Objectives: 
  • To decrease or maintain amount of PRN medications administered to a group of Alzheimer residents. 
  • To examine sleeping and eating patterns of group, and detect changes during therapy.
  • To provide an environment that proves that intimacy is a vital component to nursing home resident management.
  • To provide a setting to counteract the social isolation many Alzheimer residents feel due to communication problems. 
Criteria:  
The therapeutic groups will be available to both sections of Meadowbrook’s "B" wing. There will be eight residents in each group. Two group sessions will be offered every weekday. The group sessions will last 1/2 hour.  
The groups will run for six consecutive months, with continuous documentation of resident's participation and progress, by both clinician and charge nurses. The residents will be chosen randomly but must fit the criteria set up for participation. Residents that fit the criteria will be randomly selected for participation. There are twenty two residents on each of the units. Eight residents will be invited to participate in each of the groups, with no resident participating in both groups.  

 "Sensations" 

Criteria for participation in "Sensations":  
 

  • Resident have diagnosis of Alzheimer - or senile dementia end stage. 
  • Be on PRN psychotropic medication. 
  • Have little ability to respond to staff or family or POA. 
  • Evaluation of eating patterns must be performed prior to participation. 
  • Evaluation of sleeping patterns must also be completed prior to participation
  
The group is designed for residents with very little verbal ability. We must select residents whose thought process is present, but who are unable to appropriately verbalize their daily needs. In "Sensations", we help residents use all of their available senses to identify common items. Participants do not need full use of all five senses. Use of all available senses is the key to this group. If participants are unable to visually identify an object, they might be able to smell it, feel it or taste it.  

 Goals: 

  • To provide an opportunity to use all senses in a multi model environment.. 
  • To have one-on-one contact in a group setting - and provide opportunity for interpersonal relationships to be part of that group. 
  • To have intimacy with the facilitator. 
  • To have intimacy with the other members of the group. 
  • To maintain or improve sleep patterns. 
  • To maintain or improve intake.
Definitions: 
  • Multi-model: use of senses in group work.
  • Intimacy: eye contact and touch with each member of the group, a sense of emotional closeness not experienced during many other contacts. 
  • Interpersonal relationship: eye contact and verbalizing to another member of the group. 
Group Content:  

This therapeutic group is based on use of the five senses. It utilizes every sense to the fullest to provide an opportunity for the resident to successfully identify common objects. The primary focus of this group is to socialize and to have intimacy with a staff member. The only changes in group membership occur when a resident expires or is moved to a new facility.  

The selection of items to be identified in "Sensations" can be quite diverse. More than one "prop" may be used for each item. The important thing is that all available senses are used to identify each item. Often the voice of the facilitator makes up the hearing part of the group's activity making it imperative that every sense is used and must be relate to the item. It is vital not to include items or sounds that can be confused with other words.  

Facilitator's Guidelines: 

Place the group in a semi-circle with the facilitator in an office chair in the center of the circle. Make sure the facilitator has all the props needed for the group prior to the beginning of the group, since leaving to locate props is not appropriate. Place the residents in the same location every time, it seems their space in the group is very meaningful to them. Over time, they will identify very strongly with the facilitator and their environment.  

 The facilitator welcomes everyone, but very specifically addresses each resident, introducing himself or herself to the resident and explaining that they are participating in "Sensations". The facilitator proceeds with the first sense (order does not matter) and holds the item and discusses the item with the resident without mentioning the word.  
  

Examples of items to be used in "Sensations": 

  • Coffee (coffee in a cup, picture of coffee, sound of a percolator, coffee grounds)
  • Onions (whole and sliced)
  • Pickles (in and out of a jar)
  • Turkey (sliced meat, pictures of the bird or pictures associated with Thanksgiving)
  • Salt and sugar (in and out of shakers, accompanied by pictures of the ocean or sugar cane fields)
  • Other suggested items: Lemons, Horses, Milk, Flowers, and Oranges.
  
The facilitator must wear gloves when working with food. Be sure to supply enough samples of your food for all the residents, as they should not share anything. Once the group is established, you may want to supply cups and plates marked with the residents' names.  

If the item chosen for the session is a picture of a cup of coffee, the directions of the facilitator are very simple, short sentences, like: What is this?; Can you tell me what you see?; What do you think this might be?. It is a good idea to repeat questions, but with different phrasings. The facilitator should not be discouraged with a lack of recognition. All the participants’ available senses may be brought into play. The facilitator must be creative and repetitive in helping each resident distinguish what he/she is experiencing. Continue this process until all the senses have had a chance to be used. It must be remembered that the process is simple. The more you repeat as a facilitator does, the more the resident will become familiar with the voice and mannerism. Touch and eye contact with each of the items is important. 

 "Sensations" becomes an intimate group. Remember, the facilitator's role is not primarily to get correct answers. The group does not progress at a very fast pace. It is helpful to use the same item for several consecutive sessions, to reinforce or encourage recognition. In this research we will be using the same item for 3-4 weeks as a starting point. This may be adjusted as the facilitator's skills or residents' abilities improve. 
  
"Connections" 

 Criteria for participation in "Connections": 

 Participants will be selected based on a good ability to verbalize needs and possession of some long-term memory skills . These Alzheimer patients will be more capable than the group selected for "Sensations". They must be able to physically handle items presented to them, and be able to visually identify objects they are holding and other group members are holding.  

Goals: 

  •  To provide an opportunity to identify recognizable objects.
  • To have one on one contact in a group setting
  • To provide an opportunity for interpersonal relationships to form in the group.
  • To provide an opportunity for intimacy not usually found in a nursing home environment. 
  • To maintain or improve sleep patterns.
  • To maintain or improve eating patterns.
  • To maintain or improve behavior and cut down on psychoactive medications - PRN. Knowing what these items are should bring to mind the purpose of each one. With that, participants can remember their experience with the items, and mentally build relationships between them. They'll use short term memory to identify and associate the items and their uses. They'll use their long term memory for recall of their past experience. By examining items in their hands, and the hands of those around them, they are drawn out, to connect with their immediate environment. It is closely associated with milieu therapy.
 Group Content: 

 The topics that will be covered are as follows:   

  • School: Start with chalk, a chalkboard (a small one)they might have carried to school), pencil, pen, lunch box, glue. 
  • Gardening: We use gardening tools (which participants should name), dirt, gardening gloves, a hand shovel and seeds.
  • Wedding: Simple materials include bride and groom cake, decorations, a garter, lace, rice, wedding pictures, bridal bouquet. (This and the next topic can be very emotional ones.)
  • Babies: bib, baby food, diaper (cloth is preferable), rattle, bottle and baby pictures.
  • Baking: spatula, mixing bowls, flour, hand mixer, baking pan 
  • Cooking: Bring in a pan, cutting board, tongs, cooking oil, spatula.
  • Beauty: Try bobby pins, curlers, brush, comb, mirror and hair net. 
  • Sewing: Supply a spool of thread, crochet needles, fabric, a thimble, small sewing scissors (be careful with this one), and yarn.
 Facilitators’ Guidelines: 

Set up for "Connections" is simple, and works the same way every time. This group is easily managed with 6-8 participants. It works well if there are equal number of items to the number of residents. Sit residents in a semi-circle, with the facilitator in the center. Provide a table behind the leader to hold supplies. An office chair with wheels will help the group leader to navigate the group while staying at residents' eye level.  

Begin the group in the same manner every week by welcoming each member individually and tell them your name at each introduction and tell the resident you are glad they are here and part of the Connection group. Making sure each resident is seated in the same location every week. Begin by handing an item to each participant, taking time with the item and the resident. Do not identify the item, but discuss the item with the resident. Ask them about the use and purpose of the item. It does not matter if the resident identifies the item correctly. If they do, congratulate and praise them adequately, without going overboard. Leave the item with the resident and proceed to the next resident with the next item. Continue this process, until all the residents have an item to work with. Encourage them to help each other to identify the items. Promote working as a team and finding the answers together. Once the residents have identified their items separately, ask them for a single word that describes all these items. Remember, the word is not as important as how each resident gets to that word. Praise the participants often. One thing to look out for: Make sure this group DOES NOT insult a resident's intelligence. We have not had many residents feel insulted or hurt by this group. Most of their reactions have been positive.  

Preparation is extremely important. It is possible to miss a meaningful connection made by a group member without knowing it. As in "Sensations", the facilitator should thoroughly research the discussion topic. Threads of association can be developed only through extensive research. Knowing many ways to look at a subject (weddings, for instance, in the Catholic church, in Greek culture and in American regional variants) will make it possible for the facilitator to recognize participants’ responses as valid. Without good research, the facilitator’s discussion of the topic and interplay with participants will be limited. This can frustrate participants who try to contribute to the group but are not understood. 

"Connections" is very "success" oriented making participants feel a part of an established group. We have seen group members ‘save’ seats for others, as they recall where they sit during each group. It has a huge effect on the resident's daily lives and their environment. They feel as if they belong.

 

 

 
 

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