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Making a ConnectionReminiscing with Elders

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

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Background

• How did all of this work
• with reminiscence begin?
• Clinician
• Instructor
• Researcher

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Reminiscence Interests

• implementing as part of nursing practice
• to deliver culturally competent care
• reminiscence education programs as part of
  training of nurses, CNAs
• implementing reminiscence to decrease depression
  and increase life satisfaction
• in elders

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Todays 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 elders hospital stay.
• 5. Discuss benefits of using reminiscence as part
  of the hospital experience.

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Robert Butler and Life Review Theory

• geriatrician
• developed Life Review Theory 1963
• based on Erik Erickson developmental challenge of
  old age

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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.

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Life Review

• Systematic reflection process between a therapist
  and client trying to understand
• a lifes history implications for current
  coping strategies.
• Resolution of conflicts, improved well-being,
  coming to terms with life.

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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.

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• How do life review and
• reminiscence differ?

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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

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Types of Reminiscence

• Simple
• Integrative
• Narrative
• Instrumental
• Obsessive
• Others.

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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.

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Delivering Culturally Competent Care

• University of Connecticut School of Nursig

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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?

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Definition of Cultural Competent Care

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

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Your Perspective.

• What issues/problems are you facing with respect
  to delivering culturally competent care to elders
• in a hospital setting?

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

• Becoming aware of ones own biases
• Increasing ones 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

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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

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Ethnocentrism

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

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Ethnocentrism
Everyone should look like me
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• How can reminiscence help?

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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

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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

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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.

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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.

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Other noted benefits

• students experiences in the hospital
• Eating habits
• Distraction
• The task

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Another students 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

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Reminiscence and Volunteers

• The possibilities are endless..

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Paul Fourniers 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.

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Nobody Ever Asked Me Before.Understanding
Life Experiencesof African-American Elders
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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

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Why do you want us to provide him with a
glucometer, he couldnt do it anyway, he isnt
very bright you know. -practicing RN
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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

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Research Question

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

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Research Design

• interpretive phenomenology
• bracketing prior to data collection and
• analysis

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Methodology

• Speigelbergs phenomenological method
• gives 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

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Procedure

• approval obtained from universitys IRB
• elders approached in community settings
• written consent obtained
• tape recorded interviews conducted
• 1hour-1hour and 30 minutes

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Sample

• Purposive
• English speaking
• 65 years of age by self-report
• intact cognition
• willing to share life experiences

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Themes

• 1. Nobody Ever Asked me Before.
• Sub theme Asking about the Past is Caring
• 2. Stories of Discrimination
• Sub themes School, Family, Army, Healthcare
• 3. Coping with Discrimination
• Sub themes Family Caring for Family, Home
  Remedies, Strength of Faith, Coming North,
  Memories of Mother
• 4. The Hurt of Discrimination
• Sub themes Life Regrets, Abuse, Feeling
  Different
• 5. Self Discoveries

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Theme 1. Nobody ever asked me before.Sub
theme Asking About the Past is Caring

• No, I aint never talked like this before,
  never talked with no white about it because I
  feel like they didnt care. They didnt care
  enough to ask me about my past. But you come and
  asked me because you wanted to see how I feel
  about it.

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Theme 2 Stories of DiscriminationThats the
way it was.
Sub themes School Healthcare Army
Life Work
It was like a bitter pill that we had to
swallow. I dont care how big or how bitter it
was, you just had to swallow the fear because
there was nothin you could say about it.
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School LifeFeeling 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, thats 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, thats the way it was. So thats how I feel
about going to school. I was a leftover child,
a nothing in the world.
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HealthcareYou just didnt get the medical
care.
I remember being so sick, and having to go to
him. He (MD) wouldnt 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 dont know what he had done, because he
didnt use no stethoscope didnt 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 you was sick you had to walk 2 or 3
miles to even get him to look at you. If it was
summer time youd sit down on the step and waited
for him to wait on you. You just didnt get the
medical care that you should.
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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 wont forget it. Hed be smoking a
cigarette, throw it in the hole and hed 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 hed tell you to start
digging it all over again.
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Workgiving 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. Id go and
ask the white man for stuff to help kill the
worms in the tobacco fields.Ill 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.
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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

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Sub themes Family Caring for Family Home
Remedies Coming North Strength of
Faith Memories of Mother
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Family Caring for Familythe 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.
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Home Remedies We learned to make our
medicine, so then we really didnt have
to go to the doctor.
My brother had what we called typhoid fever.
It wasnt 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
wasnt 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.
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Coming NorthFinally, I just got so angry, I
came to Connecticut.
I always wanted to come North. So I when I got
older I said I am going North because when youre
little and everything it dont bother you so
much that the race dont mix. But when I got
older I begun to look at it and everybody told me
they living better up North. So I came up North.
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Strength of FaithMy 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
dont 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 good Lord to take care of ya,
thats all you got to do and He gonna take care
of ya.
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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 wasnt 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.
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Theme 4 The Hurt of DiscriminationThis 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 dont get angry enough to fight. I
get angry because I hurt.
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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 cant. 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 up things and
reading the Bible and everything and I cant do
it? It, hurts, it really hurts
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Being AbusedI was what you call a battered
woman.
He erupted me with fights and all like that. But
he was angry too because he couldnt get things
of what he wanted and 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.
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Feeling Different And, its still all over,
its just under the cover.
You can open your eyes and still see it
todayI dont want to live on the same street
you live on, I dont want to eat with
you. Yes, it makes you feel different. You
know back in some parts of the South you couldnt
go into a Black mans house, sit down and talk to
him like youre talking to me by yourself. If you
did, theyd carry you out there, hang your head
up to a limb, kill you or beat you to death. You
know that stays with you
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Theme 5 Self DiscoveriesIt 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 God for the hardship that I was brought up
on, it made me a better person.
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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)

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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

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And the journey continues.
To improve the quality of care to elders of
all cultures