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

Published on September 20, 2023

Updated on November 4, 2023

In the realm of , 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 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 , 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 , 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 our patients toward a peaceful and dignified transition.

What is Validation Therapy

Validation Therapy was developed by Naomi Feil, a , 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 , agitation, pain, and , 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

  1. 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.”
  2. 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.”
  3. 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 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 ; 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 to the brain who lives alone. The writer is this patient's , 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.

Resources

Validation Therapy developed by Naomi Feil may be the best way to communicate with older people with dementia

The Validation Method for Dementia Care – Practical Neurology

Using Validation Therapy for People With Dementia

A Compassionate Approach to Dementia Care

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

As an Amazon Associate, I earn from qualifying purchases. The amount generated from these “qualifying purchases” helps to maintain this site.

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)

Eldercare Locator: a nationwide service that connects older Americans and their caregivers with trustworthy local support resources

As an Amazon Associate, I earn from qualifying purchases. The amount generated from these “qualifying purchases” helps to maintain this site.

My Aging Parent Needs Help!: 7 Step Guide to Caregiving with No Regrets, More Compassion, and Going from Overwhelmed to Organized [Includes Tips for Caregiver Burnout]

Take Back Your Life: A Caregiver's Guide to Finding Freedom in the Midst of Overwhelm

The Conscious Caregiver: A Mindful Approach to Caring for Your Loved One Without Losing Yourself

Dear Caregiver, It's Your Life Too: 71 Self-Care Tips To Manage Stress, Avoid Burnout And Find Joy Again While Caring For A Loved One

Everything Happens for a Reason: And Other Lies I've Loved

The Art of Dying

Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying

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