Quilting Narrative Using Repetition Techniques to Help Elderly Communicators By Angela Ballard ENG Dr. Boyd Davis May 5, 2006

Personal Narrative A way people share themselves with others A way people share themselves with others Health professionals can help people with dementia put pieces of their personal narratives together by using collaborative techniques to identify and reclaim their stories. Health professionals can help people with dementia put pieces of their personal narratives together by using collaborative techniques to identify and reclaim their stories. People beginning to experience cognitive difficulty will have trouble in a give-and-take ordinary conversation but may be able to present a story they have told several times. People beginning to experience cognitive difficulty will have trouble in a give-and-take ordinary conversation but may be able to present a story they have told several times. The moderate or moderately severe dementia person may be able to present only fragments’ of a story. The moderate or moderately severe dementia person may be able to present only fragments’ of a story. The more a nurse knows about narrative components or the different section of a story, the easier it will be for them to identify and follow up on a story fragment offered by a patient with dementia. The more a nurse knows about narrative components or the different section of a story, the easier it will be for them to identify and follow up on a story fragment offered by a patient with dementia.

How Narrative Quilting Works The nurse collaborates with the Alzheimer disease (AD) speaker to tell a story by helping to construct it. The nurse collaborates with the Alzheimer disease (AD) speaker to tell a story by helping to construct it. If the AD speaker presents what sounds like part of a story that the nurse has heard from the AD speaker, member of family, etc., the nurse repeats the utterance, waits to see if the AD speaker adds anything new, and then speaks a phrase about that other part of the story. If the AD speaker presents what sounds like part of a story that the nurse has heard from the AD speaker, member of family, etc., the nurse repeats the utterance, waits to see if the AD speaker adds anything new, and then speaks a phrase about that other part of the story. The next time the nurse is with the patient, he/she will introduce the AD speaker’s detail as a topic and wait for additional information. The next time the nurse is with the patient, he/she will introduce the AD speaker’s detail as a topic and wait for additional information.

How Narrative Quilting Works (cont’d) Learning this process requires effort and practice. Learning this process requires effort and practice. We automatically use the repetition skills as a part of our conversations with others without thinking about it. We automatically use the repetition skills as a part of our conversations with others without thinking about it. AD speakers just need more reminders to offer the details. AD speakers just need more reminders to offer the details. – Caregiver can repeat speaker’s full phrase or sentence, pause. Silence acts as a gentle probe to get the speaker to expand at that time. – Caregiver can record the detail in pocket notebook or file card as a reminder or reference for future conversations with AD patient. Caregiver should introduce one past topic at a time. – Caregiver and return to that detail in the next conversation they have with the AD speaker and phrase it as a statement. Sometimes people with AD may become very frustrated when they cannot put their entire story together. This is when the health care provider can help them communicate, thus helping the person with AD stay calm.

Language Problems and Speakers with Alzheimer Type Dementia (DAT) Characteristics of conversation and narrative by speakers with dementia, middle and later stages: Characteristics of conversation and narrative by speakers with dementia, middle and later stages: – Discourse more taciturn – Information and coherence are reduced – Preservation and tangentiality increase – Vague or empty speech increases – Turn-taking more frequent but shorter turns – Fewer elaborations – More irrelevancies My husband and I watched this happen with his father as he moved into the later stages of dementia. He gradually quit taking part in family conversations and could no longer start and sustain conversations.

Four Strategies caregivers can use to help AD speakers in conversation. The difference in an older speaker aging normally and the AD speaker is that the older speaker can use the following strategies to help the listener follow the story; the AD speaker lacks that consistency. Estimate listener’s expectations in regard to what the story will be about, how it will be told, and alert listener to any unusual features Estimate listener’s expectations in regard to what the story will be about, how it will be told, and alert listener to any unusual features Signal beginning of narrative, provide context for listener Signal beginning of narrative, provide context for listener Monitor when listener might need clarification, offer more details Monitor when listener might need clarification, offer more details Keep story on tract and end with some kind of evaluation of story events Keep story on tract and end with some kind of evaluation of story events Caregivers, spouses, and family members still need more help in knowing how they might accommodate and facilitate the discourse by AD speakers to help construct a more sustained narrative. Goodwin’s study demonstrates that meaningful conversation can be conducted if the nonaffected partner is willing to help construct.

SUCCESS in using Quilting Narratives WHO: Selected men and women residents age in a special care unit for WHO: Selected men and women residents age in a special care unit for clients with dementia. clients with dementia. WHAT: A Qualitative Study WHAT: A Qualitative Study WHERE: Residential facility in North Carolina WHERE: Residential facility in North Carolina STAGE OF DEMENTIA: Moderate to moderately severe stages of AD STAGE OF DEMENTIA: Moderate to moderately severe stages of AD HOW: Secured written informed consent from legal guardians HOW: Secured written informed consent from legal guardians Recorded conversations with eight residents on weekly basis for Recorded conversations with eight residents on weekly basis for two years two years Interviews lasted 5-20 minutes (dependent on unit activities, AD Interviews lasted 5-20 minutes (dependent on unit activities, AD speaker’s nonverbal communication of desire to continue or speaker’s nonverbal communication of desire to continue or discontinue conversation) discontinue conversation)

Results of Qualitative Study in North Carolina Results are based on different narrative components in conversation with two AD speakers and how they were helped to reclaim parts of their life story when quilting narratives were used. Listened for narrative elements that offered clues to other narratives, such as start or end of a story. Listened for narrative elements that offered clues to other narratives, such as start or end of a story. While in conversation with AD speaker, listened for something that sounded like the beginning to another story, a different event, or the repetition of more than one detail. (Repetition suggests another story is waiting to come out) While in conversation with AD speaker, listened for something that sounded like the beginning to another story, a different event, or the repetition of more than one detail. (Repetition suggests another story is waiting to come out) Listened for something that sounds like the end to a story or for a new event loosely connected to the preceding conversation. Listened for something that sounds like the end to a story or for a new event loosely connected to the preceding conversation. This study of conversation made it more apparent that people with dementia can provide narrative that shows insight into their lives. Those giving the tests learned a lot about the individual, but also noticed how the individual maintained verbal and nonverbal behaviors that gave evidence of contentment during the conversation. This confirmed to the ones giving the tests that narratives are an important part of communication for ALL human beings.

Benefits of using repetition technique of quilting narrative: Nurses can help family members see that the person with AD is trying to signal some part of life event or identity. Nurses can help family members see that the person with AD is trying to signal some part of life event or identity. Agitation is reduced and improved moments experienced as a result of piecing the blocks of the quilt together and elaborating the pattern of life. Agitation is reduced and improved moments experienced as a result of piecing the blocks of the quilt together and elaborating the pattern of life. Listen to speaker’s repetition of key details; repetition signals a pattern for speaker; a beginning or ending component to a story that is a block in his life’s quilt. Listen to speaker’s repetition of key details; repetition signals a pattern for speaker; a beginning or ending component to a story that is a block in his life’s quilt. By helping speaker build on repeated detail, we help him complete his story. By helping speaker build on repeated detail, we help him complete his story. The caregiver benefits by understanding the AD speaker. The caregiver benefits by understanding the AD speaker. The AD speaker benefits in quilting the sections of his life. The AD speaker benefits in quilting the sections of his life.

My perspective on using repetition technique of quilting narrative as a possible intervention with Alzheimer patients: My father-in-law was admitted to a special care unit for patients with dementia in a residential facility in Taylorsville, North Carolina about three years ago. My father-in-law was admitted to a special care unit for patients with dementia in a residential facility in Taylorsville, North Carolina about three years ago. We watched him transition from the early stages of cognitive difficulty to moderately severe dementia very rapidly. We lost him about a year and a half ago. We watched him transition from the early stages of cognitive difficulty to moderately severe dementia very rapidly. We lost him about a year and a half ago. He definitely exhibited the characteristics of conversation and narrative by speakers with dementia given earlier in this presentation. He definitely exhibited the characteristics of conversation and narrative by speakers with dementia given earlier in this presentation. After reading this article on quilting narrative, I remembered how the health care professionals, on many occasions, utilized some of the techniques in this article with our father-in-law when trying to initiate conversation with him. After reading this article on quilting narrative, I remembered how the health care professionals, on many occasions, utilized some of the techniques in this article with our father-in-law when trying to initiate conversation with him. We found it interesting how he responded to the nurses when he barely acknowledged our presence or comments. I can see now that the nurses knew how to collaborate with him to tell a story by helping him construct it. Sometimes, he and the nurses would carry on quite a conversation. We found it interesting how he responded to the nurses when he barely acknowledged our presence or comments. I can see now that the nurses knew how to collaborate with him to tell a story by helping him construct it. Sometimes, he and the nurses would carry on quite a conversation. After reading about how this technique can help speakers with dementia, I hope I can be more supportive of speakers with AD by putting into practice some of the strategies I learned about here to help them complete their story by quilting sections of their life. After reading about how this technique can help speakers with dementia, I hope I can be more supportive of speakers with AD by putting into practice some of the strategies I learned about here to help them complete their story by quilting sections of their life. Another reason I focused on this as being an intervention is because of my love for quilts, especially the ones my husbands’ grandmother and mother created. My mother-in-law could tell a story about each quilt that granny Reel made. How interesting to learn that we as caregivers can give back to those with cognitive deficits by helping them piece together their life story by quilting a section at a time. Another reason I focused on this as being an intervention is because of my love for quilts, especially the ones my husbands’ grandmother and mother created. My mother-in-law could tell a story about each quilt that granny Reel made. How interesting to learn that we as caregivers can give back to those with cognitive deficits by helping them piece together their life story by quilting a section at a time.

Acknowledgment: Linda A. Moore, RN, EdD, CS, ANP, GNP and Boyd Davis, PhD “Quilting Narrative – Using Repetition Techniques to Help Elderly Communicators.” © 2002 by Mosby, Inc. Geriatric Nursing Sept.-Oct Volume 23. Number 5 (pp ) Linda A. Moore, RN, EdD, CS, ANP, GNP and Boyd Davis, PhD “Quilting Narrative – Using Repetition Techniques to Help Elderly Communicators.” © 2002 by Mosby, Inc. Geriatric Nursing Sept.-Oct Volume 23. Number 5 (pp ) uncc.edu+?cid=1360&page /29/ uncc.edu+?cid=1360&page /29/ uncc.edu+?cid=1360&page uncc.edu+?cid=1360&page