Building on the important work of 2 projects, There is a Bridge and The Trebus Project,2 which were highlighted in this column (volume 22, No. 2), I would like to offer a concept of care for the families, friends, and those who care for persons with dementia. This conceptual design might also be efficacious for other residents and patients in nursing homes and rehabilitation centers of any age.

Briefly, There is a Bridge is a documentary film that brings to the forefront the work and thought of preeminent thinkers whose philosophies together create an entirely humanistic approach to the vexing problems of communicating with individuals who have Alzheimer disease and other dementias. The film explicitly demonstrates that, in fact, it is possible to have meaningful communication with those who have dementias. They have discovered a simple and yet profound way of communicating, which involves a mindful humaneness that embodies an attentive presence, listening with discernment, and deep understanding of the words and language that enhance dialogue and communication. They, in fact, create an environment wherein all can communicate with ease and enjoyment. The role of imagination is beautifully illustrated in this film by Josh Dorfman, an artist who sits with individuals and carefully listens to their life stories and draws images on a large canvas.

The second project, The Trebus Project, was created by an artist, David Clegg, and a musician, Tommaso del Signore. It is a collaboration project involving musician, artist, and individuals with dementias in song and story in which recovered memories are recorded.

These projects reveal to us all, family members, friends, and carers alike, that loved ones are not lost to us although they may have dementia. Its significance also lies in rediscovering how we are shaped by those we have known and loved.

The concept of care that I suggest here was derived out of my concern for my mother's daily stark moments of loneliness, of not being meaningfully connected to others in her environment. She is 95 years old and resides in a community care center in the Midwest. And as she often says, she is forgetful of things that have happened in recent days and weeks. Talking with her on the telephone, she lamented not being able to remember events and anniversaries of close relatives and friends and of not knowing where she was or with whom she was staying. (Since the care center was not her home, she was valid in her premise that she was just staying there.) When visiting with her and together reviving memories, it became clear that she remembered a great deal. In fact, some of her memory "problems" were and are due to the fact that she is living among strangers who knew very little about her and not among those with whom she was emotionally and spiritually connected.

Reflecting on our lively conversations and mutual enjoyment of one another and impressed by what she could remember at those times, I decided to write a life story narrative of her life for the nursing staff, hoping that they would place it in her medical record. That way, even new staff would be able to converse more effectively with her.

One afternoon last winter, she became especially confused and could not be comforted. The charge nurse, anxious to help her, began reading her life story out loud to her. All of a sudden, my mother became calm and thoughtful and said to the nurse, "Well, that is me, that really is me."

I included in her narrative not only birth data and family background but also key highlights of her life-her loves, interests, special events, travels, and unique talents. Talking with her made it easy to find the important memories. She, of course, especially enjoys stories of her children, grandchildren, and great grandchildren; their interests; and achievements.

Then I began to build on each of these categories in picture albums: one on her European travel with my father and her sisters, another with details of some of her original recipes, on her work with the girl scouts, another with reproductions of some of her paintings, one with enlarged photos of family members appropriately named in large letters, and, of course, selected photos of her and my father over the years with commentary on special events and camping trips. Most recently, grandchildren have created their own family albums for her, with the great grandchildren taking part.

There are many conversational points to be gleaned from her life story albums. Several individuals have borrowed and copied some of her recipes. One visitor baked 2 of the cookie recipes at home and brought them into the care center to share. What a fine conversation emerged that day among residents and staff that not only acknowledged my mother's baking talents in concrete terms but also allowed other residents and staff to share their favorite recipes and details of how family and friends enjoyed them. Imagine how good my mother felt that day and how others enjoyed being included. Staff were amazed to see her paintings and to learn of her creative talents and background of service to others. Aspects of her life story intrigued staff and brought out new information about other resident's lives.

Surely, many clinical nurse specialist readers have already discovered this concept and have created new ways of communicating with loved ones and have been able to instill these into care plans. It is an entirely worthwhile endeavor to promote. What emerges from these interchanges of thought and interest for my mother is exciting because she can genuinely share with others, she does not have to say or feel that she is bereft of ideas or thought. Most conversations are no longer medically oriented nor superficial, for if you know another's interests, you are more tempted to share yours and thus a part of yourself. What is missing, sadly, in long-term care at times are the spontaneous moments that build on an individual's life experiences and wisdom that makes life worth living for all concerned. For the staff, it signifies a fuller and more meaningful experience that ultimately informs their professional practice.

References