Reality orientation: its use and effectiveness within older person mental health care.

AIM: The aim of this study was to find out how psychiatric nurses use reality orientation and perceive its effectiveness in older person mental health care.

BACKGROUND: The study described in this article relates to how effective reality orientation is and how it is used, within older person mental health care. As a technique, reality orientation originated in North America in the 1950s. It has been defined as an approach which may decrease confusion and dysfunctional behaviour patterns in people with dementia. Although there exists some confusion as to how reality orientation should be delivered, it is generally agreed that reality orientation may be delivered in two ways. Firstly, through constantly orientating patients to time, place and person (24-hour reality orientation) and, secondly, orientating patients to reality within a group setting.

METHODS: Six psychiatric nurses practicing in an older person mental health care inpatient unit took part in in-depth semi-structured interviews. These six nurses all practiced upon the same older person care unit, which was part of a larger psychiatric hospital randomly selected from psychiatric hospitals in Dublin, Ireland, to take part in the study. The six nurses were also part of a larger cohort of nurses who helped the author explore how psychiatric nurses use and perceive reality orientation as used in older person and acute inpatient mental health care. This was a descriptive qualitative study, using the technique of constant comparative analysis as outlined by Strauss and Corbin as a way to code interview data and arrange themes that represented what participants had talked about in the interviews. More particularly, this form of analysis closely resembled the type of open coding as outlined by Strauss and Corbin. The analysis of interview data was presented to interview participants prior to the formal acceptance of these themes as a valid representation of what interviewees talked about.

FINDINGS: Upon analysis, interview data yielded five themes. Firstly, reality orientation means interacting with patients about the patient's current environment and issues in their predicament. Secondly, the sampled nurses use reality orientation frequently in their nursing work, with reality orientation being most often used in the mornings and evenings. Thirdly, reality orientation is implemented through interacting with the patient. It may also be implemented as part of other approaches, such as occupational therapy. Fourthly, improvements in the areas of orientation and behaviour functioning may be possible through the use of reality orientation, although more contemporary research is required to validate this. Finally, participants talked of the need for psychiatric nurses practicing in older person settings to become more aware of what reality orientation entails as an approach, such awareness may be increased through more reality orientation-based research.

CONCLUSIONS: Interview data point to reality orientation being used frequently through nurse-patient interaction. Participants talked about how using reality orientation may hold benefits for patients; however, on a more cautionary note, participants also raised the need for a greater clinical awareness of reality orientation as an approach for use in caring for older persons with mental health problems.

RELEVANCE TO CLINICAL PRACTICE: Psychiatric nurses practicing in older person care environments often have to provide care to persons having difficulty comprehending reality. For example, a person who is confused through suffering from an organic brain disorder such as Alzheimer's disease, or who is expressing a delusion through suffering from a functional mental illness such as depression. Taking this into consideration, there is an onus on psychiatric nurses to be able to care for older persons having difficulties comprehending the reality they are living in. Participants in this study identified reality orientation as an approach which can be used by psychiatric nurses in attempting to help older persons experiencing mental health problems cope with not being able to comprehend and recognize their surroundings. Participants also suggested that reality orientation may hold some benefits for older disorientated person, such as facilitating a greater level of orientation. On a more cautionary note, participants talked of the need for psychiatric nurses caring for older persons with mental health problems to become more aware of the use of reality orientation in clinical practice.