Multi-sensory stimulation in 24-hour dementia care

Abstract

This thesis starts with a review of relevant literature with regard to the effects of psychosocial interventions, including snoezelen, on apathetic, depressed and aggressive behaviour of demented persons. Then, a study with a quasi-experimental pre-test and post-test design is described, comparing six psychogeriatric wards, that implemented snoezelen in 24-h care, to six control wards, that continued in giving usual care. The aim of the study was to investigate the effects of snoezelen, or multi-sensory stimulation, integrated in 24-h dementia care on (i) caregivers'and residents' verbal and nonverbal communication; (ii) the quality of caregivers' behaviour; (iii) mood and behaviour of demented nursing home residents and; (iv) work-related outcomes of caregivers in psychogeriatric care. 125 residents with moderate to severe dementia were included in the pre-test and 128 in the post-test. Certified Nursing Assistants (CNAs) of the six intervention wards received a four-day in-house training program 'snoezelen for caregivers'. The intervention further consisted of implementation activities in the ward (e.g., history taking, stimulus preference screening, workgroup), three in-house follow-up meetings and two general meetings. Quantitative measurements, i.e., video-recordings of morning care, observations in the ward and questionnaires, were performed at baseline (pre-test) and 18 months after the start of the implementation of snoezelen (post-test). Additionally, a qualitative evaluation of the implementation process took place to find out to which extent the intervention had been delivered as intended. The results revealed that trained CNAs showed a significant increase of resident-directed gaze, affective touch and smiling during morning care. The total number of verbal utterances also increased. Regarding residents a significant treatment effect was found for smiling, CNA-directed gaze, negative verbal behaviours (less disapproval and anger) and verbal expressed autonomy. The video-observations also showed a significant increase of positive behaviours ('Positive Person Work') by CNAs and a decrease of negative behaviours ('Malignant Social Psychology'). This indicated that trained CNAs succeeded in performing a more person-centred approach. Moreover, the mean number of sensory stimuli, offered explicitly, increased. Residents receiving snoezel care demonstrated a significant treatment effect with respect to their level of apathetic behaviour, loss of decorum, rebellious behaviour, aggressive behaviour and depression. During morning care, the residents of the experimental group showed significant changes in well-being (mood, happiness, enjoyment, sadness) and adaptive behaviour (responding to speaking, relating to caregiver). Morning care by trained CNAs appeared to take more time. This suggests that (some) time investment might be required to achieve positive effects on CNA and resident outcomes. This did not result into increased workload. The analysis of work-related outcomes showed a significant effect in favour of the experimental group for time pressure, perceived problems, stress reactions and emotional exhaustion. CNAs of the experimental group also improved on their overall job satisfaction score. They were especially more satisfied with the quality of care and with their contact with residents. This study indicates that the implementation of snoezelen in 24-h daily care improves the quality of life of demented nursing home residents and the quality of working life of nurses in psychogeriatric care.