Teaching for learning and learning for teaching in care of elderly with dementia at Silviahemmet

Abstract

The overall aim of this thesis was to describe a specific non-governmental programme for training licensed practical nurses as caregivers and mentors in the care of elderly with dementia. The setting for the work was Silviahemmet in Stockholm, Sweden, and the approach was inspired by ethnography.

The aim of the first study was to describe the change in outlook of the trainees toward elderly patients with dementia during their year of special education. At the beginning of the programme, the trainees saw the patients from a staff perspective. Over the course of the year, however, this was gradually toned down as they changed to a disease perspective and eventually to a human dignity perspective. The approach to their work also changed, from task-oriented to more humanitarian (I).

The second study illuminates the educational programme, the philosophy of which was inspired by principles of palliative care. The findings were presented in four themes based on the cornerstones of palliative care emphasized during the education: symptom control, quality of life-communication-relationship, family support and teamwork. The paramount approach, didactic strategies and trainees' comments were also presented (II).

The third study illuminates how the trainees utilize their practical training to learn about dementia. The findings showed that the trainees made use of each practical training context in a similar fashion but there were differences between the contexts (day-care, group dwelling and nursing home). In the day-care unit, a human dignity perspective was prevalent. Trainees saw no gap between theory and practice, as the programme's philosophy was applied consistently. In the group dwelling, we encountered patients with various forms of dementia and could compare them. In the nursing home, trainees took a staff perspective, with a focus on organization, management, working conditions and staff attitudes. Trainees felt that the nursing home staff needed training and mentoring but many of them wished to avoid working there. They considered it "better to withdraw than fight poorly" (III).

The fourth study, "The patient as 'teacher'," examined the experiences, which the trainees gained by working with a single patient during the entire practical training period in the school's integrated day-care unit for elderly with dementia. Central themes included the role of the "personal guide" and patient relationships. As personal guides, die trainees fell into six categories (observer, shadow, converser, organizer, pal and guide) with different focuses. Another skill, which they were taught, was haw to slow the pace of their work. "Investigative mealtimes" provided an excellent opportunity for learning about dementia. For the trainees, the practical training was a new, difficult, instructive and arduous experience (IV).

The last study focused on how the licensed practical nurses as Silviasystrar (Silvia nurses) shaped their roles as caregivers and mentors in their work following die education. The patient perspective was reflected in how they prioritized time spent with the elderly and how they acted forcefully as the patients' "advocate". They applied the palliative caregiving philosophy mainly as related to its four cornerstones. Moreover, the education gave the trainees a stronger identity as LPNs. They felt assured enough to stand up for their opinions. Their new role as 'Silvia nurses' can be described as a continuum from the role model as "the good caregiver" through informal peer supporter to formal course leader and lecturer outside the working place. The LPNs were divided into two groups. Those who, following the education, received jobs tailored specifically for them or were given time for teaching or mentoring felt that they were working in a positive situation. Those who fit the category "both better and worse" felt that their employers were not utilizing their skills to the extent they had hoped and looked outside the working place for ways to promote dementia issues (V).