Reality Orientation

The primary goal of RO is to reduce confusion. In its initial conceptualization RO was believed to accomplish this goal through three components. The first component was staff maintenance of a specific attitude toward the patient, usually one of ‘‘active’’ or ‘‘passive’’ friendliness (Folsom, 1968). This component has been referred to as attitude therapy. The second component involved staff’s (a) presentation of basic orienting information during interactions with confused patients (e.g., reminding patients of who and where they are) and (b) involvement of patients in their environment, by commenting on what was happening in the environment at that time and by reinforcing individuals’ awareness of and interest in their environment. The third component entailed the use of basic and advanced classes in orientation as an adjunct to the second component. The use of props or environmental cues was encouraged, including signs, clocks, calendars, reality orientation boards (information about location, date, day, weather, holidays, etc.), newspapers, television, pictures, and personal belongings. Classes were small groups with an optimal size of three to six individuals meeting with one or two staff members (Woods, 1992). The second and third components make up, respectively, what is now known as twenty-four-hour reality orientation and classroom reality orientation.

Since RO’s conception, therapeutic goals have been elaborated, techniques have been more clearly defined (e.g., Drummond et al.) and manuals have been developed (e.g., Holden and Woods). Certain aspects of the philosophy have proliferated—for example, calendars and other orienting materials can be found in almost all long-term care facilities. The evolution of RO programs also has resulted, often, in the use of classroom RO without twenty-four-hour RO, despite the assertion by Folsom and colleagues that classroom RO will not be effective on its own. This modification deemphasizes the focus on social interaction with others in the environment that, increasingly, appears to be the most beneficial aspect of RO.