A resident is sitting in her wheelchair at the table in the breakfast kitchen. Whenever a person enters the kitchen, she lifts an arm as if to say hello, calls a word and makes eye contact. She usually has a positive and joyful attitude, and this behaviour means that she enjoys a great deal of positive contact.
If the resident is not doing well, she
“moans” quite extensively. People try to get away from her more quickly, which in turn increases the level of “moaning”.
One morning, she is looking very sad and, her voice sounding like she is crying, says,
“My foot, my foot, it’s hurting so much…”. An employee of the clinic leaves the room with a frown on his face, which shows us that the personnel have likely often tried to cater to the resident.
An employee then sits with her, looks at her and sees that her face is full of worry. She seems agitated, troubled. The resident places her hand in the employee’s hand, which the employee has offered to her with no pressure to accept by placing the back of her hand and shaping it like a bowl on the table:
Employee: “Your foot is really hurting?«
Resident: “Yeeeees!«
The wailing becomes louder, the expression on her face changes.
Employee: “You must be really worried!”
The resident answers once again with a
“yeeeees”, but this time more quietly, accom-panied by a nodding of the head.
Employee: “You need help now?”
“Yes”, she replies, “get the doctor to come!”
Employee: “OK, we’ll let the doctor know.”
“Yes, he’s coming at lunchtime”, the resi-dent answers.
The employee notices that everything has already been clarified and organised. A col-league just entering the kitchen who hears the information, nods in acknowledgement.
Employee: “That’s great! He’ll help you.”
She begins to cry again. “The doctor is coming.” she says, and shakes her head. The employee has the feeling that something else has triggered this agitation.
Employee: “You’re worried about that too!”
The resident looks relieved and answers with a clear “yes!”. She grabs her skirt, lifts it up and, looking worried again, says, “Just look at this!”
The employee sees a large coffee stain on the skirt.
Employee: “You’ve got a big stain on your skirt!”
Resident: “Yes, and the doctor’s coming.”
The pains in her foot are no longer of impor-tance.
Employee: “When the doctor arrives, you want to be clean!”
Resident: “Yes!”
Employee: “When we go to the doctor, we always need to be clean.”
Resident: “Yes!”
Employee: “It’s good manners.”
Resident: “Yes!”
Employee: “That’s the way you’ve always been.”
Resident: “Yes!” Her face progressively
Recognising the other world
becomes more relaxed, she appears relieved.
Employee: “You’d like to do that today as well!”
Resident: “Yes!”
The nursing colleague stays in the kitchen and the employee gives the information – slowly, so that the resident can keep track, the employee explains the situation to the nurse, always maintaining eye contact with the resident.
“Mrs. K. has foot pains, the doctor is com-ing this lunchtime. Mrs. K. has a coffee stain on her skirt. She’d like to wear a clean skirt for when the doctor comes. She’s always been clean when she’s gone to the doctor, this has always been important to her.” The resident constantly nods in agreement while the employee speaks. The nurse reacts positively.
“I understand what you mean, I think that’s important too.” The resident is beaming, she feels like she’s been understood.
[12]
22 Life history is an important connecting factor
Recognising the other world 2
5 Life history is an important connecting factor
Our knowledge of a patient’s life history is of particular importance when nursing patients with dementia.
Knowledge of fundamental themes in their life and their connections can make a decisive contribution to structur-ing the nursstructur-ing programme in an individual fashion. This background knowledge can provide a better understand-ing of certain behaviour and expressions in many cases.
Ultimately, only this allows us to cater for individual needs in nursing [11, 1].
Working with a patient’s life history as a basis can be oriented towards conversation (individual and group dis-cussions) or activities (familiar everyday activities such as housework or singing together etc.). The use of meaning-ful, private objects such as photos can play an important role. They are used as so-called “triggers”. These familiar and recognisable objects help to build bridges to the past and can have an activating, stimulating or calming effect.
For example, for people who grew up on a farm or have worked in farming, an appropriate trig-ger may be products from a farm.
24 Life history is an important connecting factor
Practical example
Activation using life history in an inpatient nursing facility:
The residents are individually spoken to directly for a brief moment (for example, before mealtimes). The employees use particular materials (perhaps cooking utensils, gardening tools, fruit) to “trigger” a discus-sion on the subject. Questions such as “What do you think of when you see this?” encourage the residents to activate their memories and express themselves. Expe-rience shows that this increases their level of attention, which then makes it easier from them to concentrate on their meal.
Lucky dip: A bag is filled with objects that are known to have a special meaning for each resident. The resident is encouraged to feel around the unseen contents and talk about them.
Basing the care of dementia patients on their life history means in particular to:
– find out relevant information about the person’s life history and its significance for that person, – interpret expressions based on this background, – make use of activities and objects relevant to the
pa-tient’s life history in an effective manner and
– provide individual care within the scope of the nursing process.