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What components of reality orientation are necessary to produce desired changes in patient status?
ince its initiation in the 1960s, reality orientation has been advocated as a beneficial intervention for confused or disoriented patients in nursing homes. As designed in the Veterans Administration, the goal of reality orientation is to enhance mental status by 1) having staff constantly orient patients to time, place and person and by 2) constantly exposing patients to repetition of fundamental information in a classroom setting. Numerous therapeutic effects have been attributed to reality orientation including improvements in patients' confidence, sociability, activity level, eating, dressing and grooming habits, as well as enhanced mutual respect between patients and staff.1 Most gerontological nursing texts include reality orientation programs as a major nursing intervention in their discussion of mental confusion. However, the pattern of results from experimental studies indicates only modest, temporary gains from reality orientation programs, not significant long term benefits.
A number of questions about the effectiveness of reality orientation are raised after careful review of the existing literature.
1) Is reality orientation uniformly effective for patients with varying levels of cognitive impairment?
2) Do differences in institutional setting account for discrepant results?
3) What, if any, components of reality orientation are necessary to produce desired changes in patient status? Are some components more essential than others?
Inadequate resolution of these issues has compromised evaluation studies on reality orientation. Until they are resolved a definitive answer to the question of whether reality orientation is an effective treatment for confused patients in nursing homes is not possible.
Description
What is reality orientation and how is it supposed to help nursing home patients maintain or regain an alert mental state? Varying therapeutic techniques may be incorporated under the rubric reality orientation. Generally, the term reality orientation has become primarily associated with two components. One is the 24-hour restructuring of the environment accomplished by having all who come in contact with the confused person consistently remind the individual of time, place and person.2 The second is small group classes offered to reduce social isolation and reiterate basic information such as date, time, weather or names of common objects. In addition to these two components, there was initially a third component, intensified staff involvement with...