Whilst there is no one way to begin to develop life story work,
a good starting point is that life story work is part of ‘normal'
everyday activities, which people enjoy.
However, family
members, carers and staff often find it difficult to know where and how
to begin the process of life story work for individuals who may have
some cognitive impairment arising from illness, disability or injury.
The model illustrated in the following diagram attempts to identify the
relationships between networks and support structures and the
development process for a good quality Life Story.
The central
role is taken by the individual themselves. From that person extend the
relationships, networks and support structures that may already be in
place or are beginning to mobilise. Those relationships that surround
the person are the care and support structures that can make a
potentially significant difference to the person's life when fully
engaged.
In the diagram below, the lines connecting the person
to the support networks demonstrate the different levels or strength of
relationship and vary according to the ability to support the
development of the Life Story.
Carers & Relatives
This is
denoted by a thick solid line which indicates the strongest
relationship in relation to knowing and understanding the person's
needs and hence in developing the person's Life Story. Wherever
possible the individual, with their relatives, family carers and
friends, should begin to develop their Life Story while they can
remember the things that are important to them.
Primary
Care
This includes GPs, Practice Nurses, District Nurses and
Community
Matrons. Life Stories might not begin here but there is a good
likelihood that information can be sought and included. Primary care
can provide health information though this may be more problematic
because of confidentiality where the person does not have capacity to
consent. This confirms the need to begin the Life Story as early as
possible.
Community Links
Where the person
is involved in community activities, they may be
well known at the local leisure centre, community centre, faith group
or library. These may provide good informal support at least initially.
For example, the local church or faith connections will provide an
insight into the activities the person is or has been involved in such
as voluntary work, befriending or hospital visiting. This kind of
information begins to build the picture of the individual.
Third
Sector
Relationships with Third Sector groups such as Age
Concern, MIND and
Alzheimer's Society provide a reasonable source from which to develop
the Life Story. There may be services provided to the person such as
day care, silver surfers internet club or shopping. Voluntary sector
staff may be the first to notice changes in memory or note confusion
but may not feel concerned or confidant enough to pass this information
on. This may be due to the level of awareness and education of staff.
Acute Services
If the individual has a history of
hospital admissions or out
patient treatment, the acute sector may be able to provide information
for the Life Story. Again, the issue of confidentiality and the
capacity to consent will arise. The Acute Sector is one of the main
environments where Life Story work would be of benefit. For example, a
person admitted with dementia may have difficulty communicating their
needs and wishes. Busy hospital staff could use the Life Story to
understand better the needs and preferences of the patient and treat
them accordingly. Many acute NHS trusts have embraced the Dignity in
Care agenda and Life Story work fits well into that framework.
Care
Home Sector
Staff working in residential care can support
the individual
and family carers in producing the Life Story, through their knowledge
of the resident's likes and dislikes and their community networks.
However, the care home sector often requires support to understand the
value of Life Story work. There are some excellent examples of homes
where varying forms of Life Stories have been used, but the culture of
care may still remain that of "one size fits" all with insufficient
attention to individual needs and preferences.