Sustaining mom's expression of her identity using the well-being picture scale.
Article Type: Travel narrative
Subject: College teachers (Psychological aspects)
Family (Psychological aspects)
Author: Gajkowski, Laurine
Pub Date: 01/01/2009
Publication: Name: Visions: The Journal of Rogerian Nursing Science Publisher: Society of Rogerian Scholars Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2009 Society of Rogerian Scholars ISSN: 1072-4532
Issue: Date: Jan, 2009
Accession Number: 242963616
Full Text: INTRODUCTION:

This short article represents the author's view of the utility of the Well-being Picture Scale (WPS) for an older adult. Background information will be provided on one family's unique experience, and then application of the scale's use will be delineated

Key Words: Well-being Picture Scale, Science of Unitary Human Beings

I had the very good fortune of meeting Dr. Sarah Gueldner in the fall of 2006. I was compelled to stop by and introduce myself to this new CWRU visiting professor whose office displayed a poster of Martha Rogers wearing a silly cap. In Sarah's office also hung a sign announcing, "Old People Are Cool." I discovered a treasure in Dr. Sarah Gueldner. She is a marvelous storyteller, a compassionate listener, and a humble genius. At the time of our first meeting I shared my concerns about caring for my mother. Mom had recently moved in with my youngest brother's family near my home. There were nine of us and 30 grandchildren. At the age of 89, Mom had decided that she could no longer safely live alone in our family's childhood home because of fading vision, poor balance, and difficulty "figuring things out." Sarah gave me a copy of her Well-being Picture Scale (Gueldner, et al, 2005) and suggested that I use it with my mother. I would like to share my experience of rediscovering my mother's identity through the use of Dr. Gueldner picture scale. First, I'd like to give you some background on my mother and her appreciative family.

My parents were "empty nesters" for over 20 years (although their nine children and many grandchildren visited the "nest" often). During that time my parents lived very independently together. Each one's strengths made up for the other one's weaknesses. Following my father's diagnosis of terminal cancer, my four brothers, four sisters and I had held family meetings every few months. We put home services into place as they became necessary such as house cleaning and "Meals on Wheels." Each of the seven in-town siblings chose a day of the week to cover for Mom and Dad's needs such as driving to appointments, stopping in with dinner, or cutting the grass. The grandchildren developed a love for helping out with little chores like shoveling a path to the mailbox in the winter. Each member of the family made small sacrifices to accomplish our goals of (1) respecting our parents' wishes, (2) assuring their well-being and safety, and (3) maintaining a close-knit, happy family according to the example that Mom and Dad had shown us. A delicate yet wonderfully strong balance evolved.

Shortly before his death, Dad gave each of his children "final orders;" one of them was delivered to my youngest brother, Chris, just an hour before his last breath. Chris softly whispered to our semiconscious father, "Don't worry about Mom; we'll take good care of her for you." Dad opened one eye and looked directly at Chris and replied, "You'd better!" His mandate was clear and unforgettable. Dad's death changed the alignment dramatically but balance was restored over the next couple of years.

Mom had made it very clear that she wanted to stay in her house as long as possible. She graciously accepted her family's help. Her short term memory was slipping away and her judgment was sometimes impaired. One late summer day about five years after my father's death, Mom decided that the comfortable and familiar house was no longer suited for her. Her final struggle seemed trivial; however, it was the last thing she wanted to overcome by herself. She had tried to plug her coffee maker into the socket for 3 hours but for some reason she wasn't able to get her morning coffee brewed. She called me in utter frustration. Her words on the phone were clear and directive. "I need to get out of this house as soon as possible." We helped her with change of address notes to all her old friends including her "lunch bunch" (college girlfriends), church choir, Seniors Against Crime, Bible study, and the St. Paul's Women's Guild. Her last phone call on Algonquin Road was from our pastor. She declined to speak directly to him because she was "afraid that she couldn't follow the conversation." "Some parts of my mind are a big blank." She was aware of the dementia. One of us stayed with her the last few nights in her home of 54 years.

Aside from the day that Dad died, that October day when my oldest sister, Mary Lou, and I drove Mom from Algonquin Road to Chris ' s house was the saddest day of my life. We still had each other but the loss we were experiencing was so profound. The three of us waited at my house until we got the okay that Mom's bedroom furniture and belongings had been set up for her. Mom looked puzzled as Mary Lou and I unsuccessfully tried to hold back our tears. We prayed with her because she seemed proud that she still remembered all the words to a long litany of comforting prayers.

Mom taught me many, many prayers that next year. She prayed for each of her 9 children and their spouses and her grandchildren. Eventually the names faded from her memory but never the prayer verses. She recited them each night before we put her to bed. She usually fell asleep when Chris would read the prayer to St. Joseph and St. Patrick. Another source of comfort and familiarity for Mom was sitting among her family members. She smiled contently while the conversations sailed around her. When asked if she needed anything she often replied, "I just like to be with my family."

Mom had occasional lucid moments, which were remarkable. These were the pearls that we savored and shared by phone or email with our siblings. For example, one afternoon I was discussing a vacation. I asked Mom if she wished that she and Dad had traveled more when they were younger. She responded quickly, "Are you asking me if I have any regrets? Why would I have any regrets? I always did the best I could." She was an optimist. One spring afternoon I was commenting on a gorgeous flowering azalea shrub beside us. I pointed off to the scenic view beyond her wheelchair. Then I asked her what she thought was the most beautiful. Her response was, "The most beautiful thing is a mother holding her baby." Her role as mother still defined her being and who she was.

Another important aspect of my mother's identity was her formal education. She had attended college on an academic scholarship. She graduated from Notre Dame College (South Euclid, OH) in 1938 at age 20. She proudly reminded me that their motto at the time was "When you educate a woman, you educate a family." She hoped for each of her children to be well-educated. She remained as involved as possible with her children's and grandchildren's learning. At age 90 she enjoyed helping Leland with her eighth grade vocabulary homework.

I felt a bit helpless as I witnessed my mother's energy level decline. I couldn't judge if she was miserable or not with her current situation. One warm Thursday evening in May, I visited with Mom in her bedroom at Chris's house. She had spent the day at an adult day care facility. She commented to me shaking her head, "All the folks there are way out of it." I inquired how she was doing with all these changes. Her reply was the same as usual, a hesitant smile followed by, "I'm fine for an 89-year-old woman." This brings me back to Sarah Gueldner's Well-being Picture Scale. I asked Mom if she'd like to use a picture scale to help me understand how she felt. I explained that a visiting professor at Case Western Reserve University had developed it and had requested some feedback on it. Mom perked up and said "I 'd love to help with anything I can, especially something for school." She fussed with her reading machine that magnified the pictures to six times. She looked more energized than I had seen in weeks. She was able to feel useful again. Below are her responses to the WPS.

Application of the Well-being Picture Scale:

1. Eyes

She chose the box nearest to the wide-open eyes. I was surprised considering her impaired vision from macular degeneration. She said, "I prefer to watch people with their eyes open." "With my eyesight I need to keep watching what's around me and where I am all the time." "I don't care for the people [at the adult day care] who just close their eyes."

2. Shoes

Mom looked back and forth several times at the two options shoes. She remarked, "Oh, from one end of the spectrum to the other." Then much to my amazement she decided "Put me down for the play shoes."

3. Butterfly vs. turtle

She instructed me to mark the center square between the two pictures. She said, "I like the butterfly. It's a cheerful subject."

4. Candles

Pointing to the left she said, "This one is all used up." She chose the middle square. About the lit candle she smiled and commented, "I like to feel like that. I wish I felt that way especially at this time of day."

5. Faucet

She chuckled about the dripping faucet image. She said, "Well, I feel a little depressed about the way my body is now. What's the word they use now? I guess I 'm disabled or something." "I should have done something about this before." She may have been referring to her bladder surgery which was not fully successful.

6. Puzzle pieces

This item of disjointed pieces seemed to confuse her. She asked, "Is that piece supposed to be a boy or something?" "I can't put this one together. I should know what this is." I reassured her that it wasn't a test. Then she pointed to the separate pieces and hesitantly concluded, "This one is more likely." In looking at the disjointed puzzle, there does seem to be an image of a person. She struggled to make sense of this item, which may have been a manifestation of her dementia.

7. Pencils

She smiled because she understood what the pictures were. "I can tell that this one is sharp. That one has less lead left in it. I like that sharp one; it's distinguishable."

8. Sun

She focused on the shining sun image. She asked me why there were clouds in one of the pictures. I encouraged her to give her own explanation. She had difficulty with this concept but then said, "Pick this [pointing to the left cloudy sky.] I like the clouds because the sun is coming out from the top of them." Her response may have been a reflection of the mixture of clouds and sunshine in her life at that point.

9. Balloons

Her choice for this item was vague. She had difficulty focusing on the task so I didn't pressure her. She pointed to the fully-blown balloons focusing on the one that was separate from the group and said, "I don't like those fully-blown balloons." This brought to mind her comment early in her dementia when she told me, "If I get mean, remember that is not me." She wanted to be amiable and remain close to others, especially her family. She did not want to be excluded from the family group.

10. Lion vs. mouse

Mom put her hand over the mouse as if she didn't want to even consider this choice. She smiled at the lion. I asked her to talk about what she liked about the lion. Knowing that she had often been a leader in her clubs and a mother of nine children I wanted to know how she reconciled that with her current dependent role. She pointed to the middle box. "That lion is way out of it as far as how I feel now. You can't expect too much for an 89-year-old."

I was amazed with her responses and exuberant that she could express herself so well. We hugged and held each other. She knew I was happy. I knew that she was doing well. I told her that I thought I understood her better and that she was the same great person she had always been. When I attempted to explain the concept of preserving identity she added, "My family does that for me."

That evening I called my brothers and sisters with the good news. I told them there was no need to worry about Mom because she was still her same wonderful self. I now appreciate the wisdom of Martha Roger's concept of the "irreducible human being." This human being was more than a collection of her characteristics but an individual with her own unique identity which never failed. Her spirit/energy field was transmitted on through her children and others who had the joy of living along side her. My mother died in May 2008 at the age of 90 while living in a nursing home. Recalling the evening that I administered the Well-being Picture Scale with my mother is a precious memory for me. Incidentally, there was a butterfly hovering over Dad's gravestone during Mom's graveside service. We were comforted by this symbol which Mom had identified on the WPS as a "cheerful subject."

In conclusion, this article demonstrates the utility of the Well-Being Picture Scale, and conveys meaning that one older adult was able to share. It also conveys how a provider could help in sustaining the expression of one's identity throughout the lifespan and begs further research on the clinical utility of the Well-Being Picture Scale

REFERENCES

Gueldner,S.H., Michele, Y., Bramlett, M.H., Liu,C.F., Johnston,L.W., Endo,E., Minegishi,H., Carlyle, M.S. (January 2005). The Well-being Picture Scale: A Revision of the Index of Field Energy, Nursing Science Quarterly, 18(1), 42-50.

Gueldner,S.H. (December 2007). Sustaining Expression of Identity in Older Adults, Journal of Gerontological Nursing, 33(12), 3-4

Gajkowski, L. (2008, October). Sustaining Mom's expression of her identity using the Well-being Picture Scale. In S. H. Gueldner, Establishing the psychometric properties of the Well-being Picture Scale (WPS) in an African population. Presentation at the 20th Anniversary Conference of the Society of Rogerian Scholars, Cleveland, OH.

BY LAURINE GAJKOWSKI RN, ND Frances Payne Bolton School of Nursing Case Western Reserve University
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