title: The impact of caregivers' singing on expressions of emotion and resistance during morning care situations in persons with dementia: an intervention in dementia care.
abstract: OBJECTIVE
  The aim was to describe expressions of emotions and resistiveness to care among persons with dementia (PWD), during morning care situations without and with music therapeutic caregiving (MTC).
  
  
  BACKGROUND
  Effective caregiving is dependent on the interpersonal relationship between nurse and patient. PWD suffer from major cognitive impairment, making interaction with others problematic. Such patients often react with problematic behaviours such as resistance and anger towards the care activity and the caregiver. Earlier research suggests that MTC - when caregivers sing for or together with PWD during caregiving - can reduce resistance and evoke positive emotions in PWD.
  
  
  METHODS
  This was an intervention study whereby MTC was implemented during morning care situations while PWD were being cared for.
  
  
  METHODS
  The study included ten, 66-92-year-old men and women with severe dementia living in a nursing home in Sweden. Video observations of eight weekly sessions, consisting of four recordings of usual morning care and four recordings of morning care with MTC, provided data. The resistiveness to care scale and the observed emotion rating scale were used for analysis.
  
  
  RESULTS
  Pull away was the most common resistant behaviour under both conditions. The PWDs' expressions of resistant behaviour, such as pull away, grab object and adduction, were significantly reduced under the intervention situation. Positively expressed emotions, specifically pleasure and general alertness, significantly increased under the MTC intervention compared with the 'usual' morning care sessions.
  
  
  CONCLUSIONS
  MTC can be an effective nursing intervention to provide PWD a more pleasant experience of morning care situations as it decreases resistant behaviour and increases positive emotions.
  
  
  CONCLUSIONS
  MTC offers a potential non-pharmacologic treatment that can be used in caring for PWD.
authors.affiliation: Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden. lena.marmstal.hammar@mdh.se
authors.forename: Lena M
authors.initials: LM
authors.lastname: Hammar
authors.forename: Azita
authors.initials: A
authors.lastname: Emami
authors.forename: Eva
authors.initials: E
authors.lastname: Götell
authors.forename: Gabriella
authors.initials: G
authors.lastname: Engström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003704:Dementia / Q000451:nursing / Q000503:physiopathology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D013548:Sweden