Tag Archives: dementia

The Art of Mental Health

art

Sigmund Freud is purported to have said, “Everywhere I go I find that a poet has been there before me.” Not every nursing speciality has this advantage of being informed and sustained by artists. Can those of us interested in supporting mental health consumers and carers look to art to improve our understanding and empathy of the experiences of others? 

I have created a Prezi as a seed for others to use art as an adjunct to our other sources of learning (courses, colleagues, peer-reviewed journals, text books etc). Please see the Prezi by following the link here.

The examples I have collated in the Prezi are listed below, and credit is given to the sources that were used in the Prezi.

Veronica by Elvis Costello is a beautiful song and film clip, that improves our understanding and empathy of nursing the person with dementia. The YouTube video is here: youtu.be/zifeVbK8b-g The lyrics were sourced from this website: www.azlyrics.com/lyrics/elviscostello/veronica.html I’ve written about this previously: meta4RN.com/dementia and have self-plagarised. Again. 

Dog by Andy Bull (with vocal support from Lisa Mitchell) is a fantastic song that captures some of the difficulties of the experience of depression. In the Prezi I used this YouTube link youtu.be/bBOe660BYjI and the lyrics were sourced via www.songlyrics.com/andy-bull/dog-lyrics

Dog is a poignant, wonderful song. Listen to it here:

I had a black dog, his name was depression is written, illustrated and narrated by Matthew Johnstone. It is a very accessible way think about depression and would resonate with a broad age group, I think. Here is the YouTube video used in the Prezi:

To improve understanding and empathy for the family/carers of those who experience schizophrenia I use a song called Neighbourhoods #2 (Laika). This takes a bit of explanation. First though, lets get the credits out of the way. The lyrics were sourced here: www.azlyrics.com/lyrics/arcadefire/neighborhood2laika.html The YouTube video linked in the Prezi is from here: youtu.be/8Wq917ucGaE

Laika - First dog in Space by Belgian artist Paul Gosselin. Source: http://cultured.com/image/4063/Laika_First_dog_in_Space/#fav

“Laika – First Dog in Space” by Belgian artist Paul Gosselin. Source: http://cultured.com/image/4063/Laika_First_dog_in_Space/#fav

Laika by Arcade Fire may not have been written about mental illness at all. However, as with all art, interpretation is an individual experience. I have had a few years experience as a community mental health nurse. In that role I provided direct care and support to the person experiencing mental health problems (nearly all of my clients at the time had schizophrenia) and, when family were still around, support for them too.

Much of the word imagery of Laika fits with that experience. Carers often described their frustration at the lack of insight and empathy that their family member seemed to have. Carers would oscillate between deep concern and desperate frustration about their family member. More than a few times carers expressed a nihilistic outlook – an almost complete lack of hope. The line “Our mother should’ve just named you Laika” expresses that poignantly: Laika was the name of a stray dog in Moscow who became the first living creature to orbit earth. She was never expected to return to earth safely, and died a few hours after launch. Families I have worked with have, at times, expressed that level of despair about their family member.

I also like how Laika’s story has been taken-up by the art community. I love the Arcade Fire song, and my favourite visual representation of Laika – First Dog in Space is the painting above by Belgian artist Paul Gosselin.

The last piece of art I used in the Prezi was The Scream by Edvard Munch. The source of the picture is here: www.ibiblio.org/wm/paint/auth/munch/munch.scream.jpg I’ve read that this picture has been associated with other health problems including  trigeminal neuralgia, psychosis and depersonalisation. To my eye, The Scream looks like acute anxiety and/or a panic attack. It serves as a graphic visual reminder that the first step is to assist the person to contain their distress, to be and feel safe. It shows distress that must feel overwhelming and rallies us to help: let’s think “safety first” kids.

So, that’s it for this little weekend project: if you haven’t visited the Prezi yet please do so now: The Art of Mental Health

What songs, poems, books, music and visual art will inform and sustain your clinical practice?

Paul McNamara, 7th December 2014

art

Zero Tolerance for Zero Tolerance

photoA while ago I wrote about my most frightening workplace experience in a post called “Emotional Aftershocks“, which included a section titled “Zero Tolerance is Unrealistic and Unfair”.

Today, via a Tweet by Nicky Lambert I am reminded of how ridiculous the “Zero Tolerance” approach in hospitals is and (more importantly) have been introduced to an evidence-based alternative strategy that has recently been launched in the UK. To cut-out the middle-man and go straight to source of this pretty-cool strategy, click on the link: www.abetteraande.com

To subject yourself to my ideas and waffle, please read on…

What’s Wrong with Zero Tolerance?

A dumb, shouty poster.

A dumb, shouty poster.

It is inevitable that health services, hospitals especially, will have a large percentage of patients who have cognitive and perceptual deficits due to the very medical condition that has them bought them to the health facility in the first place. About 9% of the over-65s (a significant component of health service users) have dementia. Often these people will not have the cognitive capacity to discriminate between friend and foe, and will, at times, lash out to defend themselves against a perceived threat. All the shouty “Zero Tolerance” signs in the world will not make a difference to this. Why would we want to create a false expectation for staff?

As an aside, during the week I made use of Australia’s Dementia Behaviour Management Advisory Service (DBMAS) regarding strategies to use with a nursing home resident who had been aggressive. I found the service to be very user-friendly and helpful – if you provide care to people with dementia you should keep DBMAS in mind: dbmas.org.au

Huh? Of course people will get angry: it is an unavoidable, natural human emotion.

Huh? Of course people will get angry: it is an unavoidable, natural human emotion.

The “zero tolerance” concept is unfair because it is not reciprocated. We (that’s “we” as in “we the health system”) require patients and their loved-ones to be incredibly tolerant of us. Think waiting lists, physical discomfort, unplanned delays, unclear communication, unmet expectations, cancelled procedures, lack of privacy, lack of dignity, lack of control, lack of compassion, lack of progress… the list could go on. Can you find me a health facility where no patient has ever experienced these things?

Our health system relies on people being tolerant. This “zero tolerance” malarkey doesn’t allow for the reality that people in hospital are often having the most traumatic, frightening and disempowering day(s) of their life. It would be lovely for staff if everyone experiencing acute emotional distress expressed their emotions in a clear, calm and composed manner, but is it realistic?

A Smarter, More Sophisticated Approach

We need a smarter, more sophisticated way to manage difficult emotions in the health care setting. “Zero Tolerance” is jarringly out of step with the nurturing, caring, compassionate, altruistic qualities that most health professionals identified with when choosing their career. We need a new set of posters that are attuned to the needs of patients and the aspirations of health services and clinicians.

Of course, it’s not just posters on the wall that determine the quality and tone of the conversation. All health care workers should have an opportunity to reflect on their practice in a safe, structured way. As I’ve written about before (in “Nurturing the Nurturers“) clinical supervision (aka guided reflective practice) allows this to happen. There is an abundance of evidence that clinical supervision improves management of difficult encounters in health care settings – we should insist on it.

Nevertheless, posters and signage can play an important part in setting clear expectations. Just as they’re doing in UK accident and emergency departments, let’s take a proactive approach to preventing and managing distress. Part of that strategy should be moving way from the authoritative, uncompromising and negative campaigns of the past, to one that demonstrates and models respect.

putyourhandup

This poster is my suggestion of the how we should set the parameters. Let’s not try to shut-down people from expressing distress. Instead, let’s invite patients and relatives to articulate their concerns before the emotions become so intense that they are difficult to contain.

Here’s the script to my poster:

Put your hand up and talk to us.

We don’t want you to feel distressed.

If you are feeling upset, frustrated or unsure about what’s happening please don’t bottle-it-up: talk to us.

One of the nurses, doctors or other hospital staff will listen to your concerns and try their best to help.

pdficonPDF version of the poster here: putyourhandup

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Acknowledgement

Some of the ideas here are taken from and/or informed by a keynote presentation by Professor Eimear Muir-Cochrane at the ACMHN 39th International Mental Health Nursing Conference, held in Perth, Western Australia, 22nd-24th October 2013. Some of the Tweets from that presentation have been collated here: storify.com/meta4RN/zero

What would your poster say?

Please feel free to share your ideas in the comments section below.

Paul McNamara, 7th December 2013

Emotional Aftershocks

Warning: today I will take the risk of being ridiculed for over-sharing and being melodramatic (it’s a grand tradition amongst bloggers).

8683188_lgCrap Day at Work

Recently at work I spent a bit of time wondering whether I, one of my nursing colleagues, or one of the hospital patients or visitors was going to sustain a life-threatening brain injury at the hands of a man brandishing a fire extinguisher as if it were a weapon. Fire extinguishers are generally thought of as potentially life-saving devices. However, when a fire extinguisher is being held at shoulder height by a tall, fit, powerful young man on a violent rampage in a medical ward they don’t look like life-savers.

Fire extinguishers weigh 9kg and are made of steel. The fire extinguisher this man was holding looked a lot like a skull-cracking device to me. It was the most frightening workplace incident I have experienced.

I have been a nurse for 25 years. Like many nurses I have been struck while at work (39% of nurses have experienced physical violence according to this recent Australian survey, 36% worldwide says this quantitative review). I am lucky: I have only been hit by frail people with delirium or dementia, so have never been hurt – just surprised and amused. To illustrate: once, an elderly lady forgot I was the nurse making her bed, and suddenly started punching me (with the strength of a wet kitten) saying, “Stop it Malcolm! Don’t take my money from under the mattress and go to the pub again! You’re such a bastard Malcolm!” It was pretty funny – always wondered whether Malcolm was a memory from her past or a distortion of the present (probably a bit of both).

Zero Tolerance is Unrealistic and Unfair

I am not a fan of being abused or hit, but think that the “Zero Tolerance” campaigns that have popped-up in health services in Australia over the last 5-10 years are unrealistic and unfair.

This shouty "ZERO TOLERANCE NO EXCUSE FOR ABUSE" poster hangs in the main corridor of a medical ward, adjacent to the nurses station.

This shouty “ZERO TOLERANCE NO EXCUSE FOR ABUSE” poster hangs in the main corridor of a medical ward, adjacent to the nurses station.

Unrealistic because it is inevitable that health services, hospitals especially, will have a large percentage of patients who have cognitive and perceptual deficits due to the very medical condition that has them bought them to the health facility in the first place. More than half of older persons admitted to hospital will experience delirium, and about 9% of the over-65s (a significant component of health service users) have dementia. Often these people will not have the cognitive capacity to discriminate between friend and foe, and will, at times, lash out to defend themselves against a perceived threat. We can look out for the warning signs and be proactive in protecting ourselves, but we can not expect to transfer responsibility for our safety onto someone who does not have the cognitive capacity to even keep themselves safe.

In the health system it is very common to be spending time with people who are having the most traumatic, frightening and disempowering day(s) of their life. It would be lovely for staff if everyone experiencing acute emotional distress expressed their emotions in a clear, calm and composed manner, but is it realistic?

The “zero tolerance” concept is unfair because it is not reciprocated. We (that’s “we” as in “we the health system”) require patients and their loved-ones to be incredibly tolerant of us. Think waiting lists, physical discomfort, unplanned delays, unclear communication, unmet expectations, cancelled procedures, lack of privacy, lack of dignity, lack of control, lack of compassion, lack of progress… the list could go on. Can you find me a health facility where no patient has ever experienced these things? Our health system relies on people being tolerant – this “zero tolerance” malarkey doesn’t allow for a bit of crap.

Care and Crap

"Nursing ring theory: Care goes in. Crap goes out." courtesy of http://www.impactednurse.com/?p=5755 [thank you Ian]

“Nursing ring theory: Care goes in. Crap goes out.” courtesy of http://www.impactednurse.com/?p=5755 [thank you Ian]

Instead of zero tolerance, it is more realistic to expect that patients will occasionally need to vent their emotions. Not just the pleasant emotions like love, joy, gratitude and kindness, but also the less comfortable human emotions like grief, anger, sadness, worry, despair, frustration, fear, pain and hate. For these emotions swear words are adjectives, a raised voice is empowering, tears are cathartic.

In “Nursing Ring Theory” (more info here: impactednurse.com) when someone is in a ring that is smaller than the ring you are in you offer support, compassion, care and skilful expertise. When someone is in a ring that is larger than yours you are allowed to ventilate your emotions with them. It is pure client centred care: everyone sends care going towards the direction of the patient and accepts that there will be crap coming out at times.

This acknowledgement of crap coming out is not an offer to hold out nurses and other health care workers as targets for abuse. That’s not OK. However, let’s shelf the zero tolerance crap: of course we’re tolerant of people ventilating their emotions. All we ask is that nobody is put at risk and those closest to direct patient care also have an avenue to safely ventilate their crap.

In ring theory care goes towards the patient and crap moves away from the patient. Proximity to the centre of the ring will be a fair predictor of the intensity of both care and crap.

Fire Extinguisher Guy* 

Fire extinguisher guy is admitted to a medical ward for investigation of possible neurological disorder, but it might be something mental health related. So the Consultation Liaison CNC (me) spent a lot of time talking to fire extinguisher guy before the violent outburst, and again afterwards.

Fire extinguisher guy works hard, is creative, can be warm and funny at times; sadness, anger and tears bubble-up during our conversation then settle quickly. Talking to someone is both distressing and helpful, says fire extinguisher guy. He wants to get these strong, bouncing-all-over-the-place emotions under better control. Fire extinguisher guy’s experience of terrible abuse in childhood and his recent over-the-top cannabis and alcohol use wouldn’t be helping his labile hypomanic symptoms.

Fire extinguisher guy isn’t an unlikable person – he has a job, a car, a girlfriend, workmates, footy mates, other friends and a family. Fire extinguisher guy and the people who love him are all normal people. Fire extinguisher guy is one of the 20% of Australians who will experience problems with their mental health this year.

I am really grateful that fire extinguisher guy made the choice to direct his violence at property and not people. He had the capacity to make a very bad decision to hurt somebody; he chose not to. The only person physically harmed during this violent outburst was fire extinguisher guy himself: cuts from punching glass, bruises from punching and kicking windows, doors and walls of the medical ward.

I can’t figure out how long fire extinguisher guy’s violent outburst lasted. Replaying the scene in my mind I guess it was less than 2 minutes, but it’s like time measured in dog years… even though everything happened very quickly it somehow felt like slow motion too.

The fire extinguisher had been hurled into a storeroom doorway (THUD! CRACK!), the outburst was tentatively over, and fire extinguisher guy’s mum and i were lightly holding him and talking to him quietly when security arrived. Fire extinguisher guy allowed us to lead to him to an empty room and was cooperative with all of our suggestions and interventions. He apologised first to me, then to each of the other clinicians who provided care in those first couple of hours after the event. His apologies were heartfelt. He let the nurses, the doctor and the cleaner go about their business uninterrupted: his wounds were dressed, he accepted oral medications to dampen the intensity of his emotions, the blood and broken glass were cleaned-up, the other patients and visitors were reassured, detailed file entries were made, incident reports were filled-in, and negotiations between various members of the hospital’s multidisciplinary team were underway. The request for transfer off the medical ward could not be accommodated, but the insistence on two security guards overnight for staff and patient safety was.

Those of us up-close-and-personal to the incident took a couple of moments to exchange thoughts, but we tried not to get too bogged down in feelings at the time – it’s the beginning of the shift and fire extinguisher guy is just one of many patients on this busy medical ward.

Hole punched in the wall? No problem! One of the nurses covered the hole with this poster. Nurses are good at irony.

Hole punched in the wall? No problem! One of the nurses covered the hole with this poster. Nurses are good at irony.

There is a hole in the wall that fire extinguisher guy created by punching it. One of the senior nurses on the medical ward covers the hole in with an anti-violence poster. We all laugh at the delicious irony and get on with our jobs.

As with the poster covering the hole, we crudely paper-over the cracks… it’s not fixing a problem, just covering it over… that’s good enough for now.

Emotional Aftershocks

In the days that follow I find myself a bit preoccupied at times thinking about the event. Get teary every now and then when I think of what could have happened: those skull-cracking thoughts are the worst bit… acquired brain injury anyone?

Skull-cracking thoughts are from my fear and imagination not from what actually happened.

That’s a good reminder. Keep saying that.

I’m OK: no flashbacks, no vivid dreams, no avoidance, no hyperarousal. I was back at work the next day (left a few hours early because I stayed back a few hours with fire extinguisher guy the night before). I’m seeing patients in the same medical and surgical wards, spending time with my very supportive colleagues.

I’m OK: I’m resisting the urge to quietly whisper to every fire extinguisher in the hospital, “Stay where you are my little red friend. Stay gently hooked on the wall. Do not allow yourself to be raised higher than my head. Please don’t go violently leaping about medical wards – people don’t like that THUD! CRACK! sound you make. Stay exactly where you are my little red friend.”

I’m OK: I’ve told the story a few times now – it’s losing its potency. The funny bit about the poster is good – every story needs a punchline (you’re welcome). The scary bit about the fire extinguisher is getting less vivid – it feels more like a story from the past now. It’s turning into a half-joke about fire extinguishers staying on walls exactly where they belong.

I’m OK: the only thing I’ve noticed is a bit of kummerspeck (great word, eh?). Kummerspeck is a German word that literally translates as “grief-bacon” – it refers to the weight gained through emotional over-eating. I’ve had to let my belt out a notch, and my favourite shirt feels too tight. Still going to the gym, so it must be the eating, Better keep an eye on that.

Yeah yeah yeah. If you’re so OK why are you blogging about it?

Part of the motivation is catharsis. Very self-indulgent, I know.

More importantly, senior clinicians should offer information and support that will empower and protect junior clinicians. Just a few days after the most frightening workplace incident I have experienced these two tweets popped-up on Twitter:

I do not know either of these people IRL (In Real Life), but I do feel a tremendous responsibility towards Emily, Dani and any other nearly-nurse who is as enthusiastic and passionate as these two. But what to say to Emily and Dani? How do we nurture them safely into our profession and keep their enthusiasm intact?

Nursing – mental health nursing especially – needs people like Emily and Dani.

Sharing a battle story is not enough.

Referring to a patient as “fire extinguisher guy” is not a good example to set (more about that later – look for the red asterisk*).

As a senior nurse I should be supportive and encouraging to Dani, Emily and other enthusiastic nearly-nurses, and also be providing safety-tips and useful hints. I have two:

One: Make Like a Boy Scout

Be prepared.

Be prepared for some fantastic days at work where you’ll glide home feeling like you’re doing the most important and rewarding work that any one human can do. Those will be the days where you will use your knowledge-base, your skill-set and (most importantly) yourself to make a profoundly positive difference in somebody’s life. That person might never forget you.

Not every nurse gets exposed to violence or abuse, but you’ll see it up-close-and-personal through your patient’s eyes sometimes. Nurses do emotional labour: be prepared for the emotional aftershocks that come with the job. Find out about stress reactions and how to be pro-active in protecting yourself. I have an old, kind-of-dicky resource to share with you here, but you might find something better.

Two. Nurture the Nurturer

I’ve written about this before: meta4RN.com/nurturers

I am so angry that my nurse and midwife colleagues don’t have ready access to clinical supervision as a tool to reflect on practice and keep themselves (and their patients) safe. People say it would be too expensive to provide clinical supervision to every nurse who wants it, but there is huge cost already being paid. This cost (in terms of relationship stress, sleep disturbance, emotional trauma, anxiety, depression, substance use and kummerspeck) is being borne by individual nurses and the people who love them. Clinical supervision allows another way – through guided reflective practice many of these costs can be prevented.

I don’t see why looking after a nurse’s practice and emotional self through regular confidential support with a trusted colleague would be any less important than looking after a nurse’s back. Australian health facilities all have tools, time and training devoted to safe lifting, it is time to provide tools, time and training devoted to safe thinking.

Clinical supervision is available to mental health nurses, but not nurses in general hospital wards. In his epic novel Catch-22, Joseph Heller wrote:

People knew a lot more about dying inside the hospital, and made a much neater, more orderly job of it. They couldn’t dominate Death inside the hospital, but they certainly made her behave. They had taught her manners. They couldn’t keep death out, but while she was in she had to act like a lady. People gave up the ghost with delicacy and taste inside the hospital.

It is the nurses that make death and illness more neat, orderly and ladylike.

It is the nurses who paper-over the holes punched in the walls.

It is the nurses who stay on the ward to make sure that care keeps going in.

The nurses should be provided with an avenue to let crap out.

Guided reflective practice (aka clinical supervision) should be available for all nurses and midwives.

Closing Remarks

I would like to leave the story there because I have waffled-on for a long time already. However, it is necessary to address two tricky subjects raised in this blog post: [1] mental health and violence, and [2] my use of “fire extinguisher guy” when referring to a hospital patient.

Mental Health and Violence

Let’s get the facts straight:

  • the overwhelming majority of people who experience mental health problems are not violent: never have been and never will be
  • most violence is not perpetrated by people with a mental health problem
  • people who experience mental health problems are more likely to be victims of violence than perpetrators

I started specialist education in mental health nursing in 1993 and have spent most (not all) of my career working in clinical mental health nurse positions since then. I have never been physically assaulted by a person experiencing mental health problems. Never. However, earlier in the week there was a newspaper article reporting that “half of the nurses working on hospital psychiatric wards are themselves suffering from mental illnesses such as post-traumatic stress disorder, depression and anxiety.” I know that I have been more fortunate than some of my colleagues.

There are lots of myths and misunderstandings about mental health and violence. Please scroll to the bottom of the post for evidence-based resources and references.

Explanatory Note re the use of “Fire Extinguisher Guy”*

Using the term “Fire Extinguisher Guy” protects confidentiality and is, obviously, an irreverent, playful way to refer to a person. I don’t think this is wise for somebody creating a professional social media portfolio – somebody might think I’m being disrespectful.

Yet, here i am doing it anyway. Why?

Irreverence, humour and playfulness can be useful defence mechanisms: used correctly they can trivialise the other/traumatic events and empower the self. During the event I did what I could (very little) to assist this man to regain control and to keep himself and others safe from physical harm. It would not be useful to dwell on how powerless and vulnerable we all were at that time. I spent many hours talking to the man both before and after the event and treated him with kindness, respect and dignity.

Care goes in. Crap goes out.

This blog post is some crap coming out.

End

As always, your comments and feedback are welcome (scroll down).

Paul McNamara, 11th August 2013

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References and Resources re Mental Health and Violence

SANE Australia have a very readable resource, downloadable fact sheet and MP3 file here

Queensland MIND Essentials includes a resource for nurses and midwives caring for a person who is aggressive or violent here

The references below are via Australia’s Mindframe National Media Initiative:

New South Wales Health. (2003). Tracking tragedy: A systemic look at suicides and homicides amongst mental health inpatients. First report of the NSW Mental Health Sentinel Events Review Committee.

Walsh, E., Buchanan, A., & Fahy, T. (2002). Violence and schizophrenia: Examining the evidence. British Journal of Psychiatry, 180, 490-495.

Noffsinger, S. G., & Resnick, P. J. (1999). Violence and mental illness. Current Opinion in Psychiatry, 12, 683-687.

Brennan, P. A., Mednick, S. A., & Hodgins, S. (2000). Major mental disorders and criminal violence in a Danish birth cohort. Archives of General Psychiatry, 57, 494-500.

On Being a Dementia Nurse Newbie

The #dementia hashtag has been showing-up on Twitter a fair bit lately. This is due in no small part to British Nurses hosting an online chat and gathering resources under the #WeNurses social media portal: see their chat info and transcript here.

It’s had me thinking back to my first experiences of nursing the person with dementia, of being a dementia nurse newbie.

Since those early days as a nurse I’ve come across dementia in a number of roles, most frequently when working as a Consultation Liaison (CL) Clinical Nurse Consultant (CNC). CL CNC is a role where mental health assessment, support and education is provided in the general hospital setting in partnership with the clinical staff working there. Dementia isn’t usually part of a mental health nurse’s day-to-day work, but it is a frequent trigger for referral to a CL mental health nurse. In a 2005 survey of Australian CL nurses the “Four Ds” of common CL presentations were identified: Delirium, Dementia, Depression and Deliberate self-harm (Bryant et al, 2007, p 34). These four conditions aren’t mutually exclusive, of course. In fact, somebody with dementia (even very early stage) is much more prone to developing delirium and/or depression. Additionally, there are very clear links between dementia, depression and deliberate self harm.

Anyway, back to the subject. The prevalence of the dementia hashtag on Twitter reminded me of the clinical placement where I first encountered dementia amongst the residents of a large nursing home. Being new to nursing and new to dementia I felt pretty baffled at first. Luckily there are some secret weapons to feeling baffled: they’re often found in literature, art and music.

In 1989 Elvis Costello released a song he co-wrote with Paul McCartney called Veronica. The story I’ve heard is that the song was about Elvis Costello’s Grandmother who had dementia. As we know, dementia is a progressive, irreversible brain condition that results in cognitive and physical decline with some fluctuations in alertness and lucidity. Dementia can leave many long-term memories fairly intact, but makes laying-down new memories very difficult. The song Veronica captured the fluctuations in mood and memory beautifully, and was a timely, poignant accompaniment to my clinical placement.

Veronica by Elvis Costello helped me a lot when I was a newbie to nursing the person with dementia; maybe the song will help other dementia nurse newbies too.

Veronica video [via www.youtube.com]

Veronica lyrics [via www.sing365.com]

Is it all in that pretty little head of yours?
What goes on in that place in the dark?
Well I used to know a girl and I would have
sworn that her name was Veronica
Well she used to have a carefree mind of her
own and a delicate look in her eye
These days I’m afraid she’s not even sure if her
name is Veronica

[Refrain:]
Do you suppose, that waiting hands on eyes,
Veronica has gone to hide?
And all the time she laughs at those who shout
her name and steal her clothes
Veronica
Veronica

Did the days drag by? Did the favours wane?
Did he roam down the town all the time?
Will you wake from your dream, with a wolf at
the door, reaching out for Veronica
Well it was all of sixty-five years ago
When the world was the street where she lived
And a young man sailed on a ship in the sea
With a picture of Veronica

On the “Empress of India”
And as she closed her eyes upon the world and
picked upon the bones of last week’s news
She spoke his name outloud again

[Refrain]

Veronica sits in her favourite chair and she sits
very quiet and still
And they call her a name that they never get
right and if they don’t then nobody else will
But she used to have a carefree mind of her
own, with devilish look in her eye
Saying “You can call me anything you like, but
my name is Veronica”

[Refrain]

Veronica mp3 [via iTunes]

In Closing

Nurses (#wenurses) are referred to in the lyrics: “And they call her a name that they never get right, and if they don’t then nobody else will.” It’s especially important for we, the nurses, to be fully present when dementia has made the person’s own presence tenuous, brittle.

We Nurses are fortunate to have art, literature and music to inform our empathy and build our emotional intelligence. Neither empathy or emotional intelligence are exclusive to nursing, of course, but both are core nursing qualities. I found those qualities, as they relate to nursing the person with dementia, in Elvis Costello’s song in 1989, and again by following the #wenurses and #dementia hashtags on Twitter in 2012.

Reference

Bryant, J., Forster, J., McNamara, P. & Sharrock, J. (2007) You are not alone: Results of the 2005 Australian consultation liaison nurses survey, Australian College of Mental Health Nurses. Available online here http://eprints.jcu.edu.au/2013/1/ACMHN2007.pdf or here http://www.acmhn.org/images/stories/Media/CLSIG_survey_report.pdf 

Paul McNamara, 30th November 2012