Reminiscence and life review are terms that have been used a variety of ways throughout the nursing and psychological literature. Although the phrases are often used interchangeably, they refer to different but related constructs (Burnside & Haight, 1992; Haight, 1991; Haight & Burnside, 1993). Reminiscence is an informal and spontaneous process in which individuals think about their personal past and experiences, sometimes alone and sometimes sharing those reflections with others (Buchanan et al., 2002; Soltys & Coats, 1994), and serves many functions. Life review is a more structured process with a more focal goal. Reminiscence is used for social functions (e.g., an increased sense of connectedness) and nonsocial functions (e.g., promoting a sense of self-continuity over time, solving current problems, making decisions based on past experiences, reducing boredom, preparing for death) (Bluck & Alea, 2008, 2009; Burnside, 1990; Webster, 1993, 1997). In contrast, the main goal associated with life review is facilitation of ego integrity (Haight & Burnside, 1993). In life review, individuals remember, reflect on, and re-evaluate past experiences (positive and negative) “to build integrated, meaningful life-stories that might reduce or prevent anxiety and prevent depression” (Berk, 2014, p. 606).
Reminiscence and life review can occur spontaneously or through structured and guided therapeutic activities (Hallford & Mellor, 2013; Stinson, 2009). Reminiscence techniques have been used in counseling and mental health therapy settings, with cognitively impaired and intact individuals, and have been associated with a variety of positive outcomes, such as improved mental health and well-being (Bohlmeijer, Roemer, Cuijpers, & Smit, 2007; Westerhof & Bohlmeijer, 2014; Westerhof, Bohlmeijer, & Webster, 2010). Reminiscence can reduce feelings of loneliness and depression, improve self-esteem, and help individuals find meaning in life (Bluck, Alea, & Demiray, 2010; Merriam, 1993; Romaniuck & Romaniuck, 1981; Taft & Nehrke, 1990). For nursing home residents with cognitive impairment, reminiscence can improve mood, well-being, and life satisfaction (Cotelli, Manenti, & Zanetti, 2012; Fry, 1991; O'Shea et al., 2014; Subramaniam & Woods, 2012; Testad et al., 2014). In addition, previous research has demonstrated that the act of sharing memories through reminiscence can build empathy (Bluck, Baron, Ainsworth, Gesselman, & Gold, 2013), which is an important finding for nurses and patients.
Across settings, reminiscence has been used for a variety of different functions that can serve to enhance or detract from psychological well-being (O'Rourke, Cappeliez, & Claxton, 2011). Nursing home staff have offered structured reminiscence activities (e.g., life review and nostalgia groups) to engage residents, with the goal of alleviating depression or anxiety (Pinquart & Forstmeier, 2012; Subramaniam & Woods, 2012; Testad et al., 2014; Woods, Spector, Jones, Orrell, & Davies, 2008; Woods et al., 2012). Recent research has shown that for some nursing home residents, reminiscence can be used to reduce boredom, revive feelings of bitterness, and prepare for death, but that when used for these functions, it is associated with lower morale and higher levels of depression (Henkel, Kris, Birney, & Krauss, 2017). However, nurses can also help residents engage in reminiscence activities in positive ways that can enhance feelings of social connectedness (Shellman, 2006).
Benefits of reminiscence are not limited to residents, and can extend to nursing home staff (Finnema et al., 2005; Gudex, Horsted, Jensen, Kjer, & Sørensen, 2010; Schrijnemaekers et al., 2003). For example, by finding ways to facilitate engagement with residents, nursing home staff may be less likely to experience emotional exhaustion (Gudex et al., 2010). Reminiscence activities have been found to enhance the ability of nursing home staff to see their residents as individuals (Cooney et al., 2014; Williams et al., 2011), in part by facilitating the ability of individuals with dementia to interact with others (Edvardsson & Nordvall, 2008; Gibson, 2011; Woods et al., 2008). Reminiscence can help nursing students connect with older residents (Gallagher & Carey, 2012), and enhance the relationship between staff members and residents by allowing them to know their residents more fully, thereby enhancing their personhood (Gammonley, Lester, Fleishman, Duran, & Cravero, 2014). These interventions have been used to improve relationships between nursing staff and patients and feelings of empathy (Heliker & Nguyen, 2010).
Among nurses, the degree to which reminiscence serves an intentionally therapeutic function, the type of function it serves, and the extent to which nurses engage in this process are not yet known. It is also not currently known to what degree nurses find engagement in reminiscence activities to be valuable or why they engage in these activities. It is hypothesized that reminiscence may serve different functions for nurses than for residents, and that nurses may engage in reminiscence activities for reasons not previously identified in the psychological literature regarding general functions of reminiscence in the population at large or in clinical populations.
The purpose of the current descriptive, correlational study was to understand the nature of reminiscence activities among nursing home staff. Specific aims were to understand (a) the reasons nurses engage in reminiscence activities, both personally and professionally; (b) the value they attribute to those reminiscence activities; and (c) the extent to which they enjoy them. Qualitative analyses were used to reveal novel uses for reminiscence in nursing homes. The current authors were also interested in understanding the relationship between different types of engagement in reminiscence activities (personally and professionally) and the provision of personalized care.
Setting and Sample
Data were collected from three suburban nursing homes in Connecticut. The nursing homes ranged in size from 107 to 353 beds, and included one for-profit and two non-profit, religiously affiliated homes. The nursing sample comprised staff nurses (RNs and licensed practical nurses [LPNs]) (n = 23) and certified nursing assistants (CNAs) (n = 20) working with cognitively impaired residents. All nursing home staff were invited to participate and were recruited through the posting of flyers. Data were collected through the distribution of paper-and-pencil surveys placed in break rooms and conference rooms. Nurses could take a survey, complete it anonymously, and return the completed survey to a collection folder. Surveys remained in the facilities over a 2-month period. Completing the survey constituted consent to participate in the study. The incentive of a $50 gift card via lottery drawing was provided. The study was reviewed and approved through the Fairfield University Institutional Review Board.
To better understand the degree to which nurses were engaging in reminiscence activities and the value they assigned to these activities, a survey was constructed using key elements and ideas from previously validated reminiscence surveys. The Thinking About Life Experiences (TALE) scale is a self-report questionnaire that asks individuals to indicate how often and why they think about and share their personal experiences with others in their everyday lives (Bluck & Alea, 2011). For the current survey, the original instructions from the TALE were included, as well as the first two items, which ask, “In general, how often do you think back over your life?” and “In general, how often do you talk with others about what's happened from your life?” Additional questions were modified and added to separately explore everyday life settings and the professional setting of the nursing home. In addition, items were added to examine the direction of sharing (e.g., nursing staff talking about their own lives with residents, residents talking about their own lives with nursing staff). For example, in this modified format, it was asked, “In your professional life as a health care provider, how often do you talk about your life and personal past with residents here?”
A total of 17 items assessed the frequency with which nurses engaged in reminiscence activities, both with residents as well as in their personal lives. Responses ranged from 1 = almost never to 5 = very frequently. The scale also asked how valuable they found these activities to be for residents and themselves, with responses ranging from 1 = not at all valuable to 5 = very valuable. Finally, nurses were asked how enjoyable or unenjoyable they found engaging in reminiscence activities in general and in their professional lives, with responses ranging from 1 = not at all enjoyable to 5 = very enjoyable. These additional survey items were highly inter-correlated with original, previously validated items (Table A, available in the online version of this article). Furthermore, a one-item open-response question was added to allow staff to indicate why they engage in reminiscence activities, and why they may choose to engage in reminiscence activities with residents.
Correlations Between Frequency and Value of Reminiscence Activities with the Degree to which Participants Report Knowing Residents
In addition, a modified version of the Reminiscence Functions Scale (RFS) Brief Version was used to understand the reasons nurses attributed to engaging in reminiscence with residents. The RFS is a self-report questionnaire that assesses the frequency with which individuals engage in reminiscence for various reasons in their everyday lives, and conventionally, these items load onto eight factors: boredom reduction, death preparation, identity maintenance, problem solving, facilitating conversation, maintenance of intimacy, bitterness revival, and teaching and informing others (O'Rourke, Carmel, Chaudhury, Polchenko, & Bachner, 2013; Robitaille, Cappeliez, Coulombe, & Webster, 2010). For the purposes of the current study, a total of 13 items from six of the most relevant factors in the nursing home setting were used (bitterness revival and teach/inform were not included). Similar to the original RFS, a 6-item Likert scale was used to assess how frequently reminiscence was being used for each purpose, with responses ranging from 1 = never to 6 = very frequently. Questions were reworded to be specific to nurses using reminiscence with residents. The stem of these questions began, “When you reminisce with residents about their life and past experiences, how often do you do so to…?” and were followed by a variety of different purposes. This is a modification of the RFS, in which the stem begins, “When I reminisce it is to…,” followed by a variety of different answer responses. In addition, three new items were included to assess the degree to which nurses used reminiscence for specific nursing-related therapeutic purposes not listed on the original RFS. These items included (a) to calm an anxious resident, (b) to reorient a confused patient, and (c) to distract a resident during a painful procedure. Lastly, two items were included to assess “meaning making,” a concept believed to be an important component of reminiscence (Olivares, 2012). These items included using reminiscence (a) to encourage residents to see meaning in their lives and (b) to help residents see that thinking about the past puts the present in a new light. These latter two items were assessed using a 6-point Likert scale, with responses ranging from 1 = never to 6 = very frequently. Cronbach's alpha for the modified RFS was 0.95 and 0.91 for the modified TALE. Finally, two items were asked to assess the extent to which nurses believed they knew their residents. These items were assessed using a 5-point Likert scale, with responses ranging from 1 = not at all to 5 = very well. In total, for all sections, the questionnaire comprised 38 items.
Demographic information from nursing home staff were analyzed using basic descriptive statistics. Data were then analyzed to examine the frequency of reminiscence activities of nursing staff inside and outside of the nursing home, the value attributed to those activities, and the enjoyment from those activities. These data were analyzed separately and together for licensed staff as well as CNAs. Due to the small sample, results were not analyzed to examine differences among the three facilities. Reasons for engaging in reminiscence activities were examined and ranked using their mean score. Qualitative data from the single-item free response question asking nurses to indicate the reasons for engaging in reminiscence activities were coded and sorted by theme. Exemplars from common themes were selected.
Measures of association were used to examine the extent to which engagement in reminiscence activities personally were associated with engagement in reminiscence activities professionally. In addition, the current authors sought to understand the degree to which engagement in reminiscence activities was correlated with knowing the residents better. Data were screened for outliers, and outliers were removed from correlation analyses; sample sizes are included for each statistical test. Statistical analyses were performed using SPSS 21.0.
A total of 43 nursing home professionals (23 RNs and LPNs and 20 CNAs) participated. Participants' ages ranged from 23 to 67 years (mean = 45.63 years, SD = 11.99 years). The sample was mostly female (n = 40), reflecting the population of nursing staff in these facilities. Sixty-one percent of participants were non-White individuals. Staff varied widely in their level of experience, from less than 1 year to 43 years (mean = 16.55 years, SD = 12.35 years), and an average facilitytenureof7.81years(range=<1 to 33 years, SD = 7.48 years).
Among the three facilities, 48% (n = 21) of nurses were from Facility 1, 39.5% (n = 17) were from Facility 2, and 11.6% (n = 5) were from Facility 3. Data from CNAs (n = 20) and RNs and LPNs (n = 23) were analyzed separately and together; however, there were no significant differences in results by title. Therefore, data from these two groups were pooled for all analyses reported.
Reminiscence as a Familiar Practice to Most Nurses and Certified Nursing Assistants
The frequency with which nursing staff reported engaging in reminiscence in various settings (e.g., personally, professionally) were analyzed (Table 1). Most nursing staff reported that they engaged in reminiscence activities often or very frequently in their personal lives outside of the health care setting. However, they were substantially less likely to engage in reminiscence activities with residents. In fact, 37.7% of nursing home staff indicated that they engaged in reminiscence activities with residents either seldom or almost never. Despite this sizeable minority, 60.5% of staff said that they tried to encourage reminiscence among residents frequently or very frequently, and most (88.4%) reported that they found engaging in reminiscence activities with residents enjoyable or very enjoyable. Interestingly, neither years of experience as a nurse nor years of experience at a particular facility were related to engagement in reminiscence activities. Experience was consistently negatively correlated with engagement in reminiscence activities, although these correlations were not statistically significant (p > 0.05) (Table A).
Frequency of Engagement in Reminiscence Activities
Staff who reported that they frequently talked about their personal past at home were more likely to reminisce with residents more frequently. There was a statistically significant positive correlation between the frequency of reminiscing at home and frequency of reminiscing at the nursing home (r = 0.49, p = 0.001). Some nurses (37.3%) reported that they never or rarely talked about their personal past at work. Many of this same small subset of nurses were the same nurses who also reported that they did not enjoy talking about their personal past. Few nurses (23.3%) stated that they did not at all enjoy or slightly enjoyed reminiscing with residents (Table 2). However, most nurses believed that sharing this information helped establish a personal connection with residents. One participant reported, “Sometimes it helps both you and the resident feel better knowing who you are working with.”
Enjoyment of Reminiscence Activity
Reasons Reported for Reminiscing With Residents
Nursing staff members were asked to rate how frequently they engaged in different forms of reminiscence with residents (Table 3). The most frequent reason staff reported reminiscing with residents was to calm anxiety. This finding was consistent with qualitative responses to the open-ended question asking about reasons for engaging in reminiscence. One participant reported, “Mostly it helps calm residents… orient confused residents…. It can help their mood environment.” In addition to the reasons listed on the modified RFS, participants reported that they often engaged in reminiscence activities to improve the mood of residents. Nurses reported using reminiscence to help establish a personal connection with residents. One nurse said he/she used reminiscence “to build rapport, start a conversation [and] to know the residents more.” Another caregiver said, “It helps to establish a common bond. It helps the staff see a resident as [he/she] used to be.” One participant noted how engaging in reminiscence activities is empathy-building: “It helps to know another person has experienced joy and loss.”
Most Frequent Reasons for Engaging in Reminiscence Activities with Residents
Reminiscence was infrequently used in conversations about death and dying. Nursing staff infrequently engaged in reminiscence activities to help residents prepare for death (mean = 3.44, SD = 1.29), remember a deceased loved one (mean = 4.04, SD = 1.23), or lessen fear of death (mean = 4.09, SD = 1.31).
Reminiscence and Person-Centered Care
Nursing home staff reported knowing their residents moderately well (mean = 4.20, SD = 0.81). There were positive, statistically significant correlations between engaging in reminiscence activities and the perception of how well nursing staff believed they knew residents (Table A). Across all measures, nurses who engaged in reminiscence activities, valued those activities, and engaged in those activities most frequently reported that they knew residents better. Higher frequency of reminiscence was associated with knowing residents better (r = 0.615, p < 0.001). In addition, staff who reported that they enjoyed engaging in these reminiscence activities and those who valued engaging in reminiscence activities also reported they knew residents better (r = 0.574 and p < 0.001, and r = 0.565 and p < 0.001, respectively).
The current findings indicate that most nursing staff found reminiscence to be an enjoyable and valuable activity in their personal and professional lives. Most nursing home staff (86%) reported that they found engaging in reminiscence activities with residents to be enjoyable or very enjoyable, and 86.4% found the activity to be moderately to very valuable. Despite this, only 46.5% of nurses reported engaging in these activities frequently or very frequently. There may be many reasons for this (e.g., lack of time, belief it is not valuable), but this finding is especially important to consider when juxtaposed against a key finding from previous research indicating that many nursing home residents would prefer to reminisce with staff more frequently (Henkel et al., 2017). In addition, there may be a perception that engaging in reminiscence activities or sharing personal experiences with residents may be viewed as unprofessional. Additional research is needed to determine if this is a barrier to reminiscence activity. If so, the importance of sharing these personal experiences for the development of therapeutic relationships may need to be further emphasized.
Responses provided evidence that nursing home staff engage in reminiscence activities to elicit some of the positive benefits of reminiscence that have been identified in previous research with a community sample (Cappeliez, O'Rourke, & Chaudhury, 2005). For example, nurses in the current survey reported engaging in reminiscence activities to foster conversation and maintain intimacy. In addition, nurses used reminiscence frequently or very frequently in novel therapeutic ways, such as to calm an anxious resident (67.4%), help residents see meaning in their lives (53.5%), and for reorientation (62.8%). Interestingly, nurses were not engaging in reminiscence activities to promote the discussion of difficult topics. Death preparation or to remember loved ones were among the least frequent reasons for engaging in reminiscence. These findings are in line with previous research that found that nursing home staff avoided conversations about end of life (Towsley, Hirschman, & Madden, 2015) and that they generally avoided these conversations due to discomfort in initiating discussion as well as a lack of certainty over what to say (Wadensten, Condén, Wahlund, & Murray, 2007).
Qualitative and quantitative data provided evidence that nurses use reminiscence in unique ways when engaging with nursing home residents. For example, they reported that they engaged in reminiscence activities to calm residents' anxiety and re-orient them when they were confused. In fact, these were among the most common reasons nurses engaged in reminiscence activities, and it is context-specific unique uses such as this that have not been well explored previously. Nursing staff also reported using reminiscence activities to help residents recall happy memories, and to find ways to bond with residents. Reminiscence provides a mechanism that allows nursing home staff to better understand residents as individuals, thus allowing them to provide more holistic, individualized care (Gudex et al., 2010). This personalized, individualized care can then serve as a foundation for the provision of high-quality care (Brownie & Nancarrow, 2013; Suhonen, Leino-Kilipi, & Välimäki, 2005).
Nurses in the current study who engaged in reminiscence activities with residents more often reported knowing their residents better. Therefore, these findings expand the current knowledge, indicating that reminiscence is an intervention benefiting nursing home residents and caregivers in addition to demonstrating the relationship between engagement in reminiscence activities and an enhanced nurse–patient relationship.
This research provides insight as to the frequency with which nursing home staff engage in reminiscence, the purpose of those reminiscence activities, and the connection of those activities with staff knowledge of residents. However, there were some limitations to the research. All data gathered were generated through self-report measures. Self-report is subject to a variety of potential biases and it may be that nursing home staff inaccurately reported their frequency of engagement in reminiscence. Nursing staff who chose to participate may be those who already see those activities as important and valuable, and may not necessarily represent the entire nursing staff. In addition, the sample was relatively small. Reasons for engagement in reminiscence activities were initially based on the RFS, with additional questions added that might be unique to nursing care.
Although the qualitative findings support the quantitative results, it is possible that nurses may engage in reminiscence activities for other reasons that were not included in the modified survey. Although the Cronbach's alphas for the survey instruments were high, it is possible that these alphas are not reliable given the small sample. The study also contains data from three nursing homes in a narrow geographic area, and it is possible that regional differences may exist. Despite the benefit of reminiscence found in the current study and others, a substantial subset of nursing staff reported that they rarely engage in reminiscence activities. Additional research is needed to explore methods to enhance engagement in reminiscence activities among nursing home staff.
The current study concluded that reminiscence activities were enjoyable for nursing home staff and residents. In addition, the data demonstrate that reminiscence generates value to staff and residents in their care within the nursing home setting. However, despite these benefits, fewer than one half of nurses indicated that reminiscence is a tool used frequently or very frequently. Further research is needed to explore the impediments to reminiscence in this setting. By enabling nursing home staff to increase the practice of reminiscence, improvements in quality of care and job satisfaction can be achieved.
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Frequency of Engagement in Reminiscence Activitiesa
|Question||Mean (SD)||t(df), p Value||Responding Frequently or Very Frequently (%)b|
|In your everyday life (not at work), in general, how often do you think back over your life?||3.47 (0.51)||3.78 (0.73)||−1.55 (40), 0.13||53.5|
|In your everyday life (not at work), in general, how often do you talk with others about what's happened in your life?||3.10 (0.64)||3.04 (1.22)||0.19 (34.13), 0.85||27.9|
|In your professional life as a health care provider, how often do you talk about your life and personal past with residents?||2.80 (0.83)||2.43 (1.27)||1.13 (38.27), 0.27||18.6|
|In general, how often do you encourage residents to think back over their lives?||3.7 (0.92)||3.61 (1.08)||0.3 (41), 0.77||60.5|
|In general, how often do you talk with residents about what's happened in their lives?||3.6 (0.88)||3.39 (0.89)||0.77 (41), 0.45||46.5|
|How often do the other members of the nursing staff talk about residents' lives and personal past with residents?||3.2 (1.01)||2.74 (1.34)||0.93 (41), 0.36||37.2|
Enjoyment of Reminiscence Activitya
|Question||Staff Responses (%)b||Mean (SD)|
|Staff discussing their personal past with residents|
| How enjoyable or unenjoyable is it talking about your personal past with residents?||14||9.3||27.9||18.6||30.2||3.42 (1.38)|
| How valuable is it for you?||14||9.3||23.3||23.3||30.2||3.47 (1.37)|
| How valuable is it for residents?||4.7||0||7||18.6||69.7||3.86 (1.36)|
|Staff encouraging residents to reflect on their own lives and personal past|
| How enjoyable or unenjoyable is it talking with residents about their lives?||4.7||9.3||0||27.9||58.1||4.26 (1.16)|
| How valuable is it for you?||4.7||0||7||34.9||53.5||4.33 (0.97)|
| How enjoyable or unenjoyable is it for residents?||4.7||0||7||27.9||60.5||4.40 (0.98)|
Most Frequent Reasons for Engaging in Reminiscence Activities with Residentsa
|Reason for Reminiscing||Staff Responses (%)b||Mean (SD)|
|Calm anxiety||0||4.7||2.3||25.6||27.9||39.5||4.91 (1.23)|
|See meaning in life||2.3||2.3||4.7||37.2||27.9||25.6||4.79 (0.94)|
|Reorient a confused resident||2.3||4.7||4.7||25.6||27.9||34.9||4.77 (1.25)|
|Ease conversation||0||2.3||4.7||34.9||41.9||16.3||4.65 (0.9)|
|Improve mood||2.3||2.3||4.7||37.2||27.9||25.6||4.63 (1.13)|
|Mentally stimulate||2.3||0||4.7||34.9||44.2||14||4.60 (0.95)|
Correlations Between Frequency and Value of Reminiscence Activities with the Degree to which Participants Report Knowing Residents
In your everyday life (not at work), how often do you think back over your life?
In your everyday life (not at work) how often do you talk with others about what's happened in your life? 0.56**
In your professional life as a healthcare provider, how often do you talk about your life and personal past with residents here? 0.09 0.49**
How enjoyable or unenjoyable is talking about your personal past with residents for you? 0.15 0.47** 0.73**
How valuable is it for you? 0.23 0.48** 0.60** 0.79**
How valuable is it for residents here? 0.18 0.29 0.51** 0.50** 0.61**
How often do the other members of nursing staff here talk about their lives and personal past with residents here? 0.03 0.34* 0.57** 0.74** 0.64** 0.34*
How often do you think residents would like to talk to the nursing staff? 0.29 0.26 0.52** 0.63** 0.50** 0.42** 0.43**
In general, how often do you encourage residents to think back over their lives? 0.10 0.22 0.07 0.33* 0.38* 0.23 0.30 0.19
In general, how often do you talk about what's happened in their lives? 0.12 0.54** 0.55** 0.57** 0.32* 0.26 0.50** 0.43** 0.47**
How enjoyable is talking with residents lives for you? 0.02 0.34* 0.31* 0.54** 0.46** 0.08 0.53** 0.30 0.47** 0.57**
How valuable is it for you? 0.14 0.47** 0.37* 0.50** 0.47** −0.02 0.51** 0.29 0.29 0.51** 0.75**
How enjoyable is it for residents? 0.06 0.51** 0.39** 0.54** 0.44** 0.10 0.49** 0.47** 0.36* 0.60** 0.73** 0.76**
How enjoyable is it for you? 0.09 0.38* 0.22 0.32* 0.38* 0.01 0.31* 0.37* 0.42** 0.45** 0.54** 0.70** 0.84**
How often do other members of the nursing staff talk about residents' lives and personal past with them? 0.03 0.12 0.51** 0.66** 0.51** 0.29 0.66** 0.65** 0.29 0.57** 0.63** 0.48** 0.53** 0.43**
Overall, how well do you feel you know the residents? 0.10 0.37* 0.15 0.39** 0.16 −0.09 0.33* 0.13 0.27 0.56** 0.44** 0.57** 0.50** 0.39** 0.33**