Naomi Feil is an expert in gerontology and the creator of validation therapy, which is a means of communicating and acknowledging the internal reality of patients with dementia. When properly utilized, validation therapy can enhance the quality of life of patients with dementia as well as reduce stress on 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 using this method of communication to maintain 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 the most recent event of Tuesday, July 26, 2022. In contrast, as the visiting RN Case Manager (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 accurate, it is also extreme in the sense that most of the time, comfort medications like lorazepam (Ativan), Roxanol (liquid morphine), haloperidol (Haldol) are available to help reduce discomfort 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, I hope that if you, a friend, a family member, or another caregiver are in a pinch (including medications being available but not working as intended or otherwise not fast enough), you 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:
It's 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 feel 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 believe anything amiss). I reached out with both hands, taking her hands between my mind as gently as possible, and paused. She batted away my non-dominate hand and held my dominant hand like a handshake frozen in time, yet within moments, batting away my hand that I let lie limp on purpose, pulling it back to hold, petting my hand, and so on. While this was happening (go back to Gladys Wilson and Naomi Feil's 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 and quiet and fell asleep, allowing me time to talk with the brother and caregivers about the medication plan once the medications arrived, etc. Now and then, during the hour-long education session, the patient would start groaning and moaning, and I would excuse myself to lay nearby. Having learned that she didn't like her handheld with two hands, I 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 before she was calm and sleeping.
What I learned from this experience reinforces the value of learning validation therapy and the essential parts that everyone needs to know! We are not alone! We matter!
I hope you can review the resources below and apply 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.
