Validation Therapy: A Valuable Tool for Families and Healthcare Teams

Published on July 27, 2022

Updated on November 4, 2023

Naomi Feil is an expert in gerontology and the creator of which is a means of communicating and acknowledging the internal reality of patients with dementia. When properly utilized, can enhance the quality of life of patients with dementia as well as reduce stress of the family and caregivers.

While Naomi Feil and her followers (of which the writer of this article may be considered one at least in form) focus on the use of this method of communication for maintenance of health with the potential for a level of restorative health, I want to share how the concepts of this method can be used during times of crisis.

Let me share with you the most recent event of Tuesday, July 26, 2022, whereas the visiting (RN CM) I was with a patient diagnosed with Alzheimer's who was dying and uncomfortable without access to comfort medications (late night admission, hospital system reports not getting the FAX, and other system failures). The patient in question was a 98-year-old female at a FAST Scale of 7C unable to answer even the simplest of yes or no questions, agitated, restless, laying sideways on her regular bed in an almost fetal position moaning, groaning, and having thirty breaths per minute of respirations. While this example I'm going to provide is real, it is also extreme in the sense that most of the time comfort medications like lorazepam (Ativan), roxanol (liquid morphine), haloperidol (Haldol) is available to help reduce quickly without the need to adapt a concept such as validation therapy to mimic the outcome of such medications. Yet, by using a real-life extreme example, it is my hope that if you, a friend, a family member, or other caregiver are in a pinch (including medications being available but not working as intended or otherwise not fast enough) can provide a measure of comfort to the loved one in question.

I want you to please take less than six minutes to watch the interaction of Gladys Wilson and Naomi Feil. I want you to please focus on the following key areas:

All coming out in a compassionate way of communicating, “I see you!” “I acknowledge you!” “You are not alone!” “You Matter!”

For the real-life case of my 98-year-old patient who was having labored breathing, frequent moaning, and groaning, in a fetal position, yet trashing out with her arms I laid down on the bed at an angle from the end of the bed such that I was about one arm's length away in a safe position (think of it as a form of a safe hug where you think the person may have been abused so you hug sidewise vs. front-on; and safe also from the perspective that anyone walking into the room would not think anything amiss). I reached out with both of my hands taking her hands in between mind as gently as I could and paused. She batted away my non-dominate hand and held my dominate hand like a handshake frozen in time; yet within moments batting away my hand that I let lie limp on purpose, then pulling it back to hold, then petting my hand and so on. While this was happening (go back to Gladys Wilson and Naomi Feil video and focus on how Naomi let the person touch her and vice versa with safe touches), I softly spoke that I was a nurse, her brother was in the next room, she's at home, she's safe using short phrases and lots of pauses.

In approximately thirty minutes the patient became calm, quiet, and fell asleep allowing me time to talk with the brother and caregivers about the medication plan once the medications arrived, etc. Every now and then during the hour-long education session, the patient would start groaning and moaning, and I would excuse myself to lay nearby, and having learnt that she didn't like her hand held with two hands, let my one hand hold her hand, be batted away, pulled, pushed, held, etc. while calmly speaking to the patient. Each subsequent time, calming her was a shorter amount of time such that before I left, it took only a few moments of time before she was calm and sleeping.

What I learned from this experience not only reinforces to me the value of learning validation therapy, but also the very key parts that every single one of us needs to know! We are not alone! We matter!

I hope from here you look through the resources below and start applying validation therapy with your loved ones. Over the years, I've found simple techniques that help diffuse the most troublesome situations based on the application of validation therapy.

Resources

My Loved One with Dementia

Understanding Dementia (Alzheimer's & Vascular & Frontotemporal & Lewy Body Dementia) (Video)

How Do I Know Which Dementia I'm Looking At? (Video)

Dementia Training material (Free)

Promoting Meaningful Relationships with Dementia Patients through Validation Therapy

Unlocking the Power of Validation Therapy in Compassionate End-of-Life Care

Validation Therapy: A Valuable Tool for Families and Healthcare Teams

Best Practices for Approaching Combative Dementia Patients

The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer's Disease and Other Dementias

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How Do I Know You? Dementia at the End of Life

The Dementia Caregiver: A Guide to Caring for Someone with Alzheimer's Disease and Other Neurocognitive Disorders (Guides to Caregiving)

Sundown Dementia, Vascular Dementia and Lewy Body Dementia Explained

The Caregiver's Guide to Dementia: Practical Advice for Caring for Yourself and Your Loved One (Caregiver's Guides)

Ahead of Dementia: A Real-World, Upfront, Straightforward, Step-by-Step Guide for Family Caregivers

The Dementia Caregiver's Survival Guide: An 11-Step Plan to Understand the Disease and How To Cope with Financial Challenges, Patient Aggression, and Depression Without Guilt, Overwhelm, or Burnout

Dementia Care Companion: The Complete Handbook of Practical Care from Early to Late Stage

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The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease and Other Dementias

Dementia Home Care: How to Prepare Before, During, and After

The Dementia Caregiver's Survival Guide: An 11-Step Plan to Understand the Disease and How To Cope with Financial Challenges, Patient Aggression, and Depression Without Guilt, Overwhelm, or Burnout

Dementia Caregiving: A Self Help Book for Dementia Caregivers Offering Practical Coping Strategies and Support to Overcome Burnout, Increase Awareness, and Build Mental & Emotional Resilience

Navigating the Dementia Journey: A Compassionate Guide to Understanding, Supporting, and Living With Dementia

Ahead of Dementia: A Real-World, Upfront, Straightforward, Step-by-Step Guide for Family Caregivers

Four Common Mistakes by Caregivers of loved ones with Dementia and what do differently (video)

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

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Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side , A Guide for Caring for the Dying at Home

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