Reality Orientation

RO was developed for reducing confusion in institutionalized individuals. The source of confusion could be any of various conditions (e.g., stroke, dementia, psychiatric disorder). However, little consideration has been given to whether there should be differences in RO according to the reason for confusion. In practice, RO is used most commonly with patients with dementia, but few attempts have been made to explain the way in which dementia might affect the individual’s ability to benefit from RO.

Some have suggested that RO permits the demented individual to build competency (e.g., relearning information), thereby reducing feelings of helplessness engendered by repeatedly failing to accomplish simple tasks because of progressive impairment. However, feelings of competence are contingent on the use of activities that are appropriate to the ability level and needs of the demented individual (Woods, 1979). Targets also must be carefully considered; for example, rote learning of the day, date, and time does no good the following day. These issues have led some professionals to recommend that care providers implement only techniques that will impact quality of life (Woods, 1992). For example, it has been argued that it may be better to teach a general mnemonic strategy such as use of a diary (e.g., Hanley and Lusty), or to implement ward orientation procedures (e.g., Williams et al.) rather than to directly teach orienting information that either is not very important or could be obtained from external sources (Woods, 1992).

In addition, when working with individuals with dementia, staff need to be aware of the effects of their body language, tone of voice, and facial expressions on patients. They also should be sensitive to the patients’ nonverbal communication because as verbal expression becomes more difficult, nonverbal gestures give cues about what individuals are trying to communicate (Woods, 1992).