The nurse-patient encounter and the patients' state: Effects of individual care and clinical group supervision in dementia care.

The aim of thesis was to investigate the nurse-patient encounter in dementia care (n=9 patients), functional and cognitive ability, behaviours and mood of the patients as well as the reliability of the instruments used (n=75 nursing home patients). A further aim was to investigate the effects on the aspects mentioned above of a one-year controlled intervention (individually planned care and clinical group supervision) on one ward (EW) in comparison to a control ward (CW), each housing 11 patients. The nurse-patient encounter was studied by means of tape recorded interaction episodes including patients' regarded as vocally demanding. The inter-rater reliability of the Patient Mood Assessment Scale (PMAS), the General Behaviour Assessment Scale (GBAS), the Gottfries-Bråne-Steen Scale and the patients' state were investigated using nurses' assessments of the patients. The intervention effects were investigated at baseline and throughout the year, for the patients' state using PMAS, GBAS, Organic Brain Syndrome scale, Multi Dimensional Dementia Assessment Scale, Demanding Behaviour Assessment Scale and Mini Mental State Examination, and for the nurse-patient encounter using non-participant observations during morning care and analysis of notes from clinical supervision sessions.

Patients actively seeking contact and nurses mediating "caring about", i.e. mutuality and confirming actions, characterised high quality encounters. Nurses' or patients' withdrawal, nurses being inattentive i.e. unilaterality and disconfirming actions, characterised poor quality encounters. The inter-rater reliability of the nurses' assessments of patients' state was acceptable for ADL and intellectual functions but low for emotional dimensions. Significant improvements were seen on the EW for nurse-patient encounters, patients' sensitivity and demanding behaviours while significant detoriations were seen on CW in nurse-patient encounters, patients' functional performance and orientation in the ward, speech performance and strength. Thus the nurse-patient encounters and the patients' state developed in opposite directions on the two wards, positively on the EW and seemingly the intervention supported the nurses in their encounters with the patients, which in turn was reflected in the patients' state.