Authors

  1. Marshall, Katherine A. DNP, NP, PMHCNS-BC, CNE
  2. Hale, Deborah MSN, RN, ACNS-BC

Article Content

Patients with cognitive impairment often have difficulty remembering or recalling what they did earlier in the day (recent memory), but will be able to recall events and experiences from their earlier life easily and vividly. This ability to recall distant or remote events can provide patients with a sense of self-esteem or competence and facilitate social engagement with others despite their difficulty with day-to-day activities. Many home healthcare clinicians employ strategies that elicit reminiscence, or the recall of memories, during casual conversations without the specific goal or intent of doing so.

 

Butler (1963), a well-known geriatric psychiatrist, described reminiscence as the act of reviewing one's life. Butler identified this activity as a normal process in aging that supports a reflection of past events, both pleasant and conflicted, that facilitate the individual's movement and adjustment toward the end of life. Reflecting on one's past experiences is a common activity for all age-groups, but can often be used as a significant source of social interaction with older patients, particularly those with cognitive impairment. The goal of reminiscence is to prompt forgotten memories that promote increased emotional awareness and support or facilitate interaction and socialization in older adults (Stinson & Long, 2014). Home healthcare clinicians are in an excellent position to implement reminiscence strategies during visits with community-dwelling patients who are often isolated or limited in their ability to engage in regular social stimulation.

 

Reminiscence techniques can be utilized by clinicians in everyday interactions with their patients or as a formal intervention (individual or group). As a formal group process, structured reminiscence follows a protocol developed by Stinson and Long (2014). The protocol outlined 12 sessions that identified specific content for discussion including props and guidelines for a therapeutic termination or closure. The use of this protocol in several research studies provided evidence through objective screening tools that reminiscences sessions showed a positive decrease in depression in participants. Despite the noted benefits of the protocol, the ability to organize and run formal groups from a home healthcare perspective is unlikely.

 

Improved quality of life and gratifying social interaction can occur one-on-one between home care clinicians and their patients during home care visits. The focus on reminiscence through the use of therapeutic communication techniques such as active listening skills, therapeutic silence, and use of open-ended questions can foster therapeutic communication (Halter, 2014). An individual sharing personal aspects of his/her life really wants to be heard and feel that the individual they are speaking with is present and available socially and emotionally. The art of actively listening meets this important need by acknowledging the patient's expressions through the clinician's undivided attention and concentration on how the patient is feeling and what they are saying. The use of active listening enhances the patient's self-esteem, helps minimize feelings of isolation, and allows them to revisit important events or experiences of their past. Therapeutic silence gives the patient time to recall memories and associated feelings without interruption. Clinicians need to develop comfort with silence and avoid interrupting or directing the conversation. The final and most important therapeutic technique for stimulating reminiscence is the use of open-ended questions. Open-ended questions encourage the patient to share and expound on experiences and perceptions that are important to them. Open-ended questions also facilitate the development of the therapeutic rapport. An open-ended question stimulates conversation by asking a question that can't be answered with a yes, no, or one-sentence response. For example, the clinician may wish to ask a patient about their relationship with their spouse. Asking the patient how long they have been married would elicit a simple response regarding the number of years married. An open-ended question such as; "tell me about this photo, it looks like your wedding day," sets the stage for a conversation around an important event in that patient's life (Halter).

 

As reminiscence is all about engaging the patient in gratifying conversation, it can take place at anytime during the clinician's visit. Occupation therapists can encourage conversation while assessing the patient's performance of activities of daily living. Physical therapists can stimulate a conversation during walking or during rest periods between strengthening exercises. Nurse clinicians have multiple opportunities to engage their patients in reminiscence during assessments and the collection of data and history. Reminiscence conversations are not defined by when, how, or the length of time they occur; rather their value is measured in the satisfaction and sense of well-being and belonging a patient feels after discussing and reexperiencing a significant event in his/her life. Clinicians can measure the benefits of reminiscence experiences through the positive development of the therapeutic rapport, decrease in depressive symptoms, and patient verbalizations of feeling positive and valued.

 

Topics for reminiscence are vast and frequently cover the life-span. Common areas of interest to all patients are holidays and special events in their life. Using the holiday closest to a visit can serve as an orienting theme for patients with memory loss or cognitive impairment. Simple reminders of the special day, such as a mini flag for the 4th of July, a snack-size candy for Halloween, or a paper heart for Valentine's Day are all concrete and symbolic reminders of a holiday that can help foster memories and support orientation. Leaving these reminders with the patient after the visit also serves as a reminder of the special conversation they shared with you. Clinicians can use these props to stimulate conversations of the patient's memories surrounding the holiday, including favorite activities or family traditions. The patient may offer as many memories as they feel comfortable sharing, and the time spent reminiscing can last for a few minutes to larger blocks of time.

 

Other topics for reminiscence can include current and past hobbies, careers, anniversaries and important cultural events, favorite foods, or recipes, school days or achievements. Veterans may enjoy speaking about their travels and service to the country, whereas mothers and grandmothers may focus on raising their children and grandchildren. Helpful multisensory props include photos or photos albums, souvenirs, or mementos and keepsakes that a patient may have in his/her room or home. Music common to the patient's era can stimulate many pleasant and strong memories; they may even choose to sing or dance to the music. The primary author uses an I-pad to pull up photos of animals or flowers to stimulate conversations around pets and gardening days.

 

Reminiscence is a valuable intervention that can be utilized by all clinicians in every home healthcare visit. Reminiscence can be used to support engagement and socialization in home-bound patients. An underrated, but healing and comforting skill of the home care clinician is the simple and compassionate gift of time and conversation.

 

REFERENCES

 

Butler R. N. (1963). The life review: An interpretation of reminiscence in the aged. Psychiatry, 26(1), 65-76. [Context Link]

 

Halter M. J. (2014). Varcaroli's Foundations of Psychiatric Mental Health Nursing (7th ed., pp. 151-159). St Louis, MO: Elsevier. [Context Link]

 

Stinson C., Long E. M. (2014). Reminiscence: Improving the quality of life for older adults. Geriatric Nursing, 35(5), 399-401. http://dx.doi.org/10.1016/j.gerinurse.2014.08.006[Context Link]