[ktwlpn]

Originally Posted by Jesskanurse

Well, first off, taking care of a patient with dementia IS taking care of a patient with a psych issue. Psych can be found everywhere, not just in behavioral health facilities.

What should we do as Nurses? We need to allow the patient as much ability to function independently of staff as possible to be considered therapeutic. If you have a patient that is constantly asking you the same question and you continue to feed into their delusion, you are not assisting them in being more functionally independent. You in fact are allowing them to depend on you, because they may not remember asking the question already, but they will remember that you have helped them in the past.

Dementia cannot be treated as a blanket disruption in memory. It depends on the cause- to in every case pacify the patient and not attempt to reorient is not being attuned to the fact that not all patients with dementia have it because of the same cause. Also, dementia affects different parts of the brain depending on the cause. To blanket pacify is laziness because it's not keeping in mind any of these factors.

If therapeutic communication did not work, I highly doubt we would be taught it in Nursing school.

No-methods for caring with dementia pts. are very different from dealing with psych pts. I believe some of us have pointed out that the approach depends on the pt and their response to it....Alzheimer's currently is recognized as having 7 stages.Aslo what works today may not work tomorrow...However if you follow the basic rules for communicating with these pts. you'll see that re-orienting them can't work.They loose the meaning of language.The more you talk the more agitated they usually become.That's where validation comes in-therapeutic touch,environmental control.Short simple sentences. I really think that if you refer to some of the links you'll understand how your aopproach is wrong.....

[ragingmomster]

Just a quickie...

I spent 18 months working in a locked unit with 22 SDAT patients. One lady thought I was her sister.

Not good considering her sister had stolen her beau back in the 30's.

The worst was the day that she picked up a heavy metal pill crusher and had it behind me. She was mid backswing with the crusher over her head and behind her back with two hands on the handle about to come down on the back of my head. No one was close enough to stop her from trying to kill me.

The pill crusher proved too heavy for her and it slid out of her hands and landed on the floor behind her.

About a week later, after consults with staff and md, we decided to try an apology. I sat down with the pt during a calm period, before she started her sundowning and I gave her a heartfelt apology for taking her boyfriend. It lasted about 2 days. Then I did it again.

[cotjockey]

Originally Posted by Jesskanurse

Well, first off, taking care of a patient with dementia IS taking care of a patient with a psych issue. Psych can be found everywhere, not just in behavioral health facilities.

What should we do as Nurses? We need to allow the patient as much ability to function independently of staff as possible to be considered therapeutic. If you have a patient that is constantly asking you the same question and you continue to feed into their delusion, you are not assisting them in being more functionally independent. You in fact are allowing them to depend on you, because they may not remember asking the question already, but they will remember that you have helped them in the past.

Dementia cannot be treated as a blanket disruption in memory. It depends on the cause- to in every case pacify the patient and not attempt to reorient is not being attuned to the fact that not all patients with dementia have it because of the same cause. Also, dementia affects different parts of the brain depending on the cause. To blanket pacify is laziness because it's not keeping in mind any of these factors.

If therapeutic communication did not work, I highly doubt we would be taught it in Nursing school.

Therapeutic communication is one of the latest and greatest theories in dealing with dementia patients...it doesn't mean it works...often it does, but often it does not. If letting a resident believe that I am "Margaret" or having them sign checks or telling them the cows have been milked keeps them from getting agitated and possibly injuring themselves or someone else, I don't think it is a bad thing. Sure you should try to do the "right" thing first, but the "right" thing isn't always the best thing. I'm certainly not saying we should run around all willy-nilly lying to our residents and letting them believe whatever they want to believe just to make it easy for us, but you often have to simply do what works.

Our town has a home for children with special needs...one of their residents gets pneumonia very frequently and needs to be transported by ambulance. Our protocols indicate that we should administer O2 because of his respiratory distress, but every time we do, he gets EXTREMELY agitated and his SpO2 drops further than it does if we forgo the O2...it is better to try and force the O2 simply because it is the "right" thing to do? I don't think so. Therapeutic communication, validation therapy, reality orientation, etc should be tried first, but sometimes you just have to go with the flow and do what is works to keep your resident safe, calm, and medication free...I hate having to sedate someone because a staff member told them their mother, father, and brothers and sisters are all dead. Sometimes you can't do anything about the cause...all you can do is treat the symptoms.

[CapeCodMermaid]

[quote=Jesskanurse]"Therapeutic lying" is absolutely inappropriate. It is unethical and in my opinion, it implies pure laziness on the Nurse's part. Telling the patient what you think 'they want to hear' does nothing for them therapeutically.
It's sad that so many Nurses just take the easy way out by 'pacifying' these people.

"Think of a time you've been lied to. Say your 12year old son said he would be at his friend's house but in reality he went to park to skate with a bunch of kids you don't know. You most likely would be upset that your son lied. If you had dementia, however, you may never remember your son saying where he'd be. He gets home and says, "I had a great time at the park." Whether or not you remember does not change the fact that he lied. It is no different when speaking to a client (patient). They may not remember their daughter isn't coming to get them, but it doesn't change that you lied to them."
* * * * * * * * * * * * * * * * * * * * *
You are wrong. It is not unethical to go along with an alzheimer's patient. To continually try to reorient them will only upset them and frustrate the staff. There is, and one would think it goes without saying, a huge difference between a kid telling his mom a lie to get away with some bad behavior, and a caregiver going along with a dementia resident. I suggest you read some of the aforementioned books on dementia. You can not improve the short term memory of a dementia patient.

[lovingtheunloved]

yeah, sorry

[lovingtheunloved]

Originally Posted by santhony44

I was telling "Mrs. Claus"
yet one more time where she was, what day it was, and so forth. She was smiling at me and patting me gently on the arm. She was humoring me!! I could almost read the thoughts in her head: "Poor dear, she's so confused! She thinks this is a hospital and she's a nurse..."

That is THE funniest thing I have ever heard!

[lovablelvn]

You are wrong. It is not unethical to go along with an alzheimer's patient. To continually try to reorient them will only upset them and frustrate the staff. There is, and one would think it goes without saying, a huge difference between a kid telling his mom a lie to get away with some bad behavior, and a caregiver going along with a dementia resident. I suggest you read some of the aforementioned books on dementia. You can not improve the short term memory of a dementia patient.

I couldn't agree more, well said.

[michelle126]

Not trying to flame or start a mean discusion, but I'm very curious to your background and experince with the alz dementia patients? Have you spent time in a nursing home or in a community setting?
Dealing with a confused or pt with short term delerium is very different. A previous poster mentioned that there are different forms of dementia...SDAT, vascular...etc Yes these all need to be considered.

Please enlighten us on your experiences (not school instruction). Maybe the rest of us are missing something.
Again...not trying to flame, but I'm always willing to learn something new.

[Jesskanurse]

Originally Posted by ragingmomster

Jess, while the word orientate does bother me as does using the word "arouse" when "rouse" is preferable, please keep in mind that maybe you don't know it all...

from merriam webster dictionary online -
Main Entry: ori·en·tate
Pronunciation: 'or-E-&n-"tAt, -"en-
Function: verb
Inflected Form(s): -tat·ed; -tat·ing
intransitive verb : to face or turn to the east
transitive verb : ORIENT

Please take a step back from your opinion and listen to what many of these nurses are saying. I am also glad that you had a great psychology professor when you were in school. Perhaps you have forgotten that Alzheimer's is not a psychological condition but rather an organic brain disorder which involves neuron deterioration?

I will refrain from making any sarcastic comments here to respect your post. It was a good effort, but when you are going to quote a dictionary, remember to read the definition first. Orientate IS a word, yes, but it means 'to face or turn to the east.' The way the OP used it was 'orientated' to a situation, and that is incorrect. Orient refers to 'the orient' which historically was used to refer to the east, as in eastern asian countries. Again, I mean no disrespect by reminding you of this.

Anyways... lets try to get back to the main topic shall we?

[lovingtheunloved]

Tell my 88 year old resident who constantly looks for her mother that her mother died in 1964. Then watch her grieve all over again. Watch her cry hysterically and refuse to eat and say she wants to kill herself. Hey, why not "reorient" her on a daily basis, as she forgets the conversation every day. THAT is unethical.

(and someone at work got the bright idea to do this for four days before she figured out maybe that wasn't the greatest idea.)