Nurses’ Experiences of Reminiscing with HIV Patients at End of Life

1. Nurses’ Experiences of Reminiscing with HIV Patients at End of Life Juliette Shellman, Ph.D., Betty Morgan, Ph.D., Marisa Shuman, BSN, RN, & Jenna Connolly University of Massachusetts Lowell

2. Background • Approaching Death: Improving Care at the End of Life (IOM Report, 2009) • Goal of respectful and high quality care at end of life. • Dignified dying • Meeting spiritual needs • Volker, & Limerick (2009) • How this study evolved.

3. Specific Aims Explore nurses' experiences when reminiscing with HIV patients at end of life. Describe benefits and challenges of facilitating reminiscence with HIV patients at end of life.

4. Reminiscence • Recollection of past experiences • Informal process, unstructured, interpersonal • Unstructured process of life review • Informal therapy that may increase EOL patient’s life satisfaction and decrease depression

5. Methods • Design: Qualitative Study • Setting: Urban Hospitals and Community Centers • Sample: Advanced Practice Nurses • Methodology: Face to Face Interviews • Graduate students trained to conduct interviews.

6. Preliminary Findings Connections Seeing the Person Forgiveness of self and others “Letting go”

7. Connections “If you can find something that they can connect back to an earlier time, then people achieve some peace or some sense of forgiveness or some sense of connecting…” “People need to feel valued and cared about as they’re passing out of this world and I think [reminiscence] helps facilitate this process…”

8. Seeing the Person “There are so substance abusers that I’ve worked with, you know healthcare professionals don’t like them. They’ve destroyed relationships with their families. They’re shunned by society. They don’t feel good about themselves and so [reminiscence] is a process where they can get in touch with a very human part of themselves that [nurses] can relate to and you know a connection can be made.”

9. Forgiveness of Self and Others “ So our conversation was mixed, it was sad for him but he was saying I could’ve been one of your colleagues. You know I could’ve worked with you, so there was a part of him that wasn’t so sad. His recollection and recognition that drugs really ruined his life, … for lots of substance abusers that’s a hard acknowledgement that they’ve ruined their life, that I was an okay person who had some abilities at one point.”

10. Letting Go “I wasn’t listening to subtle changes, but he was my teacher because every step of the way he would gradually recognize for himself that he was not doing well.” “I think the fact that we had reminisced, you see we had only talked about her relationship with me, but then we talked about her experiences and with other patients she had been close to. This helped her let go.”

11. Discussion • Nurses had limited knowledge of reminiscence – couldn’t name or didn’t know what they were doing. • Unstructured, natural • Benefits for nurses/patients/families • The interview was beneficial to the nurse • Specific interventions related to the reminiscence that had occurred.

12. Future Directions • Continue until data saturation • Use findings to develop educational programs • Examine outcomes when using structured life review or reminiscence. • Death anxiety • Life satisfaction

13. “People need to feel valued and cared about as they’re passing out of this world and I think [reminiscence] helps facilitate this process…”