritual issues.
Participatory action research was conducted with dementia care professionals who spoke to 62 clients and 36 loved ones. Research consisted of two cycles of analyzing support, formulating strategies to try, testing and reflecting on the success of these actions and formulating new ones. The Diamond model for existential and spiritual issues regarding mild to moderate dementia, developed in previous research, was used as a framework.
Five types of approaches, corresponding to the five fundamental polarities within the basic framework, were found to be helpful in alleviating tensions and bolstering strengths. For issues of self-confidence and -worth, an approach of exploring the felt self was developed; for issues of capacity and adaptability, an exploring daily routines approach; for issues of security and loss, an exploring a trinity of needs approach; for issues of burden and enrichment, an exploring memory approach; and for issues of faith and meaning, an exploring ones' predicament approach. When exploring these approaches, participants found sets and sequencing of questions and prompts to be helpful and transformative.
Professionals can use the Diamond framework to provide conversational support to alleviate tension, enhance meaning and bolster strength for clients and loved ones.
轻度至中度痴呆症患者及其家属可能会因疾病而经历强烈的存在和精神挑战。因此，痴呆症患者可以从持续的对话支持中受益匪浅。在文献和支持性实践中，很少有工具可以帮助专业人员提供这种类型的支持。因此，专业人员可能不知道或不确定如何提供支持。
开发和测试支持方法，使专业人员能够更好地进行关注存在和精神问题的对话。
采用参与式行动研究，与 62 名患者和 36 名家属交谈的痴呆症护理专业人员参与了研究。研究包括两个循环的支持分析，制定尝试策略，测试和反思这些行动的成功并制定新的策略。以前的研究中开发的针对轻度至中度痴呆症的存在和精神问题的钻石模型被用作框架。
发现五种类型的方法有助于缓解紧张局势并增强优势，这些方法对应于基本框架中的五个基本极性。对于自信和自我价值感问题，开发了一种探索自我感觉的方法；对于能力和适应性问题，开发了一种探索日常生活常规的方法；对于安全和失落感问题，开发了一种探索三位一体需求的方法；对于负担和丰富感问题，开发了一种探索记忆的方法；对于信仰和意义问题，开发了一种探索困境的方法。当探索这些方法时，参与者发现问题和提示的集合并置非常有帮助和具有变革性。
专业人员可以使用钻石框架为患者和家属提供对话支持，以缓解紧张局势，增强意义并增强力量。
