Using Validation to Honor Folks with Alzheimer’s or Other Dementia & Avoid Power Struggles

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As rational judgment and situational awareness deteriorate with progressive forms of dementia, folks may want things that aren’t realistic or safe such as driving a car or leaving a secure unit in a long-term care facility. Each individual has different limitations in their ability to process and express verbal and nonverbal language.   Awareness and responsiveness may shift over the course of the day and disease process and  each is a unique individual despite dementia.

 

Validation is a principal of listening that demonstrates understanding what the other person is saying/feeling/thinking.  It is a communication step that is easy to skip, but extremely important in building relationship and minimizing conflict.  Both are important in providing care for this population whether individually or in a community.

 

Here’s an example of a nurse validating a resident who wants to “go home” or is “exit-seeking”.  This is a common experience, especially in the late afternoon, early evening when “sundowning”  (increased confusion, frustration & combativeness) tends to occur.

 

Resident:  I want to go home.lady crying

Nurse:  You want to go home?

Resident:  Yeah, how do I get out of here?

Nurse:  It sounds like you don’t want to be here one bit!

Resident:  I hate it here.

Nurse:  I’m sorry it is so hard to be here.

At this point the conversation could go in several different directions and I can’t guarantee that validating will eliminate escalating frustration or even a physically threatening situation, but I promise it is better for everyone to try.  Consider how it might be different for you if we had that conversation or one of these:

 

Resident:  I want to go home.

Nurse:  You can’t go home.

 

       Resident:  I want to go home.

Nurse:  This is your home.

 

Resident:  I want to go home.

Nurse:  I’ll get you some ice cream.

 

 

 

Notice how validating someone helps to join WITH them in the situation rather than contribute to a power struggle?  Validation is so important, I sometimes think we are showing love, compassion and even acknowledgement of another person’s very existence.  We don’t have to fix,  change, or even believe the circumstances in order to validate someone’s experience. It is part of the listening process that the listener is active in, but has little, if anything to do with her/him.  Offering ice-cream, engaging in an activity, or walking with the resident to their room aka “home” may be all be very effective too, yet AFTER validating!

 

It is effective even when someone can’t speak.  For example, sometimes when I give someone medication mixed in applesauce and she makes a face.  I can tell by her expression, (and the fact that I have mixed in a pill or two) that it doesn’t taste very good. This is a great opportunity to spend a moment, seek eye contact and/or a simple light tough on an arm and say, “I’m sorry.   That tasted gross didn’t it?  I’ll get you some juice”.

 

Whether or not there is a conscious exchange of information,  folks feel safer and more trusting.  Remember, somewhere between 80-90% of our communication is non-verbal!

Building the “soft skills” such as listening, speaking up, empathizing, cooperating contribute to positive patient experience as well as safe, quality, and cost-effective care.

Medical Improv is a great way to build skills like validation!

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