Dipl. Pflegewirtin (FH) Charlotte Berendonk
Interview of March 25, 2013 with Birgit Teichmann
What exactly is biography work?
Before I explain the meaning of biography work, I want to say something about biography. Biography or life story refers to a subjective representation of ones own life and lived time. Life story rather means the course of life e.g. place of birth, education, professional career. With their biography, each person describes their own way of looking at life. For example, experiences that were individually important and connected to emotions. We should be aware that biography is newly constructed with each dialogue partner.
We are all our lived life story, meaning that on one hand our biography is saved in our autobiographic memory. But on the other hand, it is also embedded in the body memory- everything we do habitually, our rituals, familiar activities etc-, are placed in an implicit part of memory. These aspects of our biography can be hard to put into words sometimes. When we are asked about our biography, we often forget our habits and usually remember different incidents during our time in school, being a teenager, etc.
As part of biography work, we specifically look at significant memories, interests, habits etc. of the person being cared for. Through this data, carers want to get to know the person cared for better, and find out which individual measures can be taken for the support of life quality for these people.
In what way does good biography work, respectively knowledge of the biography of people with dementia, facilitate care?
In the care and support of people with dementia, biography work is a significant concept. The current experiences of people with dementia are characterized by past experiences and can therefore only be understood, classified and influenced by knowledge of this biography. Without consideration of individual lifetime backgrounds, needs of people with dementia are often unknown and wrongly interpreted and thereby their wellbeing is threatened and reduced.
In literature and also in the interviews held within my PhD project, it became clear that the understanding of people with dementia is getting better. When I look back at my interviews now, I was often told by the interviewed people that their understanding of a persons behaviour is better, when they know more about the life of that person. For example, when a person with dementia shows behaviour that is connected to their past working life, carers can understand this better by having knowledge of the persons working life. Another example are habits. One study participant mentioned that the team was very irritated because one female patient would not go to bed at night but wanted to sleep in her chair. It became clear through talks with the relatives, that this had been her usual sleeping position for the last few years. Therefore the carers were able to act different in this situation.
A greater understanding of the cared for person is one aspect of biography work. The other part is taking measures for preservation of the wellbeing in care and therefore achieve individual care. For example, when a carer knows that someone liked to talk about certain things, he or she can target that subject while interacting with the person with dementia, especially when he is unable to initiate it himself. In this way, the carer can try to better the wellbeing in the current situation.
Is it known that some people are happy to have forgotten their past? Maybe due to too many losses or because they want to escape their past for other reasons?
Definitely! This needs to be respected. There always will be people that say: I do not want to disclose myself. Or I don’t want my information written down. He or she is entitled to and it should be accepted by everyone.
This was also a topic in the interviews. The interview partners mentioned, that they have to be really sensitive and move forward slowly, because biographical information is something really private. You shouldn’t come with a biographic questionnaire to get information on the first day because it needs trust. The carers also said, that people with dementia differ on who they tell what. So co-workers in a team do not always have the same state of knowledge, it depends on sympathy, on the relationship that develops. So they know different things about the person with dementia.
Can it be dangerous to have certain knowledge of a person? That I might not be sensitive enough for changes of his or her preferences?
You need a certain openness. This was also mentioned in the interviews: Just because they have knowledge on what someone did 30 years ago, it definitely does not mean, that this applies to the current situation. One example was of a person that liked to play cards at an younger age but it is not relevant to him in the current situation. Instead, this person developed new interest e.g. activity on the computer.
Significant interests, preferences and habits of a life story should be compared with the present situation, the actual importance should be determined and it should be reacted flexible according to changes.
Musical preferences are another example. Some carers report that relatives told them that the person with dementia never liked to sing in his or her life but the carers noticed that this person had a lot of fun singing in a group.
In my opinion, it is important that carers are open to possible changes. Meaning, they should reflect what knowledge they have about significant preferences etc and what is currently important to the person. This information should be updated, e.g. in the team or through observation. So from my point of view, it is not necessarily expedient to collect a lot of information through a biography sheet after the move in of a resident. Instead, this collection of information should be a continuous process and never be looked at as finished but as a ongoing process to notice changing relevancies.
What advice would you give relatives of people with dementia to ease the care or the biography work? Or are there suggestions for everyone, even if they are not affected by dementia, to prepare their relatives, so they know something about their biography?
Caring relatives could reflect on what memories of their own biography are positively important to the person with dementia. For example, memories the person has joyous feelings about or that are often mentioned by him or her. Furthermore, it would be important to think of which moments in the current situation are positively experienced. Those are possible situations in which someone shows interest, can relax or laugh full heartily. When the carers receive information about that, they can shape care more individually and support life quality of that person.
Transferred to all of us, some parallels can be found. When we think on how we are trying to design our own everyday life positively, we are trying to create situations that do us good. Those are often little or short situations and rarely fill the whole day, like making a hot chocolate, going to have coffee with friends, going to the movies, taking time to read a good book, buying myself some nice flowers or a glass of wine for dinner. And these little things we need to be aware of and communicate those to our reference persons. Because they are moments that could become important in care later and can therefore be individually arranged. The individual differences are very significant.
Those little things make our everyday life and we should always keep that in mind. We should talk about them at an early stage, tell them what has a meaning to us, what makes us feel good and what habits are important to us.
Charlotte Berendonk studied care at the University of Applied Science in Fulda and received her degree as a health care administrator in 2006. In the following 3 ½ years she worked as a research assistant in a care research project at the Institute of Gerontology of the Heidelberg University. Before her study, she completed her examination in geriatric care (2002). Until 2009 she worked in different positions in clinical care for the elderly. For a few years now she leads seminars on care of people with dementia in clinical care as well as institutions of geriatric rehabilitation.
Since 2010 she is a scholarship holder of the graduate program “Dementia” at the NAR, that is supported by the Robert Bosch Foundation. In the context of her dissertation, she concentrates on the subjective theories of carers in biography work with people with dementia.
Her individual significant moments are with her husband, family and friends, sports and a nice dinner in her favourite restaurant.