Background

According to current data, approximately 1.2 million people in Germany suffer from dementia. Especially due to the foreseeable demographic ageing process, this number is expected to increase to over 2 million affected persons by 2050.

The effort to deal with this group of people in a humane way requires a high degree of professional competence on the part of professional care and support. A particular challenge is dealing with people whose behaviour changes so much due to the course of the disease that it is perceived as problematic or "disturbing".

It is assumed that many of these so-called challenging behaviours are often the only remaining ways for those affected to express their needs, their wishes or their suffering. In doing so, however, they often meet with rejection and incomprehension from those around them.

The "Framework Recommendations for Dealing with Challenging Behaviour in People with Dementia in Inpatient Care for the Elderly" published by the Federal Ministry of Health in 2006 recommend a series of measures which, as non-drug nursing intervention measures, are intended to contribute to improving the quality of care and quality of life for dementia patients with "behavioural problems".

Nevertheless, very little is known to date about howsuccessful the recommended measures actually are and what effects they have both on the dementia patients themselves and with regard to a possible strengthening of the competence to act and the job satisfaction of the caregivers. In empirical research, the topic described has hardly gained a foothold so far and thus there are only a few studies that meet high methodological standards. This lack of or ambiguous evidence applies in particular to the emotion-oriented approaches to the non-drug care and support of persons suffering from dementia.

The object of the Emoti-Komm project is the scientific development of stage-specific, emotion-oriented, nursing approaches and strategies for dealing with people with dementia in inpatient and day-care long-term care. The emotion-oriented approaches of "Integrative Validation" (IVA) according to Nicole Richard and "Basal Stimulation" according to Fröhlich and Bienstein are to be examined. Both approaches are part of the aforementioned "framework recommendations" of the BMG. So far, the IVA concept according to Richard has not been subjected to any scientific analysis. And there is also a lack of meaningful studies on the significance and effect of basal sensory stimulation in adults and the elderly.

Research questions

The theoretical elements of the concept of IVA according to Richard and of basal stimulation according to Fröhlich and Bienstein are reconstructed and evaluated. This leads to the following basic research questions:

• Are these theoretical concepts based on scientifically sound expertise and conclusive?
• Is it a matter of communicable action knowledge that can be applied in individual nursing cases, i.e. with regard to dementia-related behavioural changes, and that evokes a better quality of care and quality of life?
• Can conclusions in the sense of generalisable statements on (elderly) care be drawn from the concepts and their applications?
• How are the concepts of IVA and basal stimulation applied and what effects do the individual interventions achieve in relation to certain target criteria, such as "activities of daily living", "aggressiveness", "agitation" or "depressiveness"? How can difficulties in understanding and especially the problem of challenging behaviour and thus conflict situations be reduced or prevented?
• Which concept-related techniques and methods can prevent the known problems in dealing with people with dementia?
• Which concept-related nursing or caring research methods are suitable for generating findings on the above-mentioned target criteria as well as additional interpretative knowledge on the perceptual world of persons with dementia on their own experience of the world?

The study design of the Emoti-Komm project is planned as a qualitative case study in the sense of an integrated longitudinal study. Through the case comparisons and case contrasts carried out here, relevance, variances, heterogeneities and, in particular, their effects are analysed - in relation to the concepts applied. The method of grounded theory is considered a suitable procedure for adequately addressing the present research question: Modes of action and strategies of action are methodologically appropriately elicited and reconstructed from different perspectives. In this sense, the interactive-communicative care action (structured, unstructured, participatory and non-participatory, use of videographic recordings) is observed. Situational conversations and interviews on the observed care situation will be conducted with the caregivers and the relatives.

The data collection will take place in two field phases in the facilities of the practice partners listed above. The required data will probably be collected in a total of 10 living areas with approx. 50-70 residents. At least 3-4 interviews with caregivers and possibly 2 interviews with relatives will be conducted per residential area.

Aims, qualification and dissemination

The emotion-oriented communication approaches in the care of people suffering from dementia that are being investigated here are, on the one hand, very well known, they are widely used and learned, on the other hand, their effects have not yet been scientifically evaluated. As a result, the research project should be able to make differentiated statements about the indication areas and effects of the above-mentioned concepts. On the one hand, with regard to an improvement in the quality of care and life of those affected in institutional care situations themselves and, on the other hand, with regard to an increase in the competence to act and the job satisfaction of the caregivers.

The results of the research project will also provide important information and generate further research hypotheses on the palliative care of persons with dementia.

With the help of the study results obtained, an empirically based contribution will also be made to clarifying the question of the professionalisation of nursing raised in the debate on nursing science and sociology of professions.

The study results are to be transported into practice across the board and in a way that is appropriate to the target group, especially to people affected by dementia, relatives, carers and voluntary carers.

The research project will provide health and long-term care policy-makers as well as nursing associations with insights into the issues relevant to education, further education and training as well as the organisational orientation of inpatient long-term care facilities.

Dammert M, Keller C, Beer T, Bleses HM (2016): Person-Sein zwischen Anspruch und Wirklichkeit: Eine Untersuchung zur Anwendung der Integrativen Validation und der Basalen Stimulation in der Begleitung von Personen mit Demenz (Randgebiete des Sozialen). Edition: 1. Weinheim: Beltz Juventa.