Nursing Times Award Winner

A safer place

The lady in the bay was very agitated. In the corridor outside, a man was pacing up and down looking distraught. He was the lady's fifty year old son and from the storm of abuse she was giving everyone, it was clear that he, along with the nursing staff and anyone else who went too close, were not welcome anywhere near her at that moment. He looked broken.

"I'm so sorry," he apologised, "but if I say anything to her, it only makes it worse. She's upsetting everyone. It's so distressing."

That afternoon we were on a ward, specialising in the care of older people, to read familiar stories or poetry to trigger long-term memories, especially for patients who had dementia. Everyone over the age of sixty was taught classic poems by heart at school. Hearing them again not only helps them remember, it can also triggers memories of the time and place where they learned them. Memories of childhood, schooldays and a happier time often come flooding back. The reassurance they gain from hearing the familiar words can calm them down and makes them smile.

Swearing at anyone who came near her, and endlessly pacing up and down, this lady was having a profoundly negative effect on other patients, visitors and the ward staff. Some visitors were complaining. The nurses were doing their best, but her distressing cries were both upsetting and hugely distracting.

Gently, I explained to the man what we were doing that afternoon. Aware that turning up beside her with a poetry book might be the last thing she wanted, I simply asked if the man knew of any poems or stories that his mother had enjoyed in the past. He looked at the books I was carrying and smiled when he saw our collection of Winnie the Pooh stories and poems. "She used to read that to me," he said simply. "It was a favourite for both of us."

"Do you want us to give it a try?" I asked. 'I think we might have a way of getting through to her."

"Why not?" was his simple response.

The group with me that day were all members of First Act Workshop , a dynamic drama group of talented schoolchildren from the Midlands. Feisty, and with brilliant voices, their leader Ross, had been delighted to suggest that some of them become part of our team. Amongst them was Harry, sixteen years old, with style and confidence well beyond his years.

I had an idea. I had a quick word with the senior nurse, and then beckoned Harry over. Indicating the lady, I asked if he would be happy to go into the bay with the book in his hand, clearly visible. "I've checked and she's not going to hurt you," I explained. "She is just very unhappy and frightened. Think of her as a young child having a temper tantrum. Children do that when they are frightened and feel out of control. Don't talk to her and don't go 'into her space' " I advised. `"Just be close enough for her to see the book. Only talk to her if she shows any interest. I think it's important that she feels in control."

So he did. Standing by the window she watched him as he walked across the room, not making eye contact at that stage. Staring first at him, and then his large book, she suddenly stopped shouting. He looked at her and smiled. And she smiled back. He offered her the book but she didn't take it. We watched from outside the bay as she slowly moved closer.

After a few moments we saw them both move back to her bedside. She sat down and Harry pulled up a chair. Gently he began to read. She looked mesmerised.

Beside me, her son whispered "That's my mum looking the way I want to remember her. I didn't think I'd see her look like that again. All it took was a simple story."

But I think there was more to it than that. Harry was very good looking. What I was seeing, I believe, was a lady with dementia who, having lost her short term memory, believed she was much younger. But, although her memory for facts was profoundly damaged ( she may not have recognised her son as a fifty year old man), her emotions were still strong. As I watched her eyes, and her body language, I could see someone who was gently flirting with the young man opposite her. I think she was also loving the familiar words and, read by Harry, they had a much deeper value. Harry was completely unaware of her thoughts, but I am convinced that is what was happening. How many women, read to by a handsome young man with a stunning voice, would not respond in a similar way?

The lady's son was clearly very moved. The atmosphere was now calm. The agitated lady was now sitting quietly, no longer in danger of falling over in her distressed state. In other areas of the bay, visitors looked on and smiled, now free to concentrate on lifting the spirits of the patients they had come to visit. And that, of course, is hugely helpful to the nursing staff too who, feeling less distracted, now felt more able to concentrate on other things.

Winnie the Pooh and a charming young man had made Bay 2 on that ward a calmer, safer place to be.

Across the country, every day, through Kissing it Better, whether through poetry, music, simple beauty therapy, hundreds of students are having a similar effect on patients. It is beautiful and touching to see an agitated patient sit quietly and enjoy a hand massage of manicure, or to see someone become instantly calm when a familiar song is sung to them. When two or our wonderful students sang 'Greensleeves' to a highly distressed lady in a care home who had been shouting and banging the table, the effect was instant. On that day, we had been joined by the former Poet Laureate, Sir Andrew Motion. Her cries were a huge distraction to our session and were upsetting other residents. But we knew instantly how to calm her down. We knew her favourite songs.

So, none of my regular team thought too much about singing her the song. The moment she heard it, she calmed down and simply whispered 'That was very nice'. In a instant, residents, visitors and staff felt more relaxed, those caring for the lady suddenly free to do other things - the music not only affecting the lady, but also lifting the spirits of everyone. In that atmosphere staff feels more energised, appreciated and so more ready to go 'the extra mile'.

Just as a mother knows that singing a gentle lullaby to a distressed baby can instantly calm them, we get to know the songs that can have a similar effect on the ladies and gentlemen we see regularly. Done with the utmost dignity and respect, it is important that we only sing songs that have some meaning to the people who are listening.

But, to a visitor like Sir Andrew, the effect we had on that lady that day, touched him so much that, over a year later, during an interview on BBC Radio 4, he recalled the moment by saying.

'I don't think there have many things in my life that have been more moving and more immediate than the sight of this poor distressed person hearing this piece of music, which I think was 'Greensleeves', and immediately calming down', and then say "That was very nice"

For us, it is simply what we do.

Kissing it Better - simple ideas that make the world of difference

Sir Andrew Motion, You and Yours BBC Radio 4 (33 seconds from start)

The story of our work with poetry that went around the world in four languages

Jill Fraser

Jill Fraser

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