Alzheimer’s Disease & Dementia

Biography

Biography: Anke Erdmann

Abstract

In order to facilitate communication with dementia patients and to accord them more respect and appreciation, Naomi Feil developed validation therapy which has been modified by Nicole Richard in Germany since 1993 in cooperation with care facilities and which has resulted in her Integrative Validation Therapy (IVA). Since then, Integrative Validation Therapy has been implemented in many care facilities in Germany and increasingly in hospitals as well. Since so far there has been little research on IVA, the corpus of knowledge relating to this intervention method is rather small. The presented evaluation study helps to expand the available knowledge on IVA. Research questions: Two research questions were examined: 1. With which categories can we describe the praxis of Integrative Validation? 2. How is Integrative Validation evaluated by nurses and relatives? Methods: A Fourth Generation Evaluation Study was conducted with IVA practitioners, IVA trainers, a neurologist/psychiatrist and relatives of people with dementia living in a care facility in northern Germany. To provide additional expertise, the originator of Integrative Validation, Nicole Richard, and 14 more IVA trainers from Germany and Switzerland also participated in the evaluation. The participants from the care facility were questioned on their experience with Integrative Validation Therapy in 18 individual problem-centered, guideline-based interviews. These interviews were supplemented by four unstructured participating observations of interactions between IVA practitioners and residents in the care facility. After a qualitative content analysis of the transcribed material, the results of the individual interviews and the observations were validated in a group discussion with some participants from the care facility. Inconsistencies were resolved and unresolved questions were answered to the best possible extent. The questions remaining unresolved after this group discussion were discussed in a further group with Nicole Richard and 14 IVA trainers. The result of this Evaluation is a case study on the implementation of Integrative Validation in a care facility. Results: As far as the first research question is concerned, the empirical study led to the development of a model of Integrative Validation Therapy as a complex intervention describing conditions, components and outcomes of Integrative Validation in the case investigated. This model comprises the IVA’s components (of action): attitude, perception, validation, evaluation, documentation. Contextual components identified are theoretical and institutional factors as well as current health-care policies. The description of outcomes relates to the residents of the care facility involved in the study, their relatives and the facility’s employees. In the presentation some categories are described in detail and illustrated with the help of examples. As far as the evaluation of IVA on the part of caregivers and resident relatives is concerned, it can be stated that all those involved in the study are highly satisfied with IVA. In the eyes of the study participants, IVA means the following for the facility’s residents: an experience of trust, belonging and attachment, the chance to remind their own identity, the feeling that someone understands their situation and emotions, the opportunity to derive comfort from somebody, the experience of appreciation, respect, well-being and joy as well as less challenging behavior such as agitation or aggressive behavior and the ensuing reduced consumption of benzodiazepine and neuroleptics. But also as far as they themselves are concerned the participants from the care facility have a positive view of IVA because from their point of view IVA leads to reduced stress for the employees and makes the residents less resistant to care measures thus resulting in a decreased danger of violence in nursing care. Due to this basically positive attitude, IVA, in the eyes of the employees, also improves communication with colleagues and superiors and contributes to greater job satisfaction in general. The main benefit for the residents’ relatives is less strain on them. All relatives participating in the study rated communication through IVA methods positive to the extent that they feel less strain as well as less anxiety for their relatives suffering from dementia. Discussion: The results of this study show that IVA has the potential to support personcentered care, for the interviewees associate effects with IVA that cater to the needs of people suffering from dementia. Personhood as defined by Kitwood is only possible if elementary needs are met and these are appreciation, love, comfort, attachment, inclusion, occupation and identity. It is obviously easier to satisfy some of these needs by implementing IVA as the present study shows. This and other developed hypotheses of the study should be investigated in further research.