Objective: One of the major problems for carers in rehabilitation units for demented people is the emotional and social deterioration as well as the dissolution of existential perspectives and the loss of identity. We describe here a rehabilitative nursing care intervention focused on the patient identity, which aims to modify the illness perception of carers and families.
Design and methods: During a one-year period, images of the past were used as structural and relational operators between patients, families and care staff. The work was carried out over 4 periods, each period being marked by a one-day event. This event was a facilitated meeting with the families that included an exposition of photographs illustrating a theme centred on the patient and his family life (the childhood, work, genealogy…) in link with the care activities in the unit and the present with the illness. The images were used as visual supports of individuals' memories, lightened by patients’ words and stories.
Results and discussion: The starting hypothesis was that using such material would permit patients to objectify periods of their past, recreate previous family cohesion, and fix themselves in time. This work centred on the patients identity, has based on a psychodynamic group approach. The originality of this group experience is the temporality (continuity through the time) and the fact that it concerns the notion of group at three levels: the patients, the families and the multidisciplinary carer staff. This nursing care intervention proved beneficial for the different participants in several ways. Patients have been able to remember emotionally relevant past events, reinforce his/her identity, restore his/her dignity and assume a new social role. Families have found reinforced unit and memory by sharing their functions of transmission, recollection, and reflection. Most importantly, there was an improved understanding of patients' identities, a feeling of increased significance of the work for the care team, thereby changing it, an unifying and motivating element, as well as the development of stronger relationships with patients’ families. The second phase of this project includes the assessment of this intervention, in respect to the illness representation among families and care staff members’.
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