Care Relationships Research Articles

Walking the Table: Caring-with landscape

Walking the Table is an experimental project that develops a relationship of care, registering and becoming conscious of subtle changes within an Australian landscape. Drawing on Donna Haraway’s ideas of ‘making-with’1 and Tim Ingold’s concept of ‘thinking through making’2 this visual essay explores ideas of relational care within a rapidly altering landscape and how one may become an attentive participant, moving with a changing landscape as a practice of care. Understanding ‘landscape’ to be a layered entanglement of systems, materials and inhabitants (more-than-human and human) movements and projections that are influenced by the past and present, the role of the photographs and two forms of text is to weave three different layers of conversation that are relational and form an overall narrative. Photography is used to capture the process of a dialogue emerging between the walker and the landscape, facilitated through the camera and the table when walking the table around the site. Landscape and care is an ever-evolving relationship that requires attentiveness and participation. When a relationship with a landscape is built over a prolonged period of time, revealed are the drastic differences in scales of temporal shifts that landscapes undergo, formulating an ongoing dialogue between the landscape and the inhabitant of that landscape. Cover image: Shadow 11, Noticing an unusual shadow of a tree branch I looked up. What we humans botanically classify as an Ulmus species had a strange growth on its smaller branches. Unknown to me whether the tree has wing-bark disease or is a cork-winged Elm, after this discovery and unsure whether the Elm was sick or not, each time I passed by, I would check on the tree.

What is recovering? Reflection on the place of perception, time and norms in health recovery

The notion of recovery is frequently evoked in healthcare, but it carries with it a number of ambiguities: do we envisage a return to a state that preceded the illness, or a way of composing a new way of living based on the illness? In order to think more precisely about recovery, this paper proposes to take a philosophical look at the notion of norm and to develop its importance through an approach to time, body and world. This analysis will make it possible to clarify the existential aspects involved in health recovery, and to describe the issues at stake in the care relationship in terms of these dimensions of subjective experience.

Healthy@Home, An Integrated Health and Social Care Program for a Marginalized Population Group in Toronto, Canada

Introduction: Integrated health and social care (IHSC) can support improved health and social care outcomes for highly vulnerable and marginalized population groups. Toronto has one of the most diverse populations in the world. Immigrants account for 46% of the city's population. Russian-speaking Jewish older adults are a population group who are at significant risk of isolation and poor access to health and social services. In response an adult day program, Healthy@Home (H@H) was established through multi-organizational partnership among community-based health and social care outcomes led by social services agencies has spread to 20 sites across Canada.
 Methodology: a qualitative study of H@H was undertaken to explore the factors that support successful integrated services delivery for this high-risk population group. Key informant interviews and focus groups were completed involving eight health and social care agencies to explore the factors that support successful IHSC. 
 Results: The qualitative study identified eleven critical factors that support IHSC among many health and social care agencies. They include strong communications, shared vision and goals, team-based care, dedicated resources, inter-organizational culture, and pre-existing relationships were overwhelmingly regarded as being key to the success of H@H partnerships. Leadership and accountability agreements were also regarded as being important factors. The H@H case also identified pre-existing relationships, role clarity and champions that contributed towards its integration success. The H@H case offers up some unique insights into how context can have an important role in influencing IHSC and that may be unique to services provision in Toronto. Ten contextual factors were identified as having exerted an influence on services partnership. They include aging population, immigration population, transportation, differences in the healthcare and social care sectors, accountability agreements with governing authorities and funders, public funding, governance authorities, sense of community among the providers, public policies and being part of the not-for-profit sector.
 Lessons Learned: The H@H study has shown that IHSC can occur voluntarily and at the grass-roots level. It also provides insights into how IHSC can be initiated and driven by social services agencies who are united by a shared vision and goal, and a strong sense of community. Despite limited funding and external resources, these organizational partners have been able to engage in IHSC for more than a decade in order to respond to a significant unmet need for a population group that was being ignored and marginalized due to their socio-economic status, their immigration status, and language barriers by existing health and welfare systems. Their isolation from mainstream society put them at significant risk of falling through the Canadian welfare system cracks. These community-based agencies, with close ties to their neighbourhoods were able to engage, respond, coordinate, and integrate flexibly. Contextual factors including a supportive policy environment that was aimed at supporting ageing in place, seniors care, poverty reduction and immigrants and a vibrant community of culturally competent providers has made H@H a success.

Becoming Healthier

To meet the challenges of an ageing population, increasing chronic diseases, and rising healthcare costs, Singapore is embarking on a long-term, multi-year strategic reform to shift care to the community, to improve value for resources expended, and to make the prevention of diseases and complications the focus of the health and social care system. Healthier SG will launch in the middle of 2023 for those aged 60 and above.
 The reform will enlist, integrate and enhance the mostly-private primary care sector into primary care networks. Residents will enrol to a selected primary care provider for long-term care relationships based on individualised health plans incorporating primary and secondary preventive activities like lifestyle improvements, health screenings and vaccinations. Social prescribing to community partners will enhance the prevention of disease and complications. Corollary enablers will also be enhanced, from health and social information sharing, to manpower development, to financial incentives and support. Digital Health capabilities like the national patient information repositories and personal trackers will be part of the intended new health ecology.
 This presentation will describe the health and social care reform, its origins and drivers and currently intended plan and desired outcomes, and discuss its theory of change, implementational challenges and potential enablers and barriers for success. In particular, we will discuss the difficulties in the systematic measurement, monitoring and evaluation of a large-scale multi-year reform, and the governance and leadership challenges to maintaining coherence and shaping trajectories in such complex endeavours.

Traces of Hope from a New Transnational Well-Being Index: World Love Index

The article discusses the development of a new measurement called the World Love Index, which aims to evaluate people’s capacity to care for others and the world as an indicator of well-being. Drawing inspiration from appeals by intellectuals to shift towards a new form of humanism, the proposed new index aims to mark the transition towards a new social ecology, and it emphasizes the importance of social connections and relationships. In this way, it tries to capture the challenge of the quest of hope in the post-pandemic era. The study integrates data from the Gallup World Poll and World Values Survey to create this index, focusing on dimensions like overabundance of giving and care for others. The research identifies different clusters of countries based on their orientation towards environmental concern or humanitarian support, revealing how social love varies across income levels. The study argues that focusing on social love as a measure of well-being can lead to transformative policies that emphasize community-building and solidarity, offering a new narrative of progress centered on caring for one another and the environment. Against the backdrop of the post-pandemic era’s socio-economic challenges and echoes of historical crises, the study advocates for a paradigm shift away from traditional GDP-centric metrics, advocating for a comprehensive approach to measuring well-being that considers diverse dimensions of human experience. Ultimately, the World Love Index presents an innovative way to assess societies’ propensity for compassion and offers a fresh perspective on fostering hope and transformation through community-building and caring relationships.

Management Strategies for Blood Pressure Control in Elective Pre-Surgery Patients: Focusing on Family Support Improvement, Anxiety Control, and Caring Behavior in Receiving Room

Surgery can be generally defined as a medical action that causes a stressor on a person's integrity, resulting in a stress response, both psychological and physiological. It is totally normal to feel anxious before surgery. This study aimed to identify the management strategies for blood pressure control in elective pre-surgery patients, focusing on family support improvement, anxiety control, and caring behavior. It was an analytical-correlational study which the total samples were 130 respondents at the receiving room of Malang Lavalette Hospital. The data analysis confirmed significant relationships in elective pre-surgery patient care. Family support and nurses' caring behavior had notable impacts on patient anxiety with p values of 0.000 and 0.034 respectively. Moreover, family support and anxiety, as well as anxiety and blood pressure, demonstrated significant associations with p values of 0.000. Notably, family support exhibited a direct effect on blood pressure (0.568) greater than its indirect effect through anxiety (0.453), summing to a total effect of 1.021. Similarly, nurses' caring behavior had a direct effect on blood pressure (0.1225) exceeding its indirect effect through anxiety (0.1099), resulting in a total effect of 0.2324. The researchers found that there was an effect of elective pre-surgery patients management strategies on blood pressure control in terms of increasing family support, anxiety control and caring behavior in receiving room.

The experiences of people living with dementia and their care partners participating in an online therapeutic songwriting program.

Despite the impact of dementia on close care relationships, accessible therapeutic services for people living with dementia and their care partners remain scarce. Further, there is an increasing demand for online services, highlighting the need for ongoing telehealth research. This study aimed to explore the experiences of people living with dementia and their informal and formal care partners following participation in a 10-week online therapeutic songwriting program. The songwriting program included four duo and six group sessions facilitated by a music therapist. Post-program semi-structured interviews were analysed using thematic analysis. Nine people with dementia and six care partners (nine duos) participated in the program. Five duos were in spousal relationships and four people with dementia participated with a formal care partner. Participants attended an average of four duo sessions and three group sessions. Six people with dementia and five care partners participated in post-program interviews. Four themes were developed: (1) No one else does this; (2) It's all about us as people; (3) After the sessions we'd come out buzzing; and (4) The journey was as important as the product. Participants highlighted songwriting as a unique opportunity to connect with music, experience welcomed challenges, and spend 'real time' together. The program drew on participants' lived experience and promoted connection with others, resulting in feelings of enjoyment, enhanced mood, and achievement. Participants valued both the songwriting process and song product, emphasising the importance of sensitive and skilful facilitation. Our findings suggest that these distinct benefits were not available through other support services. Further, online songwriting is a viable option for people living with dementia and their care partners where in-person sessions are not available or accessible.

THE READYR PROGRAM FOR WELL-BEING IN DEMENTIA: PILOT STUDY AND SIX-MONTH FOLLOW-UP RESULTS AMONG SPOUSE–PARTNER DYADS

Abstract The READyR Program assesses and targets everyday routines of care dyads (older adults with cognitive impairment and their co-habiting partners) using in-home sensors and video-conference sessions in order to understand future care needs, and promote greater well-being. This study aimed to evaluate the feasibility, acceptability, and pilot test of efficacy for READyR. Fifteen dyads (96% married) were enrolled in the 6-month study, and randomized to immediately join READyR (n=8 dyads) or to complete READyR after an educational control condition (n=7 dyads). Feasibility was high: 100% of enrolled dyads completed ≥1 session; 80% completed all sessions. Acceptability was also high: responding participants (n=26) reported that READyR helped them express their care values and understand their care needs (92%), that they were comfortable sharing their views (92%) and doing so with their partner present (96%). Hearing and visual impairments were reported to interfere with online sessions for 4 and 6 participants, respectively, but 93% of participants reported that the digital components were easy to use and understand. After receiving the READyR sessions, awareness of future care needs among care partners increased (d = 0.85) and relationship strain for both dyad members decreased (d = 0.58–0.82), when compared to changes among participants in the active control group. No effect was observed on participants’ quality of life, mood, or care-related strain at post-test or at 6 month follow-up. As a remote dyadic intervention, READyR is feasible, acceptable, and may help dyads decrease strain in the care relationship and prepare for future care needs.

A MODEL FOR DISSEMINATING EVIDENCE-BASED RESIDENT-TO-RESIDENT AGGRESSION INTERVENTION PROGRAMS

Abstract In elder mistreatment research, a key problem is the failure to disseminate interventions to broad audiences. This gap prevents most interventions from benefitting victims and improving their quality of life. Interventions are often not disseminated because of a lack funding, staffing, and support from provider organizations. We report on a novel, low-cost dissemination model to circumvent these barriers and expand program reach. The program, Improving Resident Relationships in Long Term Care (IRRL), trains staff to recognize resident-to-resident aggression (RRA) and to learn how to manage it. The training consists of two sessions, (1) recognition and (2) management. A dissemination model was created that included systematic marketing, outreach, and organizational sponsorship. We describe the model, which is replicable for a variety of dissemination efforts: 1) creating an easily accessible manual, supporting documents, and evaluation materials; 2) designing a user-friendly website for distribution; 3) identifying provider associations for program marketing; 4) developing partnerships with LTC organizations for dissemination; 5) providing national informational webinars; 6) offering webinar participants subsequent train-the-trainer sessions and coaching. This plan is feasible with limited expenditures and can be accomplished via the use of student research assistants. Using this model, the IRRL program has gained organizational support and has employed web-based training to reach over 300 providers. The dissemination of the IRRL program offers a potential method for intervention delivery with limited funding. Implications for future dissemination research are discussed.

IDENTIFYING AND PREVENTING RESIDENT-TO-RESIDENT AGGRESSION IN LONG-TERM CARE: EMERGING GLOBAL PERSPECTIVES

Abstract Resident-to-resident aggression (RRA) is a widespread form of mistreatment in long-term care facilities, affecting 1 in 5 residents every month. Despite its high frequency and adverse consequences for residents, staff, and family members, RRA remains under-recognized and insufficiently studied. Several reasons exist for this, including challenges in obtaining high-quality data to inform evidence-based prevention and intervention strategies. Improved understanding of RRA aligns with recent national policy imperatives to increase nursing home safety and quality of care. To accelerate knowledge-to-practice translation, this symposium highlights expertise from North America and Asia to review the latest evidence and experiences that characterize and improve RRA. Dr. E-Shien Chang will identify the role of racial and ethnic conflicts in RRA using data from the largest RRA prevalence cohort study of U.S. nursing home residents. Dr. Elsie Yan will examine resident and environment risk factors of RRA in Hong Kong, illustrating the needs for improved dementia care training among direct care workers. Dr. David Burnes will discuss barriers, successes, and lessons learned in replicating and adapting a gold standard U.S. based RRA prevalence study in the unique context of Canada. Dr. Karl Pillemer will describe a novel dissemination model to expand program reach of Improving Resident Relationships in Long Term Care (IRRL), an evidence-based RRA intervention program. Finally, Dr. Laura Mosqueda, as policy expert of long-term care services and discussant, will moderate a discussion on translating RRA research to practice and policy changes within the global contexts of long-term care. This is a collaborative symposium between the Abuse, Neglect and Exploitation of Older Persons and Research in Quality of Care Interest Groups.

COLLABORATING WITH LONG-TERM CARE PROVIDERS IN ELDER MISTREATMENT RESEARCH

Abstract To study elder mistreatment in institutional settings, collaboration is needed with nursing home and assisted living providers. Studies show that common problems emerge in researcher-practitioner collaboration, including differences in the key areas of orientation, training, nature of evidence, time horizons, and uses of research. Barriers specific to collaboration with. LTC providers also present challenges, including reputational risk from participating in EM studies and demands on administrative and staff time that limit availability for research. We report on a successful model for collaboration with LTC providers, based on the implementation and evaluation of the “Improving Resident Relationships in Long-Term Care” program. This evidence-based program was implemented to prevent and treat resident-to-resident aggression in nursing homes (16 facilities) and assisted living (14 facilities), involving over 2000 residents. Findings revealed a set of replicable elements to obtain LTC provider collaboration on sensitive issues like resident-to-resident aggression: (1) Preparatory efforts to gain commitment of administrative personnel; (2) agreements regarding confidentiality and anonymity; (3) identification of one or more “facility champions,” who demonstrate enthusiasm and willingness to advocate for the program; (4) providing payment to participating facilities to cover expenses such as overtime needed to release staff to attend trainings; (5) gaining the support of trusted provider organizations; (6) demonstrating that the program helps meet regulatory requirements; and (7) a procedure to allow for pragmatic modifications to the intervention that allow greater fit with the provider’s workflow. Implications for elder mistreatment intervention research are discussed.

USING NATIONAL CORE INDICATORS—AGING AND DISABILITIES—FOR QUALITY, POLICY, AND SYSTEM TRANSFORMATION

Abstract National Core Indicators Aging and Disabilities (NCI-AD™), uses survey data to support State Medicaid, aging, and disability agencies to conduct surveys with individuals receiving publicly-funded long-term services and supports and measure and track their own outcomes and performance using reliable data collection methods and tools. Established in 2015, NCI-AD is now in use by 22 states nationwide. The NCI-AD portfolio includes the flagship survey – the Adult Consumer Survey (ACS) and the State of the Workforce—Aging and Disabilities (SotW-AD) survey. The ACS collects data directly from older adults and people with physical disabilities to assess the outcomes of services provided to individuals. Indicators address key areas of concern including service planning, rights, community inclusion, choice, health and care coordination, safety and relationships. In 2022, NCI-AD piloted the SotW-AD survey with five participating states. A first of its kind for the aging and disabilities field, this new effort collects and aggregates statewide information about wages, benefits, and turnover of the direct service workforce—as reported by the agencies that employ them. The SotW-AD will launch to all AD states in summer 2023. This session will provide an overview of the NCI-AD program, the type of data collected from each survey, and how state-level and research partners have utilized the data sets.

EXAMINING DIFFERENCES IN SLEEP QUALITY AMONG CAREGIVERS FOR PERSONS LIVING WITH AND WITHOUT DEMENTIA

Abstract Sleep disturbances among caregivers are linked to increased burden and worse mental health outcomes. Caregivers for persons living with dementia experience more sleep disturbances than non-caregivers. Few studies examine whether sleep quality differs between dementia and non-dementia caregivers. This study analyzes whether dementia caregivers experience worse sleep quality than non-dementia caregivers. Using 2017 National Study of Caregiving, National Health and Aging Trends Study, and time diary interview data, we examined the relationship between caregiver sleep quality (“excellent/very good” versus “good/fair/poor” the previous night) and care recipient’s dementia status (“probable” versus “no”) for 1,374 caregivers in a series of nested multi-variable logistic regression models, controlling for the caregiver and care recipient sociodemographic characteristics, relationship quality, and other controls. Caregivers’ mean age was 62.3 years old (SD=14) and about two-thirds were women (68%), non-Hispanic White (69.4%), and married (66%) Thirty-eight percent cared for persons living with dementia. In the bivariate model, being a caregiver for someone living with dementia was associated with significantly lower odds of reporting “excellent/very good” sleep quality (OR: 0.78, 95%CI: 0.62-0.97, p=0.02). This relationship persisted independent of caregiver and care recipient demographic characteristics. However, caregiver perceptions of the quality of their relationship with the care recipient and the benefits of their caregiving role explained the relationship between care recipient dementia status and caregiver sleep quality ratings (AOR: 0.80, 95%CI: 0.63-1.02, p=0.08). Addressing caregiver burden and relationship quality may help improve sleep quality among dementia caregivers and reduce disparities in sleep quality between dementia and non-dementia caregivers.

Assessment of back pain behaviors, attitudes, and beliefs of chiropractic research conference attendees after a biopsychosocial educational workshop.

The purpose of this study was to assess the behaviors, attitudes, and beliefs of attendees of a chiropractic research conference (which included chiropractic students, clinicians, researchers, and educators) toward chronic low back pain (CLBP) before and after a biopsychosocial (BPS)-based CLBP educational workshop. This single-arm intervention study used the Health Care Providers' Pain and Relationship Scale (HC-PAIRS) and CLBP-related clinic vignettes to assess behaviors, attitudes, and beliefs toward CLBP before and after a single 90-minute educational workshop. The HC-PAIRS is a self-reporting questionnaire that consists of 15 items rated on a 7-point rating scale, with a higher score suggesting a belief that pain is linked to movement and that recommendations should be given to avoid physical activities. The pre-education intervention HC-PAIRS and vignettes were completed by 40 of 56 attendees. A total of 18 participants completed the posteducation intervention HC-PAIRS and CLBP-related clinical vignettes. Most of participants identified as full-time clinicians, employees of the United States Department of Veterans Affairs, and musculoskeletal/neuromusculoskeletal providers. The pre-education intervention HC-PAIRS mean score was 44.8 (SD 9.22), and the postscore was 39.5 (SD 6.49). Findings suggest an immediate change in HC-PAIRS scores following a BPS-focused CLBP education intervention for a chiropractic audience. However, due to limitations related to sample size and target population, findings should be interpreted cautiously.

Mindfulness, awareness, partner caring, and romantic relationship quality: Structural equation modeling.

Studies investigating the potential structures underlying the connection between mindfulness and romantic relationship quality are not sufficient and require additional empirical findings. The current study aimed to examine a hypothesized model underlying the association between mindfulness and relationship quality, while investigating the roles of individuals' level of awareness and application of care in a romantic relationship among 199 adult participants in a southeastern region of the United States. Structural equation modeling (SEM) and path analysis were executed to examine the hypothesized structural model, testing a multi-step pathway as to how mindfulness influences relationship quality. The SEM and path analyses showed a good fit for the present study's hypothesized model, indicating that individuals' mindfulness had a direct influence on their self-awareness level. Individuals' self-awareness and application of care mediated the link between mindfulness and relationship quality. Implications for family life educators, dyadic couples researchers, and marriage and family practitioners are discussed.

Physical education mentors in initial teacher training: who cares?

PurposeThe broad aim of this paper is to use Noddings' theory of ethical care to analyse mentors' caring experiences. More specifically, it aims to analyse how physical education (PE) mentors provide care, how they are cared for and how this impacts their role within the context of secondary PE initial teacher training (ITT).Design/methodology/approachSemi-structured interviews were used to generate data from 17 secondary PE mentors within the same university ITT partnership in the north-west of England. Questions focused on the mentors' experiences of care and the impact this had on their wellbeing and professional practice. A process of thematic analysis was used to identify, analyse and report patterns in the data.FindingsThe participants reflected established definitions of mentoring by prioritising the aim of developing the associate teachers' (ATs) teaching rather than explicitly providing support for their wellbeing. This aim could be challenging for mentors who face personal and professional difficulties while supporting the training of an AT. Mentors frequently referred to the support of their departmental colleagues in overcoming these difficulties and the importance of developing interdependent caring relationships. Receiving care did not impede mentors from providing support for others; it heightened awareness and increased their desire to develop caring habits.Originality/valueTeacher wellbeing has drawn greater attention in recent years and is increasingly prioritised in public policy. These findings highlight the value of mentor wellbeing and how caring professional relationships can mitigate the pressures associated with performativity and managing a demanding workload.

Precision cancer medicine and the doctor-patient relationship: a systematic review and narrative synthesis

BackgroundThe implementation of precision medicine is likely to have a huge impact on clinical cancer care, while the doctor-patient relationship is a crucial aspect of cancer care that needs to be preserved. This systematic review aimed to map out perceptions and concerns regarding how the implementation of precision medicine will impact the doctor-patient relationship in cancer care so that threats against the doctor-patient relationship can be addressed.MethodsElectronic databases (Pubmed, Scopus, Web of Science, Social Science Premium Collection) were searched for articles published from January 2010 to December 2021, including qualitative, quantitative, and theoretical methods. Two reviewers completed title and abstract screening, full-text screening, and data extraction. Findings were summarized and explained using narrative synthesis.ResultsFour themes were generated from the included articles (n = 35). Providing information addresses issues of information transmission and needs, and of complex concepts such as genetics and uncertainty. Making decisions in a trustful relationship addresses opacity issues, the role of trust, and and physicians’ attitude towards the role of precision medicine tools in decision-making. Managing negative reactions of non-eligible patients addresses patients’ unmet expectations of precision medicine. Conflicting roles in the blurry line between clinic and research addresses issues stemming from physicians’ double role as doctors and researchers.ConclusionsMany findings have previously been addressed in doctor-patient communication and clinical genetics. However, precision medicine adds complexity to these fields and further emphasizes the importance of clear communication on specific themes like the distinction between genomic and gene expression and patients’ expectations about access, eligibility, effectiveness, and side effects of targeted therapies.

Young children's narratives of exclusion in peer relationships in early childhood education and care

In peer culture, children develop social and moral orderings that justify exclusion of one or more peers – an area that has sparked debate among early childhood education groups. Therefore, the present study employed the idea of the power order or social and moral ordering of belonging to explore young children's narratives of social exclusion. We asked what story types can be identified in these narratives and how exclusion is reasoned in them. The data consisted of 25 narratives produced by 12 children, aged 4–6 years, via the Story Magician's Playtime method in early childhood education and care in Finland. Four story types were identified (repulsion, hierarchy, adult as mediator and conciliation), in which the moral reasoning for and conclusion of the exclusion differed. The diverse story types manifested complex negotiations, meaning-makings and diversity of emotions, in which children transcended dichotomous, black-and-white moral reasoning. Children's narratives illuminate how they negotiate social orders in situational interactions. Rules prescribed for children from adults are reproduced, modified and reinterpreted in these interactions. The narratives imparted the contradictions between preserving specific rules and members for ongoing play and the altruistic all-can-participate rule. The study highlighted the importance of addressing exclusion situations in ECEC. If social exclusion is not reflected on with children, they are left alone to solve these situations, which may cause a vicious cycle for repeatedly excluded children.

Caregiving and receiving experiences in UK community mental health services during COVID-19 pandemic restrictions: A qualitative, co-produced study.

WHAT IS KNOWN ON THE SUBJECT?: At the outset of the COVID-19 pandemic, little was known about ways of delivering registered nurse practice within CMHTs under restrictions associated with a global pandemic. Emerging research focused on broad healthcare staff wellbeing during the pandemic. Qualitative research explored the overall response of COVID-19 on people with existing health needs or remote working more specifically. Over the past 2 years studies have emerged detailing experiences but no studies have used qualitative research to understand community mental health nurses and service users experience of services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This co-produced qualitative study is the first to explore the changes to CMHT care from the experience of service users and nurses later in the COVID-19 pandemic. The study questions whether recovery-based approaches are possible in a hybrid way of working. The findings identify challenges for nurses' well-being and work-life boundaries when working from home. The study adds to historical professional narratives of mental health nursing. WHAT ARE THE IMPLICATIONS FOR PRACTICE: While hybrid approaches developed in response to COVID-19 restrictions may offer more choice these approaches need further co-produced evaluation on the impact of recovery-focused care and therapeutic relationships. Mental health nurses need to review how future hybrid working continues to impact nurses' mental health and emotional safety. Nurses and service users need to raise awareness within society and policy on the impact that COVID-19 had on people with existing mental health conditions. ABSTRACT: Introduction Community Mental Health Team responses to COVID-19 included fundamental service delivery adaptations. Aim/Question Our co-produced study sought to understand which service delivery changes experienced by service users and registered nurses were helpful or unhelpful to caregiving and receiving. Method Qualitative semi-structured interviews were undertaken with 10 service users and 13 registered nurses from 3 NHS England sites. Co-produced throughout, people with lived experience of mental health services and nurses wishing to improve their research experience undertook interviews following training. Data were analysed thematically. Findings Care radically changed from in-person to large phone or video contact. This reportedly altered therapeutic relationship building and raised questions about whether recovery-focused care was possible. Hybrid working was viewed as helpful but raised challenges for nurse wellbeing. Discussion Changes to care delivery challenged the fundamentals of recovery-focused interventions and therapeutic relationships. Service users and nurses well-being consequently suffered. The impact of the pandemic on people with existing mental health conditions was poorly acknowledged in the media. Implications for Practice Recovery-focused interventions and relationship building need evaluating in the light of ongoing hybrid working. Teams need to consider the well-being of nurses engaged in complex service-user interactions from home.

The role of nursing in a day center for patients with Alzheimer

Introduction: This article addresses the complex composition of the diagnosis of probable dementia caused by Alzheimer's disease, as well as the course of action necessary to access the subjects. Objective: to analyze the trajectory of the disease and/or care through re-reading reference materials for the pathology, considering the trajectory of the disease and care. Methodology: The literature review focused on the phenomenon of dementia and the care of elderly patients with Alzheimer's, their caregivers, and family members. The research supports the writing that was carried out through observations and experiences with the elderly and families who attend the institution Day Center for the Elderly (DCE). This institution receives elderly people with this diagnosis and offers day care through an individual plan related to personal care, medications, food, and therapeutic and memory activities aimed at elderly patients with Alzheimer's. Results and discussion: Next, the care itineraries adopted by the families with the mediation of the CDI, inserted in a broad and unequal context to gender in Brazil, were analyzed. From there, we start with the descriptions and interpretations of the so-called "perceptual dilemmas", faced by those with dementia, both in terms of memory and reasoning disorientations and in terms of everyday skills with their own body. Conclusion: After defining the particularities of subjects with dementia, an analysis of the inter-subjective relationships of care has been proposed, perpetrated in the constant exercise of the caregiver in establishing perceptual alterities to understand the demands of the other to meet them.