Presentation on theme: "Portrait of a Life – a multi-media toolkit for life story work"— Presentation transcript:
1Portrait of a Life – a multi-media toolkit for life story work
2The toolkit and what are we trying to achieve.. A multi-media toolkit for training and supporting the development of life story workPrimarily indicated for use in care homes but developed for wider use with MHF supportSupporting the knowledge and evidence base of staff utilising the toolkitPromoting positive engagement with individuals and family carersSomething practical containing two DVD’s, a CD Rom, a written guide and photocopiable resourcesMenu of options for life story workAn accessible resource meeting a range of learning styles and settings
3Toolkit contents Acknowledgements Foreword Introduction The Importance of and the rationale for Life Story workThe Evidence baseThe Benefits and the RisksConsent and EthicsA Practical approach to developing life stories‘Going Home’ – learning and reflectionPersonal StoriesLeo’s storyMary’s storyEmbracing and sustaining life story work in practiceFinal thoughts
4What is a life story? Personal details Place of birth/upbringing Family history – parents, siblings, partner,childrenFamily life – family network, close relationshipsEarly years – school, special friendships, learningWorking history – occupation, importance of work, retirementReligion/spirituality – practicing religion, spiritual needs/choices/values in lifeMarital status/relationshipWartime experience
5Understanding Person Centred Care V = Values the person with dementiaI = Treating people as IndividualsP = Perspective of the person with dementiaS = Supportive Social psychology(Brooker 2004)
6Personhood The outcome of person centred care “A standing or status that is bestowed upon one human being, by others, in the context of relationship or social being. It implies RECOGNITION, RESPECT and TRUST”.(Kitwood 1997)Signs of well-being indicate this is being achieved
7Maintaining Personhood Positive Person WorkSupportive Social PsychologyInclusion- Being a part of the social worldAttachment-To others, particularly in times of changeComfort- Provision of warmth and closenessOccupation- Being involved in the process of lifeLove- The central needIdentity- Having a sense of who you are
8“Dancing with dementia: My story of living positively with dementia” “As we become more emotional and less cognitive, it’s the way you talk to us, not what you say, that we will remember. We know the feeling, but don’t know the plot. Your smile, your laugh and your touch are what we will connect with. Empathy heals. Just love us as we are. We’re still here, in emotion and spirit, if only you could find us.”(Christine Bryden, Dancing with Dementia, 2005 p138)
9Why do life story work? To maintain personhood To improve understanding of behaviour and presentationTo improve relationships with family carersTo provide quality of life for individualsTransforming care planningIncreasing engagement and job satisfactionMeets the Dignity in Care challenge- Respect
10DVD AND GROUP EXERCISES What do you think are the main issues/concerns for Stan?What could staff in the home have done to improve Stan’s experience?What are the benefits of undertaking life story work?What information do staff need to gather to complete a life story for Stan?
11STAN:-Lack of meaningful occupationNo personal touches in terms of his environmentThe corridors all look the same-no landmarks/signposts to aid orientationLittle/poor staff interactionPoor engagement in daily routines of the homeGroundhog day-all the days are the sameHobbies/interests not known or acted upon by staffLack of opportunities to maintain his sense of identitySTAFF:-Engage with Stan to find out as much about him as possibleCollaborate with family and friends to learn even moreMake time to build in opportunities for engaging in hobbies and interestsPlan his daily routines to take into account the things he likes and still can do for himselfEnsure the environment around him reflects him as an individual to maintain his sense of identityCreate a space for him to engage in work like tasks
12BenefitsAchieves a holistic and comprehensive understanding of the individual as a person rather than through the biological processes of dementia.Reduction in challenging behaviour through individualised care planningPromoting positive therapeutic interventionsPositive engagement 1 – 1 and with servicesReduced re-referrals / reduced complaints
13Are you really interested in me? I want to cry. Can I cry? What individuals say…You have given me back my life….Are you really interested in me? I want to cry. Can I cry?No-one has done anything like that for me beforeThe carers are always asking me about my life nowThe poem reminds me of school.. Thank you!Memories are lovely things as long as you don’t get the bad onesCan’t tell you what your input has meant to her and us…
14Risks Proceed with caution! Communicating the worth of the person as being in the domain of past competencies and achievements rather than in the present (Killick and Allan 2001)The impact of negative life histories – a recommended area for further research
15Evidence Base No official research Life story work helps staff form a better understanding of a personRecent policies DO support life history work
16The Evidence Base… Carers as experts model (Nolan & Keady 2001) Support carers through sharing knowledge (Charlesworth 2001)Family health nursing (WHO 1999)National Service Framework for older people (DoH 2001)The Essence of Care (DoH 2001)The Dignity campaign (DoH 2006)Kitwood T (1997) Dementia Reconsidered; The person comes first. University Press. BuckinghamBrooker D (2007) Person-Centred dementia care; making services better. Jessica Kingleys Publishers. LondonHome From Home (2007) The Alzheimer's SocietyCSCI (2007) See me not the dementia
17Things to consider… Consent from the outset Ongoing Informed consent ConfidentialityDefamation Act 1952 & 1996Supervision and support for staff
18Practical Models and Approaches CARER modelLife BooksMemory BoxesLife Story BoardsSpecial Interest/Hobbies BooksSignificant Events Music CD
22The CARER model C : Collaboration A : Assessment with R : Relatives of E : ElderlyR : ResidentsA model for working in partnership with individuals and family carers to promote person-centred care
23Life Books, Life Story boards and Memory Boxes The CARER ModelLife story journalsLife Books, Life Story boards and Memory BoxesRuth EndicottSuzanneLynda HolroydCreating Life Story Boardsand Memory Boxes23
24Exercise 1Think about an object you currently have in your possession, that is meaningful to youIf you are happy to, place it on the table in front of youWhat significance does this have for you as a personHow does this represent you as a person?How would you feel if these were taken away?
25Exercise 2 – “No ideas?” Choose an object from the table Why have you chosen this object?Consider using objects to stimulate discussion.
26Getting started Introductions Discuss life story work & consent form Developing a rapportBuild trust and confidenceFamiliar face/voiceGiving people timeShowing empathyShowing a genuine interestGive some of yourself
27The ProcessUsing CARER model to gather information from individual/ families/partners in care.Spend time with the individual & consider the environment. Is a quiet area more appropriate for discussion?Use information gathered as a baseline for stimulating discussion with the individual. E.g. Tell me about your school days? Where did you go to school? Did you wear a uniform? Can you remember any special friends? - See CARER model info leaflet.Make notes without detracting from flow of conversation.Or, tape recorder with permission!Be aware of individual’s body language during discussion – happy? sad? excited? Open/closed posture? eye-contact?
28The Process cont... Share their enthusiasm. Be sensitive to emotional memories and offer support.Is the information factual/confabulation? – Is this important?Be willing to share your own memories.Be aware of the time you are spending – too much? too little?Ensure you have support networks yourself. Life story work can evoke memories for you too
29Potential Barriers Dysphasia Repetitiveness Reduced concentration Sensory impairmentsOthers perceptions “they won’t remember!”Task orientated environment “I don’t have time? It’s not my job!”
30Overcoming barriers Communication aids Body language/facial expressionsShort sessions/don’t overload with info.Using sensory objects to touch/smell/hearThey may not remember the content but may remember the enjoyment/feelingPerson Centred Care is everybody’s business! A 5 minute conversation can make a difference!Role modelling
31What do I do with the information? Decide on a theme or significant memoryResearch information relating to the theme or significant memory.Work with families/friends/partners in care for informationGather relevant mediaConsider confidentiality
32Researching information Internet – clip art/Wikipedia – free to use.Be aware of copyright laws when using internet.LibraryBooksCharity/second hand shopsUsing individual’s photographs/personal memorabilia – colour copy/scan. Originals are precious!
33Themes for storyboards/boxes HolidaysPetsSchooldaysWashdaysWorking lifeDown the pitMake do and mendMotorbikes/carsMusic memoriesHobbiesFashionFavourite coloursThrough the yearsChildhood daysDancingGardeningLandmarksSweetshop past
34Suggested materials Glue sticks Newspaper cuttings Scissors Copied photographsWrapping paperScraps of materialFamiliar picturesColoured cardGlitterAnything pertaining to the theme of the boxPlastic walletsDisplay bookletGlue sticksScissorsImagination/funPicture frame( can be recycled)Shoebox or similar vessel
35Practical sessionUsing your photographs and the provided materials, begin to assemble your memory box or board.
36Related activities Craft work Poetry books Concentrate on facilitating hobbiesColouring/drawingPaintingUsing music tapesTalking booksReminiscence sessionsPicture books
37Confidentiality and keeping data secure Written permission via ‘consent form’On going ‘informed’ consentUse of photographsData storageEncryption
38When they are on their own, Dad can be verbally aggressive to Mum. Dear Sir,I am writing this on behalf of my mother in law to try and outline some of her problems with my father in law, Leo. For the past 12 months it has been very difficult for my mother in law.Because of Dad’s changing behaviour he now has no interests at all and just wants to be with her all the time. He is confused regarding clothing, like not remembering to put shirts on etc or not taking them off and also wearing them under his night clothes. It is also difficult because he wears two hearing aids but has very selective hearing. He will totally ignore you and then repeat things to mum when we have gone. He is also moving and losing things.He cannot relax and he is up and down all the time and in and out looking for glasses, hearing aids, teeth, etc, but are usually either wearing them or have put them away and forgot where. We realise a lot of this is age related but it is making mum ill. When they are on their own, dad can be verbally aggressive to mum saying that she is always on the phone (mostly when we ring to see if she is alright), and that she does not do things for him, etc. He snaps at her and then five minutes later has forgotten it.Mum used to have two shopping days a week which gave her a break, but now dad insists on going with her. Sometimes he will be fine, but other times he can be very moody and takes it out on her when they get home. He is very confused as to days and times, etc. Recently mum had been quite ill with the stress and had to go into hospital, but he told people that she had gone to the hairdressers or shopping.He has his own keys for the house and was left to go for a walk once when mum had a hospital appointment. When we got back dad “hit the roof” and said we had locked him in the house.Another time dad shouted and carried on and he said mum had been out playing games and dancing until 4am when she had not been out at all. I hope this gives you a little insight of what is going on, and as you can imagine there is a lot more. On the whole dad is a lovely man and means no harm, but it is causing mum to be ill and upset because dad does not know he is doing it. We feel it is mum that needs the breaks.Dad worked until he was 82 in a little cleaning job or washing up for three or four hours a day and he loved it because it was his independence and got out of the house. Now I feel not only is it his age, but boredom too. But as much as we try to give him his independence he relies on mum for everything from dressing to food. He will not make a decision about anything and then says he was not asked.He is very jealous of anyone going to the house, including us, grandchildren and great grandchildren, as we are taking up mum’s time. he does not think we are family and calls us sir or madam, or friends. I do hope this helps you and that you can help us. I am sorry but my mother in law is not up to coming to this appointment with dad as she finds it all too much and very upsetting. There is not many days go by where she is not in tears and it is taking its toll on her health.Yours Sincerely,He has his own keys for the house and was left to go for a walk once when mum had a hospital appointment. When we got back dad “hit the roof” and said we had locked him in the house.Another time dad shouted and carried on and he said mum had been out playing games and dancing until 4am when she had not been out at all.When they are on their own, Dad can be verbally aggressive to Mum.Recently mum had been quite ill with the stress and had to go into hospital, but he told people that she had gone to the hairdressers or shopping.
39This is a copy of a letter sent by Dr This is a copy of a letter sent by Dr. Orange to Leo’s GP indicating improved MMSE score.
40CODGER!...Mood lifting visibly and relationship with myself developing.
41Developing the story. The flowchart Basic interviewing Hopefully, by undertaking a Life Story Project, you can help the person build self confidence and feel valued and respected.It is also important when engaging with the person to ask relevant questionsBasic Interviewing techniquesAsk open-ended questionswhich can be developed at length by the client. It is essential that the interviewer be as unobtrusive and inconspicuous as possible.Start the session with easy and enjoyable kinds of questions…
42Tom Kitwood.As we go through life we build up a personal history with its unique mix of joys and pleasures, sorrows and pains. Our sense of who we are is linked to that history and if we lose that we lose something of ourselvesThank you !