It is amazing how a single tweet can capture your imagination… and that is exactly what happened here. I invited Ela to tell us more.
Thank you Ela for providing yet another wonderful guest post for this “in my shoes” series, looking at dementia from different perspectives. I was spellbound by this story.
I hope you are too…
Seeing beyond the image – using photographs to help care staff develop a better understanding of their clients
Any nurse will tell you, there are some patients you never forget. For me one of those patients was Tom Wood. I remember Tom not because he was extraordinary, but because he wasn’t. I can’t forget him precisely because I so very nearly did. I forgot he was a living, breathing person, with a pre-illness life, a family and a past. I forgot about what he could bring to our working relationship and instead was focussed only on the tasks I had to complete. This realisation came one shift when I found an old photo of Tom. It showed a tall, athletic young man, grinning as he posed for the camera, a child cradled in his arms. It made me stop; it made me think about what I was doing, why I was doing it, but more importantly, who I was doing it for.
Personal photos like the one of Tom can help us develop a frame of reference for our clients, enabling us to better support them in maintaining a sense of self and aiding a more person-centred approach to care giving. In the case of people with dementia, I believe personal photos sometimes help us better understand challenging behaviours and avoid those interactions which, however well meaning, can result in further distress.
Cyril was 87 when I met him, a resident in a specialist home for clients with dementia. He was usually genial and friendly. However, at times when out in the garden, Cyril would become distressed. Staff could find no pattern or trigger for Cyril’s outbursts One member of staff felt Cyril got upset when the hosepipe was turned on, but this was seen as just a random and therefore meaningless ‘dementia behaviour’ by staff. Instead they had tried to reassure Cyril by encouraging him to water the plants, something which seemed to make matters worse.
I asked the family to bring in a selection of photographs from Cyril’s life, to help staff gain a better understanding of him as a person. Amongst the ones they chose were some from his time in the RAF. Staff were struck by the change in Cyril in the photos taken just after he was called up, compared with those taken later. One member of staff said ‘he looks strained, like the weight of the world is on his shoulders.’ Another staff member noticed the trade badge on Cyril’s uniform and felt he would like to investigate further. He discovered one unpleasant task given to ground crew like Cyril, serving on bomber stations in the war, was the ‘hosing out’ of aircraft to remove the remains of aircrew killed after their planes had crashed returning to the airfield. The possibility this may have happened to Cyril helped staff to understand what he might be experiencing now and why their actions were making things worse, it allowed them to change the way they cared for him and avoid potential triggers which caused him distress.
Joan, we will call her that though nobody can remember her name, died alone, without family, in a terrace house in Birmingham. She liked writing letters, which no one replied to because care staff never bothered to post them. She cut photographs from magazines, which she pasted in to notebooks that littered the house; care staff found it an ‘irritating’ pastime.
When she was found, a house clearance company were brought in to get rid of the ‘mess’ and Joan’s life was broken up, which is why a month later, I was able to buy her photograph in a flea market.
Why do I know so much about the background to my find? Well, it bothered the clearance worker who found the photo. It bothered him that no one had tried to get to know ‘this beautiful woman’ when she was alive, and now it was too late. Would the care staff have behaved differently if they had looked closely at this photograph?
On the face of it this is a simple studio photograph. We know it was taken in London in 1943 because the studio was bombed out that year. We can tell she is a bus conductress, and that she was working in Birmingham, her badge tells us this. Was she from Birmingham or London? She was certainly doing her bit for the war effort, but was the photo taken to demonstrate this, or was it meant as a keepsake for a sweetheart serving somewhere? This is a lady who cared about her appearance, she is beautiful and I think she knows it. She wears her hair and make up in the latest style and I think she exudes an air of confidence, adding her own individual touches to her uniform.Was keeping her individuality important to her? Did she maintain her interest in fashion throughout her life? The clearance worker noted the clippings were all from fashion magazines.
Would understanding this photograph have helped give her care staff a context for her ‘irritating’ pastime? Would understanding all this have enabled them to support her better in maintaining her identity, despite illness and old age? Who knows, but I would like to think it just might.