Memory Box Memory Box P.R.N P.R.N How are You? How are You? Presented by : Joy Mason Presented by : Joy Mason BSN,RN BSN,RN
May 22, 2015
Memory Box Memory Box P.R.NP.R.N
How are You?How are You?
Presented by : Joy Mason Presented by : Joy Mason BSN,RNBSN,RN
Who Am I ?Who Am I ?
How can I tell what stage of How can I tell what stage of Alzheimer’sAlzheimer’s
Dementia a person is inDementia a person is in??
How can I talk to a person with How can I talk to a person with Dementia? Dementia?
She seems like she’s in another world at timesShe seems like she’s in another world at times There are multiple theories and research that attempt There are multiple theories and research that attempt
to explain the meaning of the world of the to explain the meaning of the world of the dementia person. dementia person.
Phenomenological perspectivesPhenomenological perspectives Husserl-the world as we experience itHusserl-the world as we experience it Haley-the world as social network satisfactionHaley-the world as social network satisfaction Stommel et al.-the world as being stress oriented Stommel et al.-the world as being stress oriented
A NURSING THEORY of HUMAN BECOMINGA NURSING THEORY of HUMAN BECOMING Parse-the world as being rhythmical, Parse-the world as being rhythmical,
having meaning, evolving, engaging and having meaning, evolving, engaging and disengaging in the world as the individual disengaging in the world as the individual person understands it.person understands it.
RALPH’S RALPH’S STORYSTORY
Life Patterns as Life Patterns as Rhythmical?Rhythmical?
Friend or ColleagueFriend or Colleague
SocializationSocialization
LunchLunch Family or spouse Family or spouse
SocializationSocialization
Wind downWind down Supper Supper
Worry a littleWorry a little Wind down Wind down
WORKWORK , AFTERNOON ACTIVITY , AFTERNOON ACTIVITY
Entertainment and Entertainment and EnjoymentEnjoyment
RelaxationRelaxation
WakefulnessWakefulness
SleepSleep
There is soothing in RoutineThere is soothing in Routine Re-create my life rhythmRe-create my life rhythm
Engagement/Speak Alzheimer'sEngagement/Speak Alzheimer'sValidate FeelingsValidate Feelings
even if the words are all wroneven if the words are all wrongg
The Tidal Model Theory: A radical approach to The Tidal Model Theory: A radical approach to person-centered careperson-centered care Let them take the lead, they are the author of Let them take the lead, they are the author of their own storytheir own story
Reminisce and Connect Reminisce and Connect Create a sense of love and Create a sense of love and
belongingbelonging
Always invite and be politeAlways invite and be polite Use humor, encourage response, have a Use humor, encourage response, have a
conversationconversation and be sincere and be sincere
Maslow: Maslow: a systematic approach to a systematic approach to discovery of needdiscovery of need
Alzheimer words … expressing unmet needAlzheimer words … expressing unmet need
If my physiological needs are If my physiological needs are not met I can get stressed not met I can get stressed out and tenseout and tense
If I don’t feel safe I may say If I don’t feel safe I may say things like “I want to go things like “I want to go home”home”
I need to love and be loved, I need to love and be loved, “Talk to me”“Talk to me”
Let me do things. Give praiseLet me do things. Give praise Let me express myself with Let me express myself with
ARTART
What if I can’t understand what the person What if I can’t understand what the person with Dementia wants?with Dementia wants?
Unusual behavior can be the expression of an unmet needUnusual behavior can be the expression of an unmet need
Meaningful Activity for Alzheimer/Dementia Meaningful Activity for Alzheimer/Dementia A Conceptual Framework A Conceptual Framework
Stage 4
Stage 5
Stage 6
Stage 7
11 yr & up
7-11 yr old
2-7 yr old
Birth-2 yr old
Writing
Books, News Lit Chores, folding, cooking
Serration,Flower arrangingFlashlights
Dough rolling
Tootsie pops pops
Sensory Music
Formal operational
Concreteoperational
Pre-operational
Sensory-motor
Mild Alz
Moderate
Moderate/Severe
Severe
Howard
Muriel
Phillip
Sally
Gloria
Thelma
Gerda
Mary
FASTPIAGET IN REVERSE CASE STUDIES
ACTIVITIES THEY MASTERED
Movies
Movies
OBJECTS IN THE ENVIRONMENT THAT OBJECTS IN THE ENVIRONMENT THAT HAVE PERSONAL MEANING HAVE PERSONAL MEANING
Inter-reactive objects have personal meaning unique to the Inter-reactive objects have personal meaning unique to the individual. individual.
WHAT DO OBJECTS IN THE ENVIRONMENT MEAN TO WHAT DO OBJECTS IN THE ENVIRONMENT MEAN TO ALZHEIMER PERSONS ? ALZHEIMER PERSONS ?
Some common inter-reactive objects provide Some common inter-reactive objects provide memory stimulation and a personal life connectionmemory stimulation and a personal life connection
EXAMPLESEXAMPLES What if one of your fondest memories of your mom was that What if one of your fondest memories of your mom was that
on cold snowy days she always made you a cup of hot on cold snowy days she always made you a cup of hot chocolate? GIVE ME A HOT CHOCOLATE AND CUP (It’s ok if chocolate? GIVE ME A HOT CHOCOLATE AND CUP (It’s ok if I make a mess)I make a mess)
What if golf was your dad’s favorite sport? GIVE ME A What if golf was your dad’s favorite sport? GIVE ME A GOLFBALL TO HOLDGOLFBALL TO HOLD
What if your mom was a housewife and raised a family of 5. What if your mom was a housewife and raised a family of 5. GIVE ME KITCHEN UTENSILS, A BAG OF BISQUICK LET ME MIX GIVE ME KITCHEN UTENSILS, A BAG OF BISQUICK LET ME MIX WITH WATER AND MAKE A DOUGH BALLWITH WATER AND MAKE A DOUGH BALL
What if your dad was a fix it yourself kind of dad his entire What if your dad was a fix it yourself kind of dad his entire life? GIVE ME A FLASHLIGHT AND BATTERIES AND ASK ME life? GIVE ME A FLASHLIGHT AND BATTERIES AND ASK ME TO PUT IT TOGETHERTO PUT IT TOGETHER
Follow the Concept Follow the Concept
Art as ExpressionArt as Expression
““a conversation with painta conversation with paint”” Seasonal cueing with colorSeasonal cueing with color
and objects are connectionsand objects are connectionsto the environment.to the environment. Colors have meaning Colors have meaning Handling materials are Handling materials are reminiscent and expressive.reminiscent and expressive.A single brush stroke with a colorA single brush stroke with a colorof choice is a job well doneof choice is a job well done
Music can be a life connection Music can be a life connection
Music can stimulate memoryMusic can stimulate memory Music can affect appetiteMusic can affect appetite Music can induce or reduce stressMusic can induce or reduce stress
Music combines Music combines movement,movement,tactile, sensation tactile, sensation with melody, with melody, vocalizationvocalizationand percussion. and percussion. MUSIC PROVOKES RESPONSEMUSIC PROVOKES RESPONSE
MAINTAINING CONNECTION:MAINTAINING CONNECTION:What are some of the benefits of providing Inter-What are some of the benefits of providing Inter-
reactive objects for persons with dementia? reactive objects for persons with dementia?
Fine and Gross motor Fine and Gross motor skill means they can skill means they can continue tocontinue to
Comb hair or brush Comb hair or brush teethteeth
Eat independentlyEat independently Dress or choose Dress or choose
clothing clothing Provide some self Provide some self
care.care.
Builds self-esteemBuilds self-esteem Maintains dignityMaintains dignity Reduces stressReduces stress Reduces caregiver Reduces caregiver
burdenburden Provides Provides
Environmental Environmental connectionconnection
CONNECT OR DISCONNECT ?CONNECT OR DISCONNECT ?evaluate responseevaluate response
1.1. BODY LANGUAGE SHOULD RELAXBODY LANGUAGE SHOULD RELAX
2.2. FACIAL FEATURES SHOULD SOFTENFACIAL FEATURES SHOULD SOFTEN
3.3. TONE OF LANGUAGE SHOULD BE APPROPRIATE TONE OF LANGUAGE SHOULD BE APPROPRIATE (even when the words are wrong)(even when the words are wrong)
4.4. DIRECT EYE CONTACT IS ACHIEVEDDIRECT EYE CONTACT IS ACHIEVED
5.5. ATTEMPTS ARE MADE TO TOUCH OR UTILIZE ATTEMPTS ARE MADE TO TOUCH OR UTILIZE OBJECTSOBJECTS
Change objects according to responseChange objects according to response
DiscussionDiscussionTrue Care-giving is… True Care-giving is… Expertise in understanding the Expertise in understanding the human response to health and human response to health and well being. well being.
Gathering and synthesizingGathering and synthesizingThat knowledge can be empirical ,That knowledge can be empirical ,ethical ,esthetic or personal ethical ,esthetic or personal ( Carper, B.A., 1978)( Carper, B.A., 1978)
Teaching is most effectively when it is reflective, Teaching is most effectively when it is reflective, respectful, and intimately practiced in the patterns of respectful, and intimately practiced in the patterns of knowing of others.knowing of others.
..
ReferencesReferences
Camp, C., (2005) Montessori-Based Activities for Persons with Camp, C., (2005) Montessori-Based Activities for Persons with Dementia Menorah Park,Dementia Menorah Park,
Cosgrove, S., (2006) A complement to lifestyle assessment: Cosgrove, S., (2006) A complement to lifestyle assessment: Using Montessori sensorial experiences to enhance and Using Montessori sensorial experiences to enhance and intensify early recollections intensify early recollections The Journal of Individual The Journal of Individual PsychologyPsychology 62,1 pp.47-58 62,1 pp.47-58
Cossentino, J., (2005) Ritualizing Expertise: A Non Montessorian Cossentino, J., (2005) Ritualizing Expertise: A Non Montessorian View of the Montessori Method American View of the Montessori Method American Journal of Journal of EducationEducation Feb. Feb.pp.211-244pp.211-244
Downs, M., (2005), Awareness in dementia: In the eye of the Downs, M., (2005), Awareness in dementia: In the eye of the beholder beholder Editorial- Aging and Mental HealthEditorial- Aging and Mental Health March pp.381- March pp.381-383383
Howorth, P., Saper, J., (2003) The dimensions of insight in Howorth, P., Saper, J., (2003) The dimensions of insight in people with dementia people with dementia Aging and Mental HealthAging and Mental Health 7(2) pp. 113- 7(2) pp. 113-122122
ReferencesReferencesKitwood, T. (1997) The experience of dementia Kitwood, T. (1997) The experience of dementia Aging and Mental Aging and Mental
HealthHealth 1(1) pp.13-22 1(1) pp.13-22Kolanowski, A., Whall, A., (2000) Toward Holistic Theory-Based Kolanowski, A., Whall, A., (2000) Toward Holistic Theory-Based
intervention for dementia behavior intervention for dementia behavior Holistic Nursing PracticeHolistic Nursing Practice 14(2) pp.67-7614(2) pp.67-76
Korfmacher, J., Spicer,P., (2002) Toward an Understanding of the Korfmacher, J., Spicer,P., (2002) Toward an Understanding of the child’s experience in a Montessori Early head Start Program child’s experience in a Montessori Early head Start Program Infant Mental Health Infant Mental Health
Markova, I., et al (2005) Awareness in dementia: Conceptual Markova, I., et al (2005) Awareness in dementia: Conceptual issuesissuesAging and MentalAging and Mental Health Sept 9(5) pp.386-393 Health Sept 9(5) pp.386-393
Schreiner, A., et al. (2005) Positive affect among nursing home Schreiner, A., et al. (2005) Positive affect among nursing home residents with Alzheimer's dementia: The effect of recreational residents with Alzheimer's dementia: The effect of recreational activity activity Aging and Mental HealthAging and Mental Health March pp.129-134 March pp.129-134
Upton, N., Reed, V., (2006) What does Phenomenology Offer to Upton, N., Reed, V., (2006) What does Phenomenology Offer to the Study of Caregiving the Study of Caregiving The International Journal of Psychiatric The International Journal of Psychiatric Nursing ResearchNursing Research 11,2 pp.1241-1254 11,2 pp.1241-1254