Care Planning & Communicating Life’s Stories Recommended Participants

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Care Planning & Communicating

Life’s Stories

Recommended Participants: Staff members who are responsible for writing and/or

implementing care plans.

Activity Type: Small Group Discussion Using Case Examples

Explanation: This activity demonstrates the right to free choice {483.10(d) (3) F280}, specifically the right to participate in planning care and treatment or changes in care and treatment. The desired outcome is to individualize the care plan by increasing resident input through the use of resident words, feelings and goals. The activity is divided into two parts. The group leader uses one or both activities depending on the time available and the staff’s training needs.
Part One is designed to promote an understanding of people through their life stories. The group leader shares Nadine’s story. This recounting illustrates the activity’s format and prepares the students for participation. Following the story, the participants are asked to answer the questions under Part I. It is important under question #6 that the students start their answers with “I would feel ... ” as indicated. This promotes empathy. After the final question, the group leader guides a discussion about how to increase resident input into care plans.
Part Two encourages empathy with residents who have dementia. After the participants have read the paragraph, they exchange views about the questions. The activity ends with a conversation about how to reflect a resident’s individual situation on the care plan.

Adaptations: To adapt this group activity for individuals, videotape the group program (with the participants’ permission) and make the video available to staff who are unable to attend the group. Copies of Part I and II along with Nadine’s story should accompany the video. If the group leader believes some staff members will be unable and/or uncomfortable with reading the materials, read all the information out loud. Rather than asking the students to write the answers, ask them to think about their answers and then respond verbally.

Page 2, Care Planning & Communicating Life’s Stories - Use with Part I
Nadine’s Story
What story have you heard from a resident that taught you something important?
Nadine was an eighty-year-old woman with severe breathing difficulties and an unstable fractured hip. She had just been admitted to the nursing home and her husband Earl had recently died. While he was in the hospital expected to die, Nadine was in the same hospital recuperating from her fractured hip. One evening a nurse came to her room and said, “Nadine, you better come and visit Earl. I don’t think he’ll live ‘til morning.”

With the nurse’s help Nadine got out of bed and into a wheel chair. A few moments later she was at Earl’s bedside. Earl rolled from side to side in the bed and when Nadine touched him he felt hot and sweaty. Nadine believed indeed it might be the last time she would see him. Just as she was about to speak to Earl, the nurse pulled up a chair beside her. Nadine thought to herself Has this nurse never had a loved one she wanted to be alone with? Nadine believed the nurse’s intention was to offer comfort, but what Nadine needed most was privacy. Frustrated Nadine turned to the nurse and said, “I appreciate you bringing me down here. But right now, I need privacy. If these are the last moments of Earl’s life, I more than ever want him to myself.” The nurse apologized and told Nadine where she’d be when Nadine was ready to go back to her room.

What were the feelings Nadine expressed about her story?

Sadness for the loss of Earl. Happiness for her good marriage. Appreciation for

the nurse assisting her to Earl’s bedside. Frustration due to the nurse’s

assumption that Nadine needed comfort when she actually needed privacy.

How would you describe this story in terms of the senses, i. e., sounds, smells, sights

and touch?
Sounds: Call lights in the hospital. The frustration in Nadine’s tone of voice.

Smells: Cleaning fluids used in the hospital.

Sights: Bright overhead hall lights. Institutional furnishings of the hospital.

Touch: The nurse touching Nadine to help her get out of bed. Nadine

touching Earl’s sweaty skin.
What did you learn from the story?

The need for privacy and sensitivity when a person is losing a loved one.

How could the nurse of handled the situation differently?

She could have asked Nadine what she needed.

Who else could benefit from hearing this story?

Other health care professionals. Family members.

Page 3, Part I: Care Planning & Communicating Life’s Stories

1. What story have you heard from a resident that taught you something important?

2. What were the feelings the resident expressed about the story?

3. How would you describe this story in terms of the senses, i. e., sounds, smells, sights

and touch?

4. What did you learn from the story?

5. Who else could benefit from hearing this story?

6. If you were 90 years old and admitted to a nursing home with a diagnosis of a

fractured hip and a prognosis of poor rehabilitation potential, what would you be


“I would feel ......”

7. How would you describe your experience in terms of the senses, i. e., sounds, smells,

sights and touch?

8. Who would you want to understand your experience of the nursing home?

9. What words would you ask the staff to use on your care plan to describe your story?

Page 4, Part II: Care Planning & Communicating Life’s Stories

You are 90 years old and living in a nursing home. You have moderate dementia and are not often sure who these people are that come in your room. Sometimes they take your clothes off and sometimes they encourage you to put small objects in your mouth. Last night someone came in during the middle of the night and put her hands under your bottom. The person startled and frightened you. You reached out and hit her as hard as you could. Though you can't remember exactly what happened, you know something is wrong; now the people who come in your room are less friendly and more cautious. Usually two people come instead of one. You are very frightened.

What would you like to tell your caregivers about yourself?

How often do we use these words on our care plans?

How can we make care plans reflect each resident's story?
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