In the realm of hospice care, where empathy and compassion are paramount, a remarkable approach called Validation Therapy has emerged as a beacon of hope and comfort for individuals facing dementia and cognitive disorders in their final journey. As an experienced hospice registered nurse case manager, I've witnessed the transformative impact of Validation Therapy on patients, allowing them to find solace, regain their self-worth, and experience a sense of dignity during their end-of-life phase.
In this article, we delve into the world of Validation Therapy, exploring its core principles, real-life applications, and the profound difference it can make in the lives of those under our care. We'll journey through vivid examples of how Validation Therapy can be employed to ease anxiety, resolve inner turmoil, and provide a compassionate presence in the face of profound challenges.
Join us as we unlock the secrets of this powerful tool, rooted in empathy and understanding, and discover how it can profoundly enhance the quality of care provided to terminally ill patients, especially those battling dementia. Validation Therapy offers not just medical solace but also emotional healing, fostering an environment of empathy and respect as we guide our patients toward a peaceful and dignified transition.
What is Validation Therapy
Validation Therapy was developed by Naomi Feil, a social worker, as a means to connect with older adults with cognitive disorders and dementia. This therapeutic approach focuses on empathy, understanding, and validating the emotions and experiences of individuals with dementia. By employing Validation Therapy, we can help reduce anxiety, agitation, pain, and discomfort, promoting a sense of dignity and well-being for those on their dementia journey.
Understanding Validation Therapy
Validation Therapy revolves around empathetically entering the world of individuals with dementia, instead of trying to force them to accept our reality. It acknowledges that people with dementia may have unresolved issues that drive their behaviors and emotions, and the key is to validate their feelings and experiences. The stages of cognitive impairment, as classified by Naomi Feil, include Malorientation, Time Confusion, Repetitive Motion, and Vegetation. In each stage, the focus is on helping the person work through their emotions and restore their sense of self-worth and dignity.
Examples of How Validation Therapy Helps
Validation of Emotional Needs: An older adult with dementia calls out for a deceased loved one. Instead of correcting them, acknowledge their need for comfort and reassurance by saying, “I understand how much you miss them. It's okay to feel sad.”
Resolving Unfinished Business: A person with dementia becomes agitated or confused about an event from their past. Validate their emotions and help them navigate the feelings by saying, “It sounds like that memory is important to you. Tell me more about it.”
Providing Empathetic Listening: An individual with dementia expresses fear or anxiety. Offer reassurance and comfort by saying, “I'm here for you, and I'll stay with you. You're not alone.”
Live Examples of How the Writer Employed Validation Therapy
The following case examples are based on real life events as experienced by the writer. Any names mentioned are fabricated to avoid issues with HIPAA compliance and protect the privacy of those involved.
Case – Hospice at a Facility – patient with senile degeneration of the brain – anxiety, sadness, exit seeking behaviors
The writer checked in at the nursing station to see if there were any changes on the patient in question and received the standard report that nothing's new. The writer then proceeds to the patient's room where the patient shares the room with three other patients only to find the patient standing in the vestibule of the room fully dressed with a hunting cap on his forehead, a walking cane in one hand, and a pair of driving gloves in his other hand about to head out of the room (based on the clothing, it appeared the patient was either going to spend time outside or flee).
The writer introduced himself (never take it for granted that a patient with any cognitive difficulty will remember you) as a visiting nurse asking the patient if he was going to spend time outside because the weather was nice (internally hoping the answer was “yes,” as patients do receive leaves to hangout outside). Instead, the patient reported they were going to the parking lot to get their car and drive home.
This required quick thinking to create a time buffer that would allow validation therapy to be employed. The writer mentioned he didn't believe the patient's car was in the parking lot for which the patient quickly responded that his brother Fred was going to pick him up. Based on that reply, the writer asked if we both could sit down for a few minutes so the writer could perform an assessment including vital signs before the patient leaves. The patient replied yes, and then we sat. This became the start of the employment of validation therapy which does require time for it to work well.
As the writer was taking his time to get out the equipment, the writer explored the patient's feelings starting first about his home, and slowly opening the door of asking who will care for the patient. Every answer involved having his feelings validated. After about thirty minutes of just sitting, talking, validating feelings, the patient started crying, “I want to die at home.” That was the entire sum of why he was trying to escape the facility… He wanted to die at home, not in a county home where he is in a room with four strangers, at a place he calls home. Knowing that allowed me to update his family and our social worker; we cannot guarantee the result, but just by taking the time and frequently validating his feelings, enabled him to share the root of the issue; and from there I was able to calm him by sharing I would get that message to his daughter. And if you are in a comparable situation, I would recommend not making any promises you cannot keep or otherwise lying. Validate feelings and do what you can do to make a difference.
Case – Hospice at Home – patient with cancer living alone – PTSD level panic attack
Imagine walking into the home of an almost 90-year-old gentleman with cancer at a location with metastasis to the brain who lives alone. The writer is this patient's hospice nurse, and our team utilizes a lock box where original pill bottles are kept in a lock box, and the writer or another nurse should the writer be unavailable fill a pill planner from the original bottles managing refills with the provider. Prior to this setup, due to forgetfulness and frequent confusion, the patient would often forget he already took his pills and take them repeatedly, including narcotics.
Imagine you are the hospice staff walking in and the patient in question starts to exhibit signs of an extreme panic attack as evidenced by the person hyperventilating, making a fist with his hands, shaking hands trembling, speaking fast in a distressed voice, pacing, saying repeatedly he's going to die, he's going to die.
In this case, it did require prompt actions to ensure the safety of the patient starting with encouraging him to sit down. Because he was in such a complete panic, the actual implementation of validation therapy needed to wait. Once sitting, the writer called the patient's family member quickly asking for permission to give liquid lorazepam (Ativan) and that the family member come over to be with the patient (the writer knew it would be some time). The writer then obtained the medication and received permission from the patient as well, in part due to helping the patient understand this medication would help bring him peace and quiet.
Once the mediation was given, validation therapy could start with the exploration and validation of feelings that lead to the panic attack. Here the patient expressed feelings of loss of control over having his driver's license and car taken from him, the loss of autonomy by not being able to leave the house when he so desired, the confinement of the home itself, and that “this is no way to live.” Yes, a suicide assessment was necessary with certain statements; and thankfully, it was negative.
Conclusion
Validation Therapy is a powerful tool for providing compassionate care to individuals with dementia. By entering their world and validating their emotions, we can help them find comfort, restore their sense of self-worth, and improve their quality of life during their end-of-life journey.
