ABSTRACT
Nurturing body, mind, and spirit is part of holistic care, and yet often the primary focus of care in nursing homes is physical needs. As part of a larger study examining factors related to hope among institutionalized elders, spirituality emerged as the only significant predictor of hope. Findings supported the active presence of hope despite age and functional limitations. The significant contribution of spirituality to hope calls for attention to the provision of opportunities to support and enhance spiritual practices in the nursing home setting. Nurses in nursing homes have the opportunity to establish close relationships with residents over time, often substituting for family and friends no longer available. Because length of stay is long, more time is available to enter into meaningful spirit-sharing relationships with residents. Suggestions for interventions that nurture hope and spirituality within a holistic and caring framework are presented.
Subject(s)
Adaptation, Psychological , Aged, 80 and over/psychology , Aged/physiology , Nurse's Role , Nurse-Patient Relations , Nursing Homes , Quality of Life , Spirituality , Female , Homes for the Aged/standards , Humans , Male , Nursing Care/psychology , Nursing Homes/standards , Sick Role , United StatesABSTRACT
PURPOSE: To determine if evidence of the persistence of a sense of self or personal identity could be found in people in the middle and late stages of Alzheimer's disease. The theme of diminishing self pervades both the popular and professional literature on Alzheimer's disease. DESIGN: Qualitative using conversational analysis. The purposive sample was 23 residents of two urban nursing homes in the southeastern United States who were in the middle and late stages of Alzheimer's disease. Their mean Mini-Mental State examination score was 10.65. Nineteen subjects were women, four were men in this 1993-1997 study. METHODS: Analysis of 45 conversations lasting 30 minutes with nursing home residents with a diagnosis of probable Alzheimer's disease. Use of the first person indexical and other evidence, such as awareness and reactions to the changes that had taken place, in support of and counter to the notion of persistence of self, were sought in conversational analysis. FINDINGS: Respondents used the first person indexical frequently, freely, and coherently. Evidence was also present that participants were aware of their cognitive changes. Many struggled to provide an explanation, but none mentioned Alzheimer's disease. CONCLUSIONS: Evidence suggests the persistence of awareness of self into the middle and late stages of Alzheimer's disease. Failure to recognize the continuing awareness of self and the human experience of the person in the middle and late stages can lead to task-oriented care and low expectations for therapeutic interventions. The bafflement noted in respondents suggests that people should be told their diagnosis and offered an explanation of what this diagnosis means.
Subject(s)
Alzheimer Disease/nursing , Alzheimer Disease/psychology , Cognition , Self Concept , Disease Progression , Female , Humans , Male , Severity of Illness IndexABSTRACT
Meaningful conversation with individuals in the later stages of Alzheimer's disease (AD) has been considered difficult if not impossible. Limiting communication to simple concrete subjects and closed-ended questions is frequently recommended. Thirty-five 30 minute conversations with individuals with advanced AD (mean Mini-Mental State Examination [MMSE] = 10) were transcribed and the interactions examined. No significant differences in length or relevance of response by type of question was found indicating that subjects were able to respond to open-ended questions. Use of broad opening statements or questions, establishing commonalities, speaking as equals, and sharing of self-facilitated expression of feeling; recognizing themes with salience for the individual helped to maintain the discussion.
