Improving Patient Outcomes Utilizing Structured Reminiscence Cynthia Kellam Stinson PhD, CNS, RN-BC Elizabeth M. Long DNP, GNP-BC, CNS JoAnne Gay Dishman School of Nursing- Lamar University Beaumont, Texas

Disclosures 1) Approval Statement-This continuing education activity was approved by the Western Multi-State Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Arizona, Colorado, Idaho, and Utah Nurses Associations are members of the Western Multi-State Division. Approval # 72-17 2) Criteria for Successful Completion-To receive contact hours, participants must check-in to the session using the barcode scanner, attend the entire session and then complete both the session evaluation and full conference evaluation by July 31, 2017.

Disclosures 3) Conflicts of Interest-This educational activity does not include any content that relates to the products and/or services of a commercial interest that would create a conflict of interest. 4) Commercial Support-There is no commercial support being received for this session.

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Measurable Learning Outcomes Discuss evidence-based data supporting the use of group reminiscence as a tool to decrease depression in a diverse older population. Describe an evidenced–based protocol that can be used in a clinical setting to implement reminiscence with a diverse older adult population Implement reminiscence strategies that can be used in a clinical setting to facilitate students’ interactions with a diverse older adult population.

Purpose Implement an evidence-based, innovative nursing educational strategy (reminiscence) to decrease depression in older adults Introduce undergraduate students to research with a diverse population through interaction and group participation with older adults.

The Need for this Education There is a shortage of nurses prepared in care of older adults Every day until 2030, some 10,000 Americans will turn 65. The percentage of Americans over the age of 65 will jump to nearly 20% by 2030 (13% today). (Robert Wood Johnson Foundation (2012) United States in search of nurses with geriatric training Retrieved http://www.rwjf.org/en/library/articles-and-news/2012/02/united-states-in-search-of-nurses-with-geriatrics-training.html)

Major Error in Caring for Older Adults Speaking as if the older person no longer exist-Reminiscence is an exercise to help students understand who the older person is

What is Reminiscence Recalling memories Reviewing memories Recapturing the emotions that went with the memories

Why is it Important for Older Adults In later life reminiscence takes on a more significant role: it's how older adults get in touch with things and times that were important to them. Through reminiscing older adults find meaning in their memories

Why is it Important for Older Adults How we have lived our lives. Reaffirm that we all made mistakes in our past, but that is the nature of human beings. We can affirm that they have had productive lives.

An Evidenced Based Protocol Stinson’s Protocol for Structured Reminiscence (Stinson & Kirk, 2006; Stinson , 2009; Stinson et.al. 2010, Stinson & Long 2014) An Evidenced Based Protocol In 2007 Bohlmeijer et.al in a meta analysis of 15 controlled outcome studies concluded that reminiscence can have potentially effective outcomes for psychological well-being in older adults. However there was a need to develop well-defined protocols

Stinson’s Protocol for Structured Reminiscence (Stinson & Kirk, 2006; Stinson , 2009; Stinson et.al. 2010, Stinson & Long 2014) Stinson’s Protocol is the first evidence- based protocol developed for reminiscence as a cognitive intervention for depression. Older adults with chronic depression are at risk for increased use of medical resources, institutionalization, and even death.

Stinson’s Protocol for Structured Reminiscence (Stinson & Kirk, 2006; Stinson , 2009; Stinson et.al. 2010, Stinson & Long 2014) One of the primary modalities used for the treatment of depression in older adults is medication. Antidepressant medications can lead to harmful side effects without alleviating the underlying depression

Viktor Emil Frankl (1905-1997) An Austrian neurologist and psychiatrist as well as a Holocaust survivor Frankl believed that people are primarily driven by a "striving to find meaning in one's life," and that it is this sense of meaning that enables people to overcome painful experiences.

Theoretical Foundation Erikson’s Developmental Stages extended to reminiscence by the work of Butler (1963) guided this study.

Examples of Topics Protocol First job First pet Favorite holidays Favorite toys School days Friends through the years

Study 2011-Stinson Protocol Stockholm, Sweden (Karolinska Institute) 12,000 community Swedish older adult citizens participated in research with Professors Marie Åsberg and Åke Nygren and Ulla Peterson Significant decrease in depression using Stinson Protocol for Reminiscence

Where is it Now? Sent: Friday, April 14, 2017 Thank you for checking in. Yes, we are still moving forward with the study, and we will be beginning the feasibility portion of it in about a month. Karyn E. Gunnet-Shoval, Ph.D. Psychology Department Harvard University Cambridge, Massachusetts

Study 2016 Stinson & Long-

Hypothesis Adults 50 years and older, who reside in a long term care facility who participate in twice weekly one-hour structured reminiscence group sessions for 6-weeks will report significantly lower depression scores, as measured by the geriatric depression scale (GDS), 3-weeks and 6- weeks after the intervention begins compared to control group.

Student Participation BSN Nursing Students Community Based Service Learning Hours Project Discussed in Nursing Inquiry Evidence-Based Practice Course

Student Benefits: Assessment Risk Factors for Depression Awareness of Signs of Depression Observation of Depression in Older Adults

Student Benefits: Application Use of Evidence-Based Screening Tools in Older Adults Use of Evidence-Based Intervention for Depression Application of Research Principles from Classroom to Bedside

Student Involvement Geriatric Depression Scales Gathering Patients Group Participation

Resident Demographics 50-92 years of age 13 already on antidepressant

Resident Demographics

Instrument The Geriatric Depression Scale was used to assess depression at baseline, 3-weeks, and 6-weeks

Results Baseline & Week 3 No significant difference Week 6 Intervention Group p=.035 Control Group p=.456

Geriatric Depression Scale: Implications Question Percentage Dropped Activities & Interests 58.8 Often Get Bored 54.9 More Problems with Memory 52.9

GDS Positive Responses

Clinical Observations: Residents Motivation to Participate Increased Interaction With Other Residents

Learning Outcomes Identified ethical issues which can surround nursing research. Examined the link between theory and research as a foundation for evidence- based nursing practice. Evaluated how evidence-based practice can improve the quality of nursing practice.

Learning Outcomes Participated in culturally sensitive patient- centered care. Recognized the role of the professional nurse as a member of the interprofessional healthcare team. Created intentional encounters with a diverse older adult population.