Strain among nurses and their emotional reactions during 1 year of systematic clinical supervision combined with the implementation of individualized care in dementia nursing

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Abstract
This study aimed at exploring nurses' views of the characteristics of severely demented patients, the difficulties these characteristics produced and the emotional reactions they evoked during the provision of care. Also, it aimed at exploring any changes in these aspects during a year of regular systematic clinical supervision combined with the implementation of individualized care at an experimental ward (EW) (n = 19) and at a control ward (CW) (n = 19). Data were collected by means of the Strain in Nursing Care scale, assessing the presence of certain characteristics in the patients, and how difficult each characteristic can be to handle. The Emotional Reactions in Nursing Care scale was also used, assessing 18 pairs of emotions. The analysis showed that agitation, not being responsive and unruly behaviour were the most common features while emptiness and agony turned out to be the most difficult problems to handle in the provision of care. Feelings of defeat and dissociation were reported to be almost as common as feelings of control and association. The EW nurses saw the patients as significantly more responsive, and victims of nihilation to a lesser degree and also patients' willfulness and emptiness was significantly easier to handle during the year of intervention. There were no significant changes on the CW. The mean values improved significantly in several aspects on the EW in comparison to the CW; patients seen as victims of nihilation, easier to handle agony, obediency, willfulness, evaluation and improved feelings of devotion and beneficence in the nurses. Thus the intervention seemed to improve the nurse-patient relationship and to decrease the experience of strain in the nurses.