“Making a Connection”Reminiscing with Elders

Juliette Shellman, APRN-BC, Ph.D.John A Hartford Foundation Post Doctoral FellowUniversity of Connecticut School of Nursing

Background

How did all of this work with reminiscence begin?

Clinician

Instructor

Researcher

Reminiscence Interests

implementing as part of nursing practice

to deliver culturally competent care reminiscence education programs as

part of training of nurses, CNA’s implementing reminiscence to decrease

depression and increase life satisfaction

in elders

Today’s Objectives

1. Present an overview of reminiscence and life review

2. Distinguish between reminiscence and life review.

3. Discuss the relationship between reminiscence and the delivery of culturally competent care with respect to elders.

4. Discuss how reminiscence can be implemented as part of an elder’s hospital stay.

5. Discuss benefits of using reminiscence as part of the hospital experience.

Robert Butler and Life Review Theory

geriatrician

developed Life Review Theory – 1963

based on Erik Erickson developmental challenge of old age

Erik Erickson

The challenge of old age is to accept and find

meaning in the life the person has lived; this

gives the person ego integrity that aids in

adjusting and coping with the reality of aging

and mortality. Feelings of anger, bitterness,

depression, and inadequacy can result from

inadequate ego integrity.

Life Review

Systematic reflection process between a therapist and client trying to understand

a life’s history implications for current coping strategies.

Resolution of conflicts, improved well-being, coming to terms with life.

Reminiscence

The act of recalling the past including persons. Places, events and feelings associated with the experience.

May occur silently, but it is enhanced in the presence of a supportive listener who facilitates the process through questions and validations.

How do life review and

reminiscence differ?

Reminiscence Research

Begins earlier than previously thought Common activity for any age Boredom reduction for children Parents/children sharing the past together

Promotes relationship Takes away from the present

Decreases stress Anxiety Pain/illness

Reconnect with someone by invoking the past Problem solving techniques Understanding and coping with painful events

Domestic violence

Types of Reminiscence

Simple Integrative Narrative Instrumental Obsessive Others….

Simple Reminiscence

An activity in which individuals look back at past experiences which they perceive as positive and meaningful - spontaneous

Involves questioning the elder about past experiences and actively listening to what the elder has to say Positive reinforcement Validation

Has shown to decrease anxiety in hospital situations.

Delivering Culturally Competent Care

University of Connecticut School of Nursig

Culture/Ethnicity

“the patterned values, attitudes, beliefs, and

social, political, economic, educational and other

behaviors that emerge and are shared in a define

or self-defined group over time” – Schenscul

Do you think we can consider the elder population a cultural group?

Definition of Cultural Competent Care

Delivering health care with knowledge, skill and sensitivity to cultural factors that may play a role in a patient’s health/illness behavior.

Six steps to delivering culturally competent care (Bernal, 1996)

Becoming aware of one’s own biases

Increasing one’s cultural knowledge about the ethnic groups that comprise our communities

Develop relationships with individuals & agencies

Increasing language capabilities & use of interpreters

Conducting target socio-cultural assessments

Negotiating plans of care

Basic Assumptions

Clients and communities as informants about their culture

The limits of the cook book approach

Gaining entry, trust are key Understanding the context of

peoples’ lives within their own reality

Ethnocentrism

A view of the world that is generally based on the socialization experienced by individuals within their own particular culture

Ethnocentrism

“Everyone should ‘look’ like me”

How can reminiscence help?

Reminiscence Education Program

Background information Elder information Interviewing and Communication

techniques Role-playing activities Simple reminiscence Several ways education could be

accomplished Set up referral possibilities

The Effects of a Reminiscence Education Program on BSN

Students in Caring for Elders

“Making a Connection” increased confidence in communication seeing elders differently the elders’ expressions as they

described their experiences Taking away the present Understanding the person, not just a

diagnosis

Benefits for Elders

“I was reminiscing with my client about memories of the period in his life where

we focused on his achievements and accomplishments. This was meaningful

for his because he is currently focusing on his disabilities and what he is no longer able to do. I felt he was really happy and forgot about his condition during the period I was reminiscing with him.”

Benefits for Students

“….it was so interesting to hear the numerous stories of their past and I also learned about history. I was able to build trusting relationships with my patients and their families. My patients were able to reminisce with me and I truly think it was therapeutic for them. Every time I reminisced with my patients, I was able to bring a smile to their faces which made me feel wonderful as well.”

Other noted benefits

students’ experiences in the hospital Eating habits Distraction

The “task”

Another student’s perspective….

“Although I had initially scoffed at the idea of reminiscence as therapy. I actively facilitated and participated in such therapy sessions with my patients and could see, hear, and sense the healing nature of many of those memories. I learned what it really means to “see” someone, not just the physical person, but rather what it is that truly defines their “personhood”, the hopes, dreams, regrets, and fears that make them all that they are…………

Study Participant

Reminiscence and Volunteers

The possibilities are endless……………..

Paul Fournier’s Reflections

“If an old, sick, or dying person sees that you are interested in his

personal life, you will see a wonderful transformation take place

in him. His eyes that seemed dull will light up with new fire; his

face will come alive with unexpected emotion. He felt that he

had been thrown on a scrap heap and all at once he came to life

again, he becomes a person once more. Just like a child, the old

man needs to be spoken to and listened to in order to become a person, to become aware of himself, to live and grow. You will

have brought about something that no social service can ever do

of itself. You will have promoted him to the rank of a person.

“Nobody Ever Asked Me Before.”

Understanding Life Experiencesof African-American Elders

Background/Significance

•U.S. Census predicts that by the year 2030, African-American elderly will represent the highest number of minority elders

•African American elderly high risk for developing chronic diseases- HTN, diabetes, CAD

•Poverty and lack of access to culturally competent care are frequently given as underlying factors

•African-American elders report their failure to adequately use healthcare system as the result of past and present discriminatory practices and lack of trust in health professionals

“Why do you want us to provide him with a glucometer, he couldn’t do it anyway, he isn’t very bright you know.”

-practicing RN

Specific Aim

• Increase knowledge and understanding of the worldviews, cultural heritage, and life experiences of African-American living in a mid-size urban community in the Northeast

Research Question

1. What are the life experiences, cultural heritage, and worldviews of African-American elders?

Research Design

interpretive phenomenology

bracketing prior to data collection and

analysis

Methodology

•Speigelberg’s phenomenological methodgives attention to relationships between and within meanings

Three procedural steps: 1. Intuiting

2. Phenomenological analysis – examining the phenomenon

3. Describing that results in the establishment of reliable guide posts that aid in understanding the experience

Relationship and connections between and within the patterns are elicited to obtain clear insights about the phenomenon

Procedure

approval obtained from university’s IRB

elders approached in community settings

written consent obtained

tape recorded interviews conducted

1hour-1hour and 30 minutes

Sample

Purposive

English speaking

65 years of age by self-report

intact cognition

willing to share life experiences

Themes

1. “Nobody Ever Asked me Before.”Sub theme: Asking about the Past is Caring

2. Stories of DiscriminationSub themes: School, Family, Army, Healthcare

3. Coping with DiscriminationSub themes: Family Caring for Family, Home Remedies, Strength of Faith, Coming North, Memories of Mother

4. The Hurt of DiscriminationSub themes: Life Regrets, Abuse, Feeling Different

5. Self Discoveries

Theme 1. “Nobody ever asked me before.”

Sub theme: Asking About the Past is Caring

“No, I ain’t never talked like this before, never talked with no white about it because I feel like they didn’t care. They didn’t care enough to ask me about my past. But you come and asked me because you wanted to see how I feel about it.

Theme 2 – Stories of Discrimination“That’s the way it was.”

Sub themes:

School

Healthcare

Army Life

Work

“It was like a bitter pill that we had to swallow. I don’t care how big or how bitter it was, you just had to swallow the fear because there was nothin youcould say about it.”

School Life“Feeling like a leftover child in the world.”

“Going to school, it made me feel bad because it made me feel like a nobody as a kid. Seven or eight years old, that’s how old I was then. I feel like we were the same as a dog or a hog or something out there because they would give black people old, leftover and ripped things. So used. Just like if you go feed the dog, after you eat, you give him what is left. Just like that, that’s the way it was. So that’s how I feel about going to school. I was a leftover child, a nothing in the world.”

Healthcare“You just didn’t get the medical care.”

“I remember being so sick, and having to go to him. He (MD) wouldn’t come to us, we had to go far to the white section. So they put me in this little room, a waiting room. He examined me, I don’t know what he had done, because he didn’t use no stethoscope didn’t ask me no questions, or nothing like that.”

Back then if you went to the doctor, you went to the backdoor step and the doctor would come out when he wanted to. If youwas sick you had to walk 2 or 3 miles to even get him to lookat you. If it was summer time you’d sit down on the step andwaited for him to wait on you. You just didn’t get the medical care that you should.”

Army Lifeinhumane punishment

“ I remember the Sergeant standing over me and making me dig a hole in the ground. He would stand there and look at you, make sure you dig it. I won’t forget it. He’d be smoking a cigarette, throw it in the hole and he’d tell you,“now cover it back up”. You had to cover that hole back up, level it off just as smooth as the ground. Then he’d tell you to start digging it all over again.”

Work“giving the white man half of what he made”

“I remember working for a white man, called myself share farming just like my Daddy did. It got so rough, the worms would eat all the tobacco up and then I tried to help. I’d go and ask the white man for stuff to help kill the worms in the tobacco fields…….I’ll never forget it……..the white man looked at me, said not one word, and spit at me in the face. He turned around and then walked on away.

Theme 3 – Coping with Discrimination “we were taught where to go, where not to go and who

to bother and who to stay away from”

.

Sub themes:

Family Caring for Family

Home Remedies

Coming North

Strength of Faith

Memories of Mother

Family Caring for Family“the family was together, you see we believed that,and we stuck very well together.”

“Those times were good you know. It was a happy childhood. I was the only girl and I got everything. My brothers they kind of catered to me and protected me because I was the only girl.”

“ When I was sick, they put me in the front room with all my brothers and there was a fire and everything. I was so sick,but it felt so good being there and everything.”

Home Remedies “ We learned to make our medicine, so then we really didn’t have to go to the doctor.”

“My brother had what we called “typhoid fever”. It wasn’t so much that you would have a doctor, she would get alcohol and stuff and she would rub him down with Gypsy weed. She would fix it.”

“Back then by being black, the doctors wasn’t too eager to work on black folk so you had to make do. In my family we would always get some kind of weed. There was a weed they called a mullet, they would give it to us to drink when we had a cold.”

Coming North“Finally, I just got so angry, I came to Connecticut.”

“I always wanted to come North. So I when I got older I saidI am going North because when you’re little and everything it don’t bother you so much that the race don’t mix. But whenI got older I begun to look at it and everybody told me theyliving better up North. So I came up North.”

Strength of Faith“My favorite memory is going to church and sitting down and praying.”

“I just prayed to God and asked him to help me, to get me through this hard life.”

“ I really don’t have to have the medicine cause He said put your trust in him and He will do the rest.”

“All you got to do is go on your knees and pray, ask the goodLord to take care of ya, that’s all you got to do and He gonnatake care of ya.”

Memories of Mother as a Source of Comfort

Memories of the elders’ mothers provide them comfort during difficult times.

“My mama she loved me like no one else.”

“I remember my mother taking care of me when I had the malaria fever. She made me feel so good. She had a way of knowing me so that she could tell about me when I wasn’t feeling good.

“ My mother, she would sit up all nightlong, make a fire and lay down across my feet, to keep my feet under cover and warm.”

Theme 4 The Hurt of Discrimination

“This is hell for us, right here on earth. This is Hell.”

Sub themes

regrets

abuse

feeling different

“ Now, looking back on my past, it makes me angry, but I don’t get angry enough to fight. I get angry because I hurt.”

Regrets

“ I feel bad sometimes thinking about how I grew up and everything. Look at peoples nowadays, they get a good education. They can read and write and I can’t. It puts a different feeling on you.”

“I never did get a chance to go to school and learn nothing.You go to church now and you see the kids setting upthings and reading the Bible and everything and I can’t do it? It, hurts, it really hurts

Being Abused“I was what you call a battered woman.”

“He erupted me with fights and all like that. But he was angry too because he couldn’t get things of what he wantedand what he wanted for us.”

“I was afraid of him because I was afraid he was going to hurt me. He might have killed me because he tried. Yes,he tried to kill me.”

Feeling Different

“And, it’s still all over, it’s just under the cover.”

“ You can open your eyes and still see it today……I don’twant to live on the same street you live on, I don’t wantto eat with you.”

“Yes, it makes you feel different. You know back in someparts of the South you couldn’t go into a Black man’s house,sit down and talk to him like you’re talking to me by yourself.If you did, they’d carry you out there, hang your head up to a limb, kill you or beat you to death. You know that stays withyou”

Theme 5 Self Discoveries

“It felt good to talk today. I finally discovered that I can talk about the war part of my life.”

“ Well now that I look back on everything I say thank Godfor the hardship that I was brought up on, it made me a better person.”

Discussion

•information can increase understanding and knowledge of life experiences of African-American elders for health care professionals to provide culturally competent care

•Never been asked before, not surprising (Davis/Smith)

•faith

• past experiences with healthcare professionals

•use of home remedies/alternative therapies

•including family in care

•lingering feelings of hurt can induce psych/physiol reactions (Williams/Morris)

Discussion Continued• demonstrates use of reminiscence as an

intervention to:

gain insight into accomplishments/coping strategies

learn about and appreciate the life of the aging individual

gather valuable information regarding psychological factors, health beliefs, coping skills, and cultural perspectives

importance of psychosocial assessment before conducting reminiscence

And the journey continues………….

To improve the quality of care to elders of all

cultures