Francesca Oliva, October 2017 firstname.lastname@example.org
Video Interaction Guidance (VIG) is a video feedback intervention that enhances communication and facilitates change in important relationships, at home, school, hospital, care setting, helping professions. It does this by using video clips of ‘better than usual’ interactions in day-to-day situations to actively engage clients in change. Clients are supported by a VIG guider in a shared review to reflect on the better than usual moments in the video clips, in the light of their own hopes and reflecting about what has been done effectively, in order to consciously do more of it (Kennedy, Landor & Todd 2011). The following article will explain how VIG was used in a home for elderly people as an approach to improve wellbeing and relationshipsamong workers and between workers and guests.
In Italy we say that becoming old means becoming a child again ….
During my VIG training, as a VIG trainee, I asked myself if it would be useful and worthwhile to offer VIG to the care givers in the home for elderly where I was working once a month as team supervisor.
I monthly supervise the care givers team of the home, with the aim of promoting effective relationships between each other and with guests and to help deal with conflicts or emotional problems which might arise. At that time I was dissatisfied with the participation and results of the supervision meetingsof my supervision’s meetings. I felt that I needed to give them something more and a new perspective … why not try with VIG?
The home‘s mission is to give a “home” to elderly people who can’t stay in their homes anymore, due to their family situation and/or their physical and mental situation. The home is owned and run by a township and it is very ‘locally based’ (most of the guests come from the town). It hosts up to 34 people who can live independently and partially independently, with 5 places for people who require intensive support.
There are 10 professional care givers, all women, working to provide 24 hour care. They mostly satisfy basic needs: assist with bathing, dressing and grooming; distribute meals; medication reminders; make beds and change linen; assist with walking, monitoring changes in client’s health. Occasionally they also engage in stimulating activities, escort on appointments or little walks, and give relational support.
Precisely because workers have to satisfy basic needs, their job is fundamental and very important, because they are the people who are most in relationships with the guests, and the wellbeing and health of the guest depend a lot on them.
Their work is actually hard, both physically and psychologically: there are many activities to be completed during a shift, many guests to pay attention to and some of them very demanding, and many unexpected events to deal with. The attitude you use to deal with this situation makes a great difference of course: workers instead tended to complain, because of the shortage of time and resources, of the lack of acknowledgment from the board and guest’s families, of the abundance of rules and procedures…
There were conflicts and misunderstandings among each other, and a significant rate of absenteeism and illness among the workers. I saw that their work was even harder because often they didn’t see the true meaning of it; they found it difficult to see the value of themselves, of each other, of what they did for the guests.
They felt forced to follow procedures and to accomplish tasks, and felt that the relational side of their work was underestimated, if not barely considered.
The aim of our meetings had become to go beyond the sense of hopelessness and despair and to help them to see what was working, what made a difference for the guests, the importance of their role and their job.
I thought that VIG could be a good approach to better spot the resources available, in terms of skills that everybody brings in and of significant relationships built up through everyday activities.
The first challenge has been to convince the Home’s Coordinator to use VIG, and to convince caregivers to participate.
I explained to the caregivers during our monthly group meeting the advantagesin using VIG, presenting it as an opportunityto be more aware of their own strengths, characteristics and approaches, and to improve relationships with both guests and colleagues. Participation was voluntary. 5 to 10 applied plus one civil service volunteer.
I met each care giver individually, found with her a helping question and identified a guest/situation to be video recorded.
I went to the Home at every time of the day, depending on the situation they had chosen: from breakfast time to sleeping time! It has been a fun and interesting activity for me, I don’t usually do it and I saw and learned a lot of things about the Home’s everyday life, about the worker’s job in practice and about the guests.
I did the usual VIG cycles, 2 or 3 per person depending on what they decided at the end of each cycle.
I measured the outcomes rating the accomplishment of VIG goals for each cycle, and asking each care giver ‘what did you learn from this activity?’
After 6 months from delivering VIG, I organized a 3 hours workshop with all the participants and their colleagues who didn’t participate. I agreed with participants to use their clips with colleagues, and we worked on Attunement Principles. They showed their clips and we used clips to find Principles in action.
- A space for self-reflection
These kind of workers don’t allow themselves to reflect on their own behaviour and the implications of what they do. There are tasks to be completed, and each shift has a determined amount of duties to be accomplished. It seems that there is no time during the day to think about emotions, relationships, and the possibility to do it is considered a luxury, something you need to ‘steal’ from everyday activities.
VIG was therefore an opportunity to reflect on what happens in the relationships with guests, observing themselves in everyday activities.
It has been possible to see the effect of small gestures during the day(a smile, a handshake, a light touch, an eye contact, a voice pause, a moment of stillness…) which can make a difference for the guests.And having the myth of ‘it takes time that we don’t have to deal with social interactions and feelings’ challenged helps us to discover how to make the time.
‘It’s something I know I do, but seeing it is different’.
- Helping questions and the choice of a situation to be video-recorded
To choose a helping question is always a crucial step in my VIG practice, and once again this was the case.
I helped participants to choose by asking them to think about something they wanted to improve or do differently, or about a relationship with a guest they wanted to explore, or challenge.
The difficulty in finding the helping question is that most of the time we are used to think about weaknesses, what we miss, the mistakes we do in our work: it’s difficult to state a ‘positive’ intention, and my effort is often to help workers to reframe and restate their intention, to find a ‘generative way’ to express themselves and pose the helping question.
Some of the participants chose to work on a relationship with a specific guest, considering a challenging situation, or the specific condition of the guest. Some chose instead a particular moment of their shift and the relationship with the group of guests in a specific activity they were carrying on.
The choice of the situation to be video-recorded has been meaningful to the people: workers who chosen to do VIG with a single guest identified a specific moment, and in fact they dedicated a special moment to the single elder, and the elders appreciated the possibility of having a dedicated space, even if very short. Workers appreciated the possibility of dedicating themselves to a single person for a moment, giving them special attention without being distracted by other activities.
It seems trivial seen from the outside, but for them it has been important to see that is possible to be fully present for a guest even for a short time, without neglecting tasks and duties.
“I’ll try to find 10 minutes every night to stay with her and listen to her stories, I like it”
These are the helping questions chosen by the participants:
|Am||I want to be sure when I am with Mrs A that what I am doing is really what she wants and she needs, and not just what I feel she needs||Tea time at A’s bed, feeding her|
|Ant||1. Is it possible for me to have dialogue and communication with the elders even during the breakfast and the distribution of medicines?
2. What can I do to give attention to each guest when they are together?
|Breakfast time at morning, in the dining room|
|B||How to improve my communication with guests who are unable to use traditional communication channels?||Helping B. to get out of the bed and to have afternoon snack|
|D||1. I am able to keep balance between to urge, to solicit and to make a step back in the cognitive stimulation activities?
2. How can I be close to M when she has difficulties during our stimulation activities?
|Group activities in the living room|
|L||What does help Mrs N to communicate with me, to have a quiet conversation with me?||Having a conversation with N just before night sleep|
- Reading the elder’s mind
We know from Elizabeth Meins (Bernier & Meins 2008) that parent’s ability to ‘tune in’ to the baby’s thoughts and feelings is crucial for a secure attachment. She also said that “Being Mind-minded is about validating other people’s perspectives and can be helpful for everyone including peers, partners, and work colleagues. If you can think about another person’s perspective, then that has the potential to improve how sensitive and sympathetic you are towards people throughout life”.
Could a mind-mindedness ability be helpful with adults as well? What about those guests with few communication skills remaining, or whose communication ability is influenced by dementia, confusion, loss of memory?
Workers in their day-by-day-activities often take for granted the consequences of their behaviour and their actions with the elders, most of the time underestimating it. VIG shared review has been an opportunity for some of the workers to think about, explore and understand what the guest could eventually think or feel related to a specific action and behaviour of the worker.
Simple typical VIG questions like “What do you think he is thinking now?”, “How do you think he is feeling now, after you did that?” helped workers to put themselves in the other’s perspective, and try to give voice and substance to thought and feelings in a non-stereotyped way.
Mind-mindedness in this environment helps workers to better understand both elders’ desire and needs, and that different ways of responding and behaving of the workers can make a great difference in the elder wellbeing and health.
“I see she’s appreciating it, she is smiling. It is a good moment for her. I like to see her smiling”. “I think he feels recognized, and that this simple gesture is very important for him”
What they said:
- I saw that even small things like a smile or a gesture are important in our job
- It’s possible to be effective and to make a difference, we don’t need too much time to do it
- Side effects?
After the use of VIG some things have changed in our usual meetings. I don’t have a ‘measure’ that the changes are related to VIG.
I believe that during our meetings, people tend to listen more, and to be more able to understand each other’s point of view and positions while discussing problem solutions.
It is possible to express disagreements and different opinions more openly and quietly, with fewer fights and confrontations.
It is possible to look for a common solution and problem solving: it is less important to “win” as a single worker, it is more important to find a shared solution and proposal.
The Home’s coordinator and nurse and Township manager asked me to do VIG with them, to improve their communication skills in difficult situations. I did one VIG cycle with each last spring, and I consider this request a further change.
Bernier, A., & Meins, E. (2008). A threshold approach to understanding the origins of attachment disorganization. Developmental Psychology, 44, 969-982.
Kennedy, H., Landor, M. & Todd, L. 2011 Video Interaction Guidance: a relationship-based intervention to promote attunement, empathy and wellbeing. London: Jessica Kingsley Publishers