Nurses ’ Experiences of Reminiscing with HIV patients and End of Life Care

1. Nurses’ Experiences of Reminiscing with HIV patients and End of Life Care Juliette M Shellman, Ph.D., APHN-BC, Betty Morgan, PhD, Marisa Shuman, BSN, RN, Kelly Ramos, RN, Jenna Connolly Department of Nursing At University of Massachusetts Lowell What are the benefits or challenges that nurses experience when reminiscing with HIV patients at end of life? Implications for Intervention Development What is Reminiscence? • Recollection of past experiences • Informal process, unstructured, interpersonal • Unstructured process of life review • Informal therapy that may increase EOL patient life satisfaction and decrease depression • Approaching Death: Improving Care at the End of Life (IOM report, 2009) • Specific Aims • To explore Nurses’ experiences when reminiscing with HIV patients at End of Life • To describe benefits and challenges of facilitating reminiscence with HIV patients and End Of Life • Immersion/Crystallization Technique • What is Immersion/Crystallization Technique? • An analytical style coined by Miller & Crabtree 1992 A fluid process that begins with a conceptualization of the research project, to data collection, to dissemination. • Requires the researcher to reflect on experiences and be aware of emotions. • Awareness of patterns and connections METHODS • Implementing early teaching practices • Introduce reminiscence classes into undergraduate nursing programs • Job training for new graduates • Design: Qualitative Study • Setting: Urban Hospitals and Community Centers • Sample: Advanced Practice Nurses • Methodology: Face to face interviews • Graduate students trained to conduct interviews Background PRELIMINARY FINDINGS (N=4) 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…” • “There are so many 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.” • 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.” • 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.” Seeingthe Person Data Analysis Future Directions • Develop a framework to facilitate the use of reminiscence therapy with HIV patients and EOL • Examine outcomes when using structured life review or reminiscence • Use findings to develop educational programs ACKNOWLEDGEMENTS 2010UMass Seed Funding Program to Advance Research and Scholarship Photography by Serena assisted living