College of Occupational Therapy Care Homes Conference Specialist section Older People Amy Mitchelson Occupational Therapist An occupational

l tool: life story work with older people in care homes. Supporting Slide Presentation Narrative
Slide 1 Opening Through the process of shaping our life story !e learn a"out ourselves !here !e have "een !here !e are no! and !here !e are going# So that !as the idea $ "egan !ith and $ %uestioned !hether or not shaping a life story could "e therapeutically "eneficial especially to those !ho have more time to spare or !ho are perhaps spending time thin&ing a"out it all any!ay# 'efore $ give you an overvie! of my presentation $ !ould li&e to share !ith you a small personal narrative# $ did this !hen presenting at the specialist section for older people(s annual development event in )**+ and $ found that tal&ing a"out myself in front of people $ didn(t really &no! in a strange and some!hat intimidating environment helped me to rela,# Slide ) Once upon a time-and not so long ago $ set foot on a .ourney of discovery in a care home for older people-this !as "ecause $ had accepted a .o" as an activity coordinator# $t !as a fantastic challenge for me and $ soon got to grips !ith the routine re%uested of me and "ecame a !ee&ly "ingo caller and a chair "ased e,ercise enthusiast to name a fe! of my roles# Not my proudest ones through as the activities $ remem"er the most !ere those leaving the residents !ith something to tal& a"out# /hen $ !as in this .o" $ sought advice from the National Association of Providers of Activities for Older People 0&no!n as NAPA1# $t !as in one of the ne!sletters $ heard a"out Tessa Perrin !ho as an occupational therapist had pu"lished material on the activities provided in care homes# Her !or& made so much sense to me and $ couldn(t !ait to find out more a"out the profession of occupational therapy# $n hindsight $ perhaps didn(t do the "est thing ne,t-as $ got a .o" as an OT assistant at the 2oyal Orthopaedic Hospital in 'irmingham# As you can imagine my days of creativity and therapy !ithout "orders !ere over for a !hile# So $ maintained my mem"ership !ith NAPA and $ even put my dog Phoe"e through Pets as Therapy in order to &eep my ties !ith older people in care homes# $ "ecame more and more interested in OT so applied for a course and managed to get a place in )**3 at 4eeds Metropolitan 5niversity# $n my final year $ had to complete a research pro.ect so !ith my interest still "eing in care homes and older people $ !as &een to contri"ute to this developing area# The title of my research pro.ect "ecame 6 An occupational tool7 life story !or& !ith older people in care homes#

Slide 8 So9uring my presentation $ !ill share !ith you the rationale for my research pro.ect: an overvie! of !hat life story !or& is and !hat $ interpreted it to "e: the methods $ undertoo& during my pro.ect: the e,periences of participating in life story !or&: and ho! $ came to no! descri"e it as an occupational tool in the promotion of !ell6"eing and life enrichment for older people in care homes# Slide ; The rationale for my research pro.ect !as "ased upon four &ey considerations- listed on this slide# <irstly $ considered the evidence related to occupational in.ustice in care homes# The significant dearth of occupational opportunities in care homes has "een long ac&no!ledged# The occupational science literature attri"utes the a"sence of occupation in care homes to &ey principles# $nvoluntary displacement could descri"e the e,perience of moving into a care home !ith the changes in temporal pattern and the change in performance of occupations leading to undesired lifestyle conse%uences# The e,perience of occupational dysfunction involving occupational deprivation and=or alienation is heightened !ithin institutionalised environments !here the e,ternal forces can restrict the availa"ility of and the control over occupations# Occupational deprivation is a matter of social .ustice in that the ina"ility to receive feed"ac& during shared occupations limits the a"ility to maintain a sense of self and self6image# $mportant to include that /ilcoc& in 1>>? advocated the occupational therapy profession need to !or& not only !ith people !ith illnesses @"ut also !ith those suffering from disorders of our timeA such as occupational deprivation alienation im"alance and in.ustice-to!ard social .ustice and a sustaina"le economyA# $ felt that this message applied to older people living in care homes# Secondly I came to understand the important human need for stories - sharing; forming stories helps us to understand who we are and where we are through interpretation of the world around us and our experiences. I began to see evidence of the need humans have to share stories all around me. An interesting example you also may be aware of is Peter, who started on youtube a popular discussion site! and now has his own website, sharing his stories on the internet. "e refers to himself as geriatric #$%& and has discussed how important sharing his stories has become for him. 'hen we tell a story we can discover deeper meaning in our lives through the process of reflecting and putting the events, experiences and feelings that we have lived into oral expression. (hirdly, I loo)ed at the evidence base for the use of life story wor) and other reminiscence based activities in care homes. (he adaptive and therapeutic benefits of reminiscence are largely theoretical and include increased sociability, improved general wellbeing characterised by improved appetite, decreased restlessness, improved mood and reduction in challenging behaviours. (his evidence predominantly featured individuals who may have dementia or a cognitive impairment of some description and so didn*t represent the individual*s sub+ective experiences of the reminiscence. (he literature also suggested that sharing stories was a means in which to promote the relationships between staff and residents by increasing awareness and changing attitudes. ,inally, the evidence available in support of life story wor) has rarely been provided by the -older people* themselves. I found that outcomes of such interventions have been measured predominantly through staff and relatives. (he experience of the person living in a care home and ta)ing part in the process of reminiscence or life

story wor) has never really been evaluated. .vidence is re/uired to support appropriate occupation focused interventions with older people living in care homes. 0y research aimed to explore life story wor) as a tool for myself and to try to ma)e sense of the sub+ective experience of it by discussing the outcome with the individuals who*d ta)en part. Therefore during selection of participants $ included ON4B older people !ho had no &no!n memory difficulties or cognitive impairment# So-!hat is life story !or&C My o!n interpretation of life story !or& has "een guided "y descriptions from t!o authors# <aith Di"son !ho has !ritten e,tensively on the su".ect of reminiscence and Charlie Murphy !ho has !ritten a"out 4ife Story /or& and used to provide training from the Stirling 9ementia Centre# The interpretations from them are as follo!s7 Slide 3 @4ife story !or& uses the interplay "et!een memory and imagination to construct a story that assists the person to locate him6 or herself !ithin his or her o!n family(s history-$t provides a sense of continuity stretching "ac& into the past and for!ard into the futureA# Charlie Murphy !rote that7 Slide + @4ife story !or& is a"out finding out recording and ma&ing use of relevant facts from the individual life story 6 past and present of the personA# My interpretation of life story !or& incorporates the others and also places emphasis on the process and not that of producing a specific product# /hen $ set out to facilitate life story !or& $ !ished to pic& up on the topics style and story path!ays naturally chosen "y the individual# $ summarise this as7 Slide E @4ife story !or& is a colla"orative process e,ploring a person through story !ithout setting out to resolve specific past or present pro"lems "ut to capture !hat the individual !ants to share doing so in the !ay shape and form they !ishA# Slide ? $ gained ethical approval from the university ethics committee to implement and evaluate life story !or& !ith older people living in care homes# $ recruited my participants firstly "y using the Care Homes 9irectory and then approaching managers of care homes# $ !or&ed closely and carefully !ith the managers !ho !ere interested and recruited 8 appropriate participants living in t!o care homes in my local area# $ then facilitated life story !or& sessions at !ee&ends or during the !ee& !henever !as most appropriate for each participant# At up to t!o hours each !ee& the longest intervention !as ? !ee&s and the shortest !as ; !ee&s# One !ee& follo!ing completion of the life story !or& $ implemented semi6structured intervie!s !ith each participant as&ing each open %uestions

relating to the e,periences of life story !or&# $ encouraged them to "e as honest and open as possi"le a!are of the impact $ myself may have on the responses $ !as given# $ then used a %ualitative analysis method &no!n as $nterpretative phenomenological analysis# <ollo!ing its principles $ !as a"le to discover themes !ithin the participant(s transcripts and then interpret the meanings of the e,periences they e,pressed# Slide > These themes formed my research data and represent the perceptions of the e,periences of life story !or& from my participants# They are socialisation realisation volition affordance and a!areness# $ !ill descri"e each theme for you and also give you time to read some of the participant responses# Slide 1* Socialisation captures the e,periences of the process of developing a ne! relationship# Allo! time to read Ma"el7 @<unny is that isn(t itC 0laughs1-$ shall "e sorry not to "e seeing you that(s certain-it(s li&e anything else $ suppose there(ll "e an emptiness for so long and then it(ll "e a happy memory $ suppose eventually-li&eA Flsie7 @/ell you(ve "een a very nice person to meet: $(ve en.oyed your company#A A theme indicating that life story !or& !as socially pleasura"le emerged and each participant mentioned pleasure from the relationship formed "et!een us# Participants found that sharing personal information !ith some"ody previously ne! !as not a pro"lem and "elieved that there !as no pressure regarding !hat to discuss placed upon them# $mportantly participants perceived to have control and choice over !hen their life story !or& sessions !ere and !hat they included# Slide 11 2ealisation captures the e,periences of realising more a"out oneself self reflection and realisation of one(s capa"ilities and the impact one has on others# Allo! time to read Ma"el# @-it has made me thin& more a"out myself and 0laughs1 may"e find fault in myself at times you &no! !hat $ meanC###see !here $ might improve myself a little "it even in my old ageA 0laughs1# Alfred7 @-it ma&es you thin& of lots of things !hich you thin& you have forgotten and erm you suddenly find you haven(t# They come up "ecause you you sort of tac&le that particular period in the life-A A sense of mastery over the process of remem"ering !as achieved resulting in ne! a!areness of !hat has not "een forgotten or lost further promoting a sense of self and social independence# Participants e,pressed that life story !or& helped in &eeping the mind active and assisted them to discover more a"out themselves#

Slide 1)

Golition captures t!o elements of e,perience# <irstly the reasons !hy the participants had chosen to ta&e part in life story !or& and secondly the impact life story !or& had on forming ne! e,periences li&e this e,ample# Allo! time to read Ma"el @ /ell $(d spent all m !or&ing life "eing a nurse so that !as !hat $ en.oy tal&ing a"out reallyA Alfred7 @No $(ve got to give a tal& this !ee& tomorro! actually a"out !hat $ did during my life strangely enough !hat $ !or&ed at you see so as $(ve !ritten it all do!n once no! $(m %uite happy to do it againA 4ife story !or& promoted the personal volition for future social occupation for Alfred# Slide 18 Affordance captures the e,periences of interaction !ith or the influence on-others related to life story !or&# Allo! time to read Alfred7 @/ell $ used it not for personal-sort of for any"ody to read $ produced it for my family "ecause $ &ne! nothing a"out my mother at all e,cept that she had three sisters-A Participants e,pressed the e,perience as an opportunity to share and cele"rate their lives and continue to contri"ute to their future generations# The participants( felt that they !ould not share their life story !or& !ith care staff unless interest had "een e,pressed priority !as given to their families# Slide 1; A!areness is the final theme used to capture the e,perience of time place and self reflection during life story !or&# Allo! time to read Ma"el7 @Bou do loo& round-and you see these people here and you !onder !hat stories there are at the "ac& of them you &no!A 0laughs1# Alfred7 @$f you go into the lounge there this afternoon you(ll find that si, or seven all sat round all fast asleep-$ don(t go to sleep li&e that 0laughs1 $ li&e to &eep reading or something li&e thatA# Participants e,pressed a!areness of others around them in the care home as "eing humans !ith stories recognising they !ere different to them# Slide 13 $ !ill no! go over each of the concepts on this diagram that $ interpreted as "eing representative of the %ualities of life story !or& "ased upon the participant(s perceptions of the meaning of this e,perience# Colla"oration ac&no!ledges that through life story !or& there !as an opportunity for participants to receive social feed"ac&# /hiteford in )**; suggested that providing the opportunity for engagement in colla"orative and social occupations challenges social in.ustice# $dentity represents that life story !or& promoted a sense of self identity and !orth through the e,perience of sharing stories chosen "y the individual#

2outine ac&no!ledges that life story !or& contri"uted to the development of a temporal pattern a structure to the !ee& determined and controlled "y the individual# MeltHer in )**1 suggested that the development of an occupational routine assists in the process of adaptation to a different environment# Creativity recognises the opportunity life story !or& gave in providing time to "e creative !hich Perrin in )**1 suggested enhances the "readth and richness of the traditional approach to occupational therapy# Additionally t!o participants chose to represent their life story !or& as an o".ect: one !as a memories "oo& 0refer to picture1 the other a !ritten "oo&# Hoc&ing in )*** suggests that o".ects of personal significance can assist in reflecting self identity during a process of transformation# Participation represents the overarching "enefits of engagement in something ne! !ith some"ody ne!# NAPA states that discovery and ne! e,perience in the conte,t of the care home is a priority for older people# <inally/ell6"eing and choice incorporates many of the %ualities life story !or& can contri"ute# $ feel that facilitating choice ultimately leads to increased !ell6"eing# $ !ill no! share a summary of my final thoughts and reasons !hy life story !or& can "e referred to as an occupational tool in care homes# Slide 1+ $ found that life story !or& can "e used to ena"le occupation facilitating participants in Idoing "eing and "ecoming( also e,isting and interacting# $ "elieve that life story !or& contri"utes to the process of sageing# Sageing is a concept do 2oHairio in 1>>? descri"es as an inherent process for older people !here occupations can "ecome the space and means "y !hich healing sharing cele"rating mentoring and giving service to the gro!th and development of future generations can occur# To"in in 1>>1 illustrated ho! one of the &ey resources older people had !as the capacity to ma&e the past vivid through story telling# He also suggested that "y allo!ing people to e,press themselves as they once !ere is a tool for sustaining psychological health# $n )**) <rench o"served "oth staff and residents in a care home and descri"ed them as e,periencing @occupational disenfranchisementA## 4ife story !or& has the potential to prevent occupational disenfranchisement through creating opportunity to alleviate the dependency culture and eradicate occupational deprivation for "oth staff and residents# 9eveloping meaningful routines distanced from personal and medical care activities can promote adaptation self realisation and social independence# Molineu, J 2ic&ard and /ic&s J /hiteford "oth pu"lished papers in )**8 discussing the use of life stories as a tool to gain insight into the e,periences of occupational participation over the lifespan and ho! this &no!ledge can "e used to inform our practice# Slide 1E <inally $ do not suggest that there is a structure or a format to life story !or& only that it must "e entirely person centred# The reality is-this tool can "e used "y anyone and can help those providing activities in that it can "e an

occupation focussed intervention in itself !hich can lead to many "enefits and assist in the planning of future occupation focused interventions# $ no! have t!o pages of references Slide 1? J 1> 6 2eferences And these are my contact details#