Academic journal article Generations

Rituals in Nursing Homes

Academic journal article Generations

Rituals in Nursing Homes

Article excerpt

Rituals-from the everyday and the sacred, to those that mark life transitions-can sustain, support, and honor people who live and work in the nursing home setting.

Rituals punctuate life. This truth remains even during the last chapter of life, and even when life is lived within a nursing home. This article explores how rituals can be grouped into three broad categories as they apply to life in a nursing home: everyday rituals, such as having an excellent cup of coffee in the morning; annual rituals that revolve around birthdays, public holidays, and other days deemed sacred; and life-transition rituals related, for example, to being admitted to a nursing home, and to the death of a nursing home resident. Opportunities exist as well for individuals and communities to honor, through ritual, direct-care workers (and their families) who dedicate themselves to nursing home care.

Simple Pleasures Count: The Importance of Everyday Rituals

Everyday rituals reflect our tastes and bring comfort through their routine. They signal continuity and stability of self. Everyday rituals have a way of providing cadence to daily life and can include the time of day a person prefers to wake up, how someone likes to be awakened, and individual practices related to bathing, dressing, and eating.

For many adults in the United States, a good cup of coffee is an essential part of their morning ritual. The importance of this ritual doesn't diminish because someone is admitted to a nursing home; in fact, the case can be made that a good cup of coffee becomes all the more cherished as other aspects of daily life are lost.

The continuation of daily rituals can help a nursing home resident retain a sense of self. When staff and family members help to facilitate these rituals, they honor the dignity of each nursing home resident. In Everyday Ethics, authors Rosalie Kane and Arthur Caplan (1990) share insights gleaned from interviews with nursing home residents. Many dilemmas they disclosed related to dining preferences. Residents said they wanted to decide whether to dine alone in their room or as part of a larger group in the main dining room. If eating in the dining area, residents wanted some say about tablemates. The types and temperature of food and its arrangement on the plate mattered. All of these foregoing factors are key parts of the daily meal ritual.

Finding out what daily rituals are important to residents is an ongoing process that can begin before admission. If a nursing home staff member (usually a nurse or social worker) visits the prospective resident at their home, they can talk about the person's everyday rituals. On the day of admission, amid all the bustle and paperwork, there could be-and should be-some time devoted to again addressing the resident's preferred daily rituals. This line of inquiry sends the message that while the new resident (and their family) will be expected to learn and adjust to group living, the nursing home staff members also expect to adjust to the resident. Asking the resident and family about their rituals, and brainstorming ways to continue these, can bring a modicum of comfort to the admissions process, which most residents and families perceive as a crisis.

Some daily rituals involve simple pleasures that help support the well-being of a person and bolster their sense of life continuity. These seemingly insignificant daily activities can matter greatly to the resident's quality of life. For example, many residents appreciate sitting outside, weather permitting. The feel of the sun's warmth and the brush of a soft breeze can be soothing. Without a family member or volunteer to accompany a resident outside, many nursing homes are too short-staffed to take residents outside even for fifteen minutes. The result is that some residents spend weeks and months inside. For people who have been accustomed to spending a lot of time outdoors-especially farmers, athletes, and smokers-this lack of access to fresh air can be upsetting. …

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