Engaging in reminiscence with palliative care patients Brian Nyatanga
Senior Lecturer in Allied Professional Studies and Lead for The Centre for Palliative Care, University of Worcester [email protected]
trusted academic colleague once explained something about reminiscence to me that has stayed with me for all these years. He explained that there was a subtle link between reminiscence and resilience. The simple process of recalling past memories to achieve a therapeutic outcome (reminiscence) tends to help our ability to be resilient. Reminiscence is a process that helps people (particularly older adults) to engage in their life review, where recall and judgment of past experiences take place with the aim of making sense of painful or unresolved issues (Cappeliez et al, 2007). At a basic level, resilience is to do with capacity to discover sense—meaning and coherence in a life that is being eroded by difficult scenarios, such as terminal illness. In order to fully grasp the effect of resilience in difficult situations, he suggested that one should think of resilience in three ways: ww When you achieve through adversity ww When you achieve despite adversity ww When you achieve, thanks to adversity. This is the true essence of resilience. Adversity can be argued to come in different forms and the phase of dying could be one such familiar occurrence in life for many people.
The technique of reminiscence Reminiscence is considered an effective technique for helping people in later life (Cappeliez et al, 2007). Life events can be both negative and positive.The argument is whether palliative care patients would benefit from reminiscence, and whether the community is the best place to encourage such a cathartic process. The fact that reminiscence is largely a private and individual activity, makes the patient’s own home and community more ideal to reminisce than in any institutions of care.
© 2015 MA Healthcare Ltd
How does reminiscence work? According to Bluck and Alea (2002), that there are eight main functions of reminiscence: integrative, instrumental, transmissive, narrative, escapist, obsessive, death preparation, and intimacy. Narrative and death preparation are closely aligned to caring, and therefore will be briefly explained: ww Narrative reminiscence encourages recall of past memories through storytelling. Through narratives, we can help patients manage their emotions to a functional level so that they can continue to ‘enjoy’ the remaining time of their life. Narrative reminiscence is thought to promote social bonding among health professionals and patients and their family
British Journal of Community Nursing June 2015 Vol 20, No 6
members. Cappeliez et al (2007) claim that intimacy can be enhanced and quality of life improved. In palliative care, better quality of life often leads to dignified death. ww Death preparation deals with how reminiscence uses past memories to face issues of impending death. At this stage, there are other spiritual and cultural concerns that need considering and reminiscence tends to support memory recall in such cases. Through reminiscence, carers can understand the wishes of patients and help them achieve their preferences with regard to location of care and death.
How can community nurses help? For community nurses, the home setting presents itself as the most ideal place to encourage patients and their families to engage in reminiscence. Indeed, community nurses will need to develop skills to facilitate such an emotionally and psychologically charged process to ensure patient safety at all times. The conversation need not be complex, but could be started with a simple question, for example, can you tell me what you used to do when you were in the army? This type of question will help gauge the ‘temperature’ mood of the patient before asking more emotional questions. Other questions could be more personal, such as can you tell me what you used to enjoy doing in your younger days? All these questions encourage the patient to start the recall process.There is no right or wrong way here, but the important point for nurses is that even with emotional reactions evident by the end of the reminiscence, the patient should be left feeling uplifted with a sense of benefiting from the process.
Conclusion Since reminiscence helps many older adults and those facing death to engage in life review, which in turn helps them to find psychological strength and meaning in their remaining life, it is important that community nurses feel confident to encourage patients to engage in reminiscence. The outcome of reminiscence is enhanced quality of life, and when quality of life is enhanced, it can be argued that dying is likely to be peaceful and dignified. BJCN Bluck S, Alea N (2002) Exploring the function of autobiographical memory. why do I remember the autumn? In: Webster JD, Haight BK, eds. Critical Advances in Reminiscence Work: From Theory to Application. Springer Publishing Company, New York: 61–75 Cappeliez P, Rivard V, Guindon S (2007) Functions of reminiscence in later life: proposition of a model and applications. Eur Rev Appl Psychol 57(3): 151–6
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 129.096.252.188 on February 1, 2016. For personal use only. No other uses without permission. . All rights rese