Validation (maintenance)

The Validation is both a method and an attitude in dealing with people with dementia , mainly in the elderly , but also in social work is to be found.

background

On the one hand, validation or validation is an appreciative attitude that was developed for accompanying people with dementia. It is based in particular on the basic attitudes of client-centered conversation according to Carl Rogers and aims to accept (“validate”) the behavior of people with dementia as valid for them. On the other hand, validation is a special form of communication that is characterized by an accepting, non-corrective language that tries to understand and reflect the needs of the person concerned.

The method of validation was first developed by Naomi Feil . Feil, an American social worker, believes that old, disoriented people strive to come to terms with the unfinished business in their lives. The users of the validation according to Feil make it their task to support people in this processing.

Nicole Richard , a German psychogerontologist , developed the validation method further in a nationwide working group and called her method Integrative Validation (IVA). Her approach does not see it as a task to accompany people with dementia in coping with “unfinished business”, but to accept them in their current being and their current state of mind. According to Richard, this has the consequence that the affected people become calmer because they feel understood.

In both approaches, dementia behaviors due to the organic brain changes of those affected are accepted. Validation does not aim to heal, but to provide relief. It is therefore not a form of therapy , the designation as validation therapy is largely uncommon today.

The validation finds its place in the fields of geriatric care , geriatrics , palliative care and geriatric psychiatry . The Gerontology deals inter alia with the research of the effects validating intercourse.

In recent developments, people are increasingly releasing the commitment to one or the other approach, and the method has also found expression in other geriatric psychiatric concepts such as maieutics . There are also parallels to Tom Kitwood's person-centered care .

Even if there is still a lack of effectiveness studies, scientists are increasingly recommending that "validation" be used as a helpful way of dealing with people with dementia and challenging behavior, such as the "framework recommendations for dealing with them developed by a group of experts on behalf of the Federal Ministry of Health with challenging behavior in people with dementia in inpatient care for the elderly ”. Also in more recent specialist books such as B. the Practical Guide to Dementia for Family Doctors, validation or validation is explicitly recommended.

Validation according to Feil

The 10 principles of validation apply:

All people are unique and must be treated as individuals.
All people are valuable, no matter how confused they are.
There is a reason for confused, very old people to behave.
Behavior in very old age is not just a consequence of anatomical changes in the brain, but the result of a combination of physical, social and psychological changes that have taken place over the course of a lifetime.
Very old people cannot be forced to change their behavior. A person only changes their behavior when they want to.
You have to accept very old people without judging them.
Every phase of life has certain tasks. If you do not manage these tasks in the respective phase of life, it can lead to psychological problems.
When short-term memory fades, older adults try to rebalance their lives by referring to previous memories. When your eyesight deteriorates, you see with your “inner eye”. As their hearing deteriorates, they hear sounds from the past.

Painful feelings that are expressed, recognized, and validated by a trusted caregiver weaken. Painful feelings that are ignored and repressed grow stronger.

Empathy / compassion leads to trust, reduces anxiety and restores dignity.

education

The Feil validation training takes place in the facilities authorized by the European Validation Association , a European umbrella organization with the aim of disseminating the method. It comprises four levels that build on each other: user, group leader, teacher and master. Its principles are now part of many geriatric care training courses.

Integrative validation according to Richard (IVA)

The Integrative Validation (IVA) according to Nicole Richard is a methodology for nurses and caregivers for an appreciative form of communication and handling in the outpatient, inpatient and home care of people with dementia .

The methodical approach is to use the resources that are still available in the brain, to work with them and to take the affected patient's feelings and drives seriously. The communication picks up the emotional content of a statement or a behavior of the caregiver and validates, i.e. H. declares the underlying feeling to be valid and recognizes it without evaluating, analyzing or correcting. The nurses use validating sentences to identify the feeling that the person with dementia feels and respond to them with utterances that they understand. The attempt is made to establish trust and closeness in order to defuse concrete conflict situations in everyday care.

The integrative validation was conceived in the 1990s by gerontologist Nicole Richard with the involvement of a five-year federal working group . It differs significantly from the validation according to Naomi Feil and can be viewed as its methodological further development taking into account the German framework conditions.

In terms of content, Richard has broken away from Feils' psychoanalytical and developmental assumptions and developed a more practice-oriented and pragmatic rather than interpretative approach. At the same time, parts of other therapeutic concepts were integrated into the IVA, such as biography work .

The aim of integrative validation is to find access to the world of experience of the disoriented person and to meet their perceptions and the resulting reactions with appreciation and empathy in order to maintain the highest possible quality of life for them.

One of the limits of the methodology is the requirement that language skills must still be available as a medium of communication in disoriented people. In addition, not every person with a restricted orientation responds to this form of validating interaction and reacts in an accessible manner, and in particular the feeling behind a statement or action of the person with dementia must be correctly recognized.

As a methodical concept for working with people with dementia, the IVA is a recognized model in the care community. Many voluntary welfare institutions were inspired by Richard, sent their employees to the workshops or trained in the methodology. The term is legally protected as "The Integrative Validation according to Richard (IVA)". In contrast to Reality Orientation Training (ROT), the IVA stands for the fact that employees (or relatives) fully accept the complex clinical picture of dementia: The people affected are not corrected in their statements and are not guided to “our” reality level.

Further areas of application

Validation as an attitude and manner of behavior is also recommended in artistic therapies , if these are used in the area of work with demented people, e.g. B. in music therapy .

research

Due to its high practical relevance, a general acceptance of the method has also developed in scientific circles, as numerous specialist books and the general recommendations for dealing with challenging behavior in dementia show. Proof of effectiveness according to the criteria of evidence-based medicine could not be provided, but the validation in the studies mentioned was examined as a therapy , which it does not pretend to be. Dementia Care Mapping is a newly developed research instrument that has been adapted to the particularities of the research subject .

literature

Naomi Feil: Validation. A way to understand confused old people. 9th revised and expanded edition. Ernst Reinhardt Verlag, Munich 2010, ISBN 978-3-497-02156-7 , ( Reinhardt's gerontological series 16).
Naomi Feil: Validation in Use and Examples. Dealing with confused old people. 6th updated and expanded edition. Ernst Reinhardt Verlag, Munich 2010, ISBN 978-3-497-02157-4 , ( Reinhardt's gerontological series 17).
Tom Kitwood: Dementia. The person-centered approach to dealing with confused people , Huber, Bern; 2008 ISBN 3456845685

Web links

Individual evidence

↑ ^a ^b Website Integrative Validation. Archived from the original on October 29, 2017 ; accessed on October 29, 2017 .
↑ ^a ^b Research report Framework recommendations for dealing with challenging behavior in people with dementia. (PDF; 1.6 MB) Archived from the original on January 23, 2015 ; Retrieved October 8, 2012 .
↑ ^a ^b Elisabeth Stechl, Catarina Knüvener et al: Praxishandbuch Demenz. Recognize - understand - treat . Mabuse-Verlag, Frankfurt am Main 2012, ISBN 978-3-86321-038-0 . , see u. a. P. 93 ff.
↑ ^a ^b R. Mahlberg, H. Gutzmann (Ed.): Recognize, treat and care for dementia diseases . Deutscher Ärzte-Verlag, Cologne 2009, ISBN 978-3-7691-0563-6 . , see u. a. P. 188
^ European Validation Association. Retrieved October 8, 2012 .
↑ Ingrid Hametner: 100 questions on dealing with people with dementia , Schlütersche 2007, 1st edition, pp. 39–40.
↑ Erich Grond : Pflege Demenzkranker , Schlütersche 2005, 3rd edition, p. 109.
↑ Nicole Neubert: Dementia care mapping: A challenge for management , Grin Verlag 2008, p. 40.
^ Elisabeth Kasten, Carola Utecht, Marcus Waselewski: Redesigning the everyday life of people with dementia. New ways of looking after and caring for residents with geriatric psychiatric behavior problems . Schlütersche, 2005, 1st edition, p. 53.
↑ Jan Sunday: Dementia and atmosphere. Music therapy as aesthetic work: shaping mood and perception in music therapy . Mabuse-Verlag, Frankfurt am Main 2013, ISBN 978-3-86321-153-0 .
↑ Cochrane Review of Validation Therapy. Retrieved October 29, 2017 .
↑ Christine Riesner (Ed.): Dementia Care Mapping (DCM). Evaluation and application in German-speaking countries . Huber-Verlag, Mannheim 2014, ISBN 978-3-45685-344-4 .

[IV-1] Website Integrative Validation. Archived from the original on October 29, 2017 ; accessed on October 29, 2017 .

[bmg-2] Research report Framework recommendations for dealing with challenging behavior in people with dementia. (PDF; 1.6 MB) Archived from the original on January 23, 2015 ; Retrieved October 8, 2012 .

[Elisabeth_Stechl,_Catarina_Knüvener_et_al_2012-3] Elisabeth Stechl, Catarina Knüvener et al: Praxishandbuch Demenz. Recognize - understand - treat . Mabuse-Verlag, Frankfurt am Main 2012, ISBN 978-3-86321-038-0 . , see u. a. P. 93 ff.

[R._Mahlberg,_H._Gutzmann_Hrsg._2009-4] R. Mahlberg, H. Gutzmann (Ed.): Recognize, treat and care for dementia diseases . Deutscher Ärzte-Verlag, Cologne 2009, ISBN 978-3-7691-0563-6 . , see u. a. P. 188

[5] European Validation Association. Retrieved October 8, 2012 .

[6] Ingrid Hametner: 100 questions on dealing with people with dementia , Schlütersche 2007, 1st edition, pp. 39–40.

[7] Erich Grond : Pflege Demenzkranker , Schlütersche 2005, 3rd edition, p. 109.

[8] Nicole Neubert: Dementia care mapping: A challenge for management , Grin Verlag 2008, p. 40.

[9] Elisabeth Kasten, Carola Utecht, Marcus Waselewski: Redesigning the everyday life of people with dementia. New ways of looking after and caring for residents with geriatric psychiatric behavior problems . Schlütersche, 2005, 1st edition, p. 53.

[10] Jan Sunday: Dementia and atmosphere. Music therapy as aesthetic work: shaping mood and perception in music therapy . Mabuse-Verlag, Frankfurt am Main 2013, ISBN 978-3-86321-153-0 .

[11] Cochrane Review of Validation Therapy. Retrieved October 29, 2017 .

[12] Christine Riesner (Ed.): Dementia Care Mapping (DCM). Evaluation and application in German-speaking countries . Huber-Verlag, Mannheim 2014, ISBN 978-3-45685-344-4 .