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Confirmation and lucidity during conversations with a woman with severe dementia

Authors

  • Hans Ketil Normann MSc RNT,

    1. Associate Professor, Department of Nursing, and Health Sciences, University of Tromso, Breivika, Tromso, Norway

      Professor, Department of Nursing, Umea˚ University, Umea˚, Sweden

      Professor, Department of Nursing and Health Sciences, University of Tromso, Breivika, Tromso, Norway
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  • Astrid Norberg PhD RN,

    1. Associate Professor, Department of Nursing, and Health Sciences, University of Tromso, Breivika, Tromso, Norway

      Professor, Department of Nursing, Umea˚ University, Umea˚, Sweden

      Professor, Department of Nursing and Health Sciences, University of Tromso, Breivika, Tromso, Norway
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  • Kenneth Asplund PhD RNT

    1. Associate Professor, Department of Nursing, and Health Sciences, University of Tromso, Breivika, Tromso, Norway

      Professor, Department of Nursing, Umea˚ University, Umea˚, Sweden

      Professor, Department of Nursing and Health Sciences, University of Tromso, Breivika, Tromso, Norway
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 Hans Ketil Normann, Department of Nursing   and Health Sciences, Tromso University, MH 9037 Tromso, Norway. E-mail: ketiln@fagmed.uit.no

Abstract

Rationale.  Patients with severe dementia sometimes surprise the care providers because they seem to be much more aware of their situation and function much more adequately than usual. Such episodes are labelled ‘episodes of lucidity’ (ELs). The aim of this study was to describe the characteristics of the particular conversations with a woman with severe dementia when ELs occurred as compared with conversations when she was not lucid.

Methodological design.  A woman with a probable diagnosis of Alzheimer's disease (AD) was selected. Her Mini Mental State Examination (MMSE) was estimated as 3. The first author met the woman for 4 hours five times over a period of 2 weeks.

Research methods.  The conversations were tape-recorded and transcribed verbatim. The text was divided into 278 content units and analysed.

Findings.  Lucidity is promoted by supporting the patient in various ways, that is sharing the patient's view, repeating and reformulating the patient's utterance, reinforcing the patient by using positive utterances, not emphasizing errors and supporting the patient's language in various ways, and avoiding making demands. The relation between the patient and her conversation partner during ELs is characterized by confirmation and communion.

Conclusions.  This case study indicates that a supportive attitude in conversation with the patient with severe dementia promotes lucidity. A supportive attitude includes the avoidance on the part of the conversational partner making demands on the patient, confirming the patient as an important, unique and valuable person and creating communion. The connection between supporting and avoiding demands and lucidity/nonlucidity during conversation needs further study.

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