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Using generative artificial intelligence (GenAI) created images, �鶹��ѡ College of Nursing faculty members Janet Reed, Ph.D., RN, CMSRN, and Tracy Dodson, Ph.D., MSN, RN, are helping older adults in long-term care (LTC) facilities tangibly see their cherished memories once again. Their pilot study, the HARMONEE project (Harnessing Artificial Intelligence Resources for Mental Wellbeing for Older Adults and Nurturing Empathy in Education), hopes to determine the effects of using GenAI on the psychological well-being of older adults as they reminisce on their lives.   

Recognizing many older adults living in LTC facilities are socially isolated, Reed and Dodson set out to introduce an innovative and meaningful activity that would bring these individuals hope and joy.

“Social isolation and demoralization among older adults in LTC facilities pose significant under-addressed public health problems which can lead to increased morbidity, mortality, poor quality of life and reduced psychological well-being,” said Reed. “The goal of HARMONEE is to reduce social isolation and demoralization for older adults in LTC by enhancing psychological well-being through visualizing memories using GenAI-created images.”

Participants in this study consisted of adults aged 65 years and older with at least one chronic disease, living at one of two local LTC facilities. Individuals all spoke English and had no blindness or aphasia. Throughout 30-minute patient interviews, participants were asked several imaginative and reminiscing prompts designed to elicit specific patient memories within three key areas:1) favorite safe childhood places; 2) key moments or achievements in mid-life; and 3) hopeful coping strategies in later life. Data was collected at 0, 30 and 60 days using a demographic form, the Montreal Cognitive Assessment (MoCA); the Herth Hope Index; NIH PROMIS which measures for Anxiety, Meaning & Purpose, and Social Isolation; patient interviews and a user satisfaction survey.

“As patients answered questions, our research team used Midjourney, a GenAI program to create images based on the text prompts. The images were then shown to the patients during the interview. Occasionally images had to be regenerated to more correctly depict a patient’s memories,” said Reed. “Patients received printed color copies of their images in a small photobook consisting of 10-12 images representing their special life moments and were encouraged to share and discuss their photobooks with family members and caregivers.”

Reed and Dodson had many great conversations with the participants and were elated to witness the joy and smiles on their faces upon viewing the special GenAI images.

“These images represent some of their favorite memories. One older gentleman shared about his experience playing college football and we were able to generate an image based on his school’s colors,” said Reed. “We also spoke with a sweet older lady who grew up in the same New York hometown as Lucille Ball. This woman was a big fan of Lucille and was an artist when she younger. We were able to combine two of her favorite things into one image.”

Funding provided by the Healthy Communities Research Institute Launch Pad Award at �鶹��ѡ allowed Reed and Dodson to hire student research assistants at both the undergraduate and graduate levels to aid on this project. It was paramount to Reed and Dodson to have at least two people in the room for the interventions so one could interview the patient while another created the images.

“By involving students in research, we are embedding a desire to ask tough questions and empowering them to find the answers. We are showing students the research process, from discussion to construction, implementation and evaluation - much like the nursing process,” said Dodson. “We are igniting a desire for scholarship and a desire to ask the questions that nobody's asking. Involving students in research at �鶹��ѡcreates �鶹��ѡnursing graduates who continue to ask questions as practicing nurses – questions that may change the landscape of patient care and healthcare at large.”

HARMONEE is bringing awareness to the older adult population and the need to continue to find ways to impact their quality of life through reminiscence therapy. According to Reed, “Initial observations indicate that participants not only enjoyed the activity, but that it also provided cognitive stimulation and memory making as well as socialization with nursing students. It has also given the nursing students positive experiences with older adults in long term care, something they do not usually get during traditional nursing curriculum and clinical experiences.”

Reed and Dodson are seeking additional funding to expand this research to a larger experimental study with a control group. Once more research is completed, they will be disseminating their findings through publications and presentations.

“As nurses, we need more tools in our toolbox to help connect with patients in meaningful ways that are evidence-based and harness available technologies for good,” said Dodson. “We are finding GenAI created images may help to impact cognition through interaction with others when discussing memories through art therapy. We are learning so much from this project and we foresee the development of this novel approach to photo/art therapy to be used not only for social isolation, but also to improve cognition in older adults.”

Reed collaborated with Joel W. Hughes, Ph.D. FAACVPR, Professor & Director of Clinical Training in the Department of Psychological Sciences at �鶹��ѡ, Rebecca Miller, PhD, LPC, ATR-BC, ATCS, program director and assistant professor of art therapy at Ursuline College, as well as �鶹��ѡ College of Nursing Interim Associate Dean of Research Amy Petrinec, Ph.D., RN, in the development of the HARMONEE research design and grant proposal.

This is not the first time Reed and Dodson have studied the effects of GenAI imagery. The duo shares an interest in harnessing technology to improve real life issues in education and healthcare and have previously published an article in Nurse Educator that focused on using GenAI images to create simulation backstories that would provide the context for nursing students on their patient’s pre-hospitalization journey. Additionally, Reed has used GenAI images to represent and start a dialogue on why undergraduate nursing students wanted to become nurses. Upon seeing her students’ positive emotional reactions, she was curious about how this technology could be used within the geriatric population in LTC facilities.