dealing with confused patients

  1. 1 I work at a nursing home and last night there was a resident who was convinced the building was on fire and needed to get out. I was trying to calm him down, telling him there was no fire. Then the nurse came in and was telling him she was calling the fire department and he needed to stay in his room for now. This surprised me a little bit, and I thought about how I am in my third year of nursing school, and I never learned how to deal with situations like this. Do you tell them they are confused?? or go along with it?? I almost feel like if they are so sure of something, its almost offensive to them to say they are wrong, but I don't really know what the best way to handle it is!
  2. Visit  sprintin08 profile page

    About sprintin08

    Joined Jun '09; Posts: 26; Likes: 14.

    29 Comments so far...

  3. Visit  sunnycalifRN profile page
    4
    It depends on the cause of the "confusion". If it's "garden-variety" sundown'ing, then I would usually try to re-orient the patient. However, if it's Alzheimer's or schizophrenia, then the RN's approach sounds reasonable. Then, I'd go check the MAR . . .
    mskate, Sparrowhawk, Davey Do, and 1 other like this.
  4. Visit  Forever Sunshine profile page
    4
    Most of the time we "play along". If we try to re-orient some of the dementia patients they go up the wall crazy or it would just be useless because their mind is so far gone.
    mskate, Up2nogood RN, JB2007, and 1 other like this.
  5. Visit  Davey Do profile page
    6
    Yeah, well, this is a very gray area. And I'm not 100% sure it's THE appropriate approach. But I have fed into a confused patient's delusion in order to calm them down.

    I think the first time I did this was in my first job in a LTC Facility. A woman in her 80's was concerned about her parents. I was relatively sure they were no longer living. So, I said, "Your parents are taken care of." It calmed her down.

    As time past, and when other confused Patients brought unfounded concerns to me, I would often give the pat answer of: "Everything's taken care of." Like most of us, confused Patients just want to be sure they, and their loved ones, are safe.

    I've even applied a name to this technique. It's called "Poetic License". Manipulating one's media in order to achieve a desired affect.

    I think this is a case where the method is justified by the end result.

    Dave
  6. Visit  JB2007 profile page
    8
    Do not argue with a demented resident or patient. In their mind they are right and you will not change their mind no matter what. In fact, you will probably cause them to become more agitated the more you try to reorientate them. Your best bet is to play along with them so that they are more agreeable to do the things that you need them to do to keep them safe.
    mskate, DizzyLizzyNurse, 86toronado, and 5 others like this.
  7. Visit  JB2007 profile page
    3
    Quote from Davey Do
    Yeah, well, this is a very gray area. And I'm not 100% sure it's THE appropriate approach. But I have fed into a confused patient's delusion in order to calm them down.

    I think the first time I did this was in my first job in a LTC Facility. A woman in her 80's was concerned about her parents. I was relatively sure they were no longer living. So, I said, "Your parents are taken care of." It calmed her down.

    As time past, and when other confused Patients brought unfounded concerns to me, I would often give the pat answer of: "Everything's taken care of." Like most of us, confused Patients just want to be sure they, and their loved ones, are safe.

    I've even applied a name to this technique. It's called "Poetic License". Manipulating one's media in order to achieve a desired affect.

    I think this is a case where the method is justified by the end result.

    Dave
    I call them therapeutic lies. I even had a resident's family tell me I was going to hell one day because I told a resident so many lies.
    michelle126, tyvin, and Davey Do like this.
  8. Visit  Nascar nurse profile page
    12
    Quote from JB2007
    I call them therapeutic lies. I even had a resident's family tell me I was going to hell one day because I told a resident so many lies.

    I got "beat up" and flamed several years back for using the term therapeutic lies.

    OP, you will probably get many different opinions on this topic and it can get pretty heated. After 25+ years of working with the geriatric population I'm here to tell ya - reorientation does not work and at times can be out right cruel. Why would I tell this sweet little ole lady that is looking for her husband that he has been dead for 10 years? Her reaction will be the same as the very first time she heard this...repeated every hour on the hour. All the initial pain & agony of this loss played out in her mind over and over. Easier on her to tell her if I see him I'll bring him right to her. (Now you and I both know I won't be seeing him anytime soon - but I don't need for her to know that).
    teeniebert, Purple_Scrubs, Muffy5, and 9 others like this.
  9. Visit  tyvin profile page
    3
    I've had em all from the gentleman who would pack his bags every morning without fail and it was when he was exiting the building I would send a nurse down to him to advise him he had a phone call. Worked every time. By the time he got to me about the phone call he couldn't remember why he was leaving or that he was leaving. I then would play the welcome this is your room number please unpack part. He never got violent or sad he just played along admitting himself daily and exiting the next morning. Alzheimer's can be cruel and I'm glad when a resident can enjoy themselves even in the throes of late stage Alzheimer's.

    Now there's the other fellow who's s/p mva and has permanent brain injury that insists he's going home every night. Now this guy gets violent. There's a certain amount of truth to what he rants which brings me to believe he could be regaining memory but everyone including his wife has given up any hope for recovery. It's impossible to talk to him so he is usually medicated with IM Ativan for the safety of the other residents, the staff and himself. I don't play games with him.

    So in your nurses case, she did just fine. At first when you do it you feel like your somehow betraying them by lying but in the end you are making there life just a little bit easier. Imagine if you would confront an Alzheimer's patient whose in the late stages and try to take them to a place of reality when they are clearly not there; usually ends up in a fiasco as I've seen nurses and family try. Let them enjoy; there's nothing wrong with it.
    Orange Tree, JB2007, and Davey Do like this.
  10. Visit  NurseKatie08 profile page
    5
    Reorientation is almost never best practice for Alzheimer's/dementia patients in my experience.

    When I was an aide on an Alzheimer's unit, we made use of a bench with signage from our local public transit (familiar to the residents) as a "bus stop". Had a lady (100years old) who would tell me every day that she needed to take the "bus down to (blank) to see my mother". I'd wheel her over to the bus stop and tell her the bus would be there soon. By the time several minutes passed she'd forget all about it.
  11. Visit  Davey Do profile page
    5
    Quote from JB2007
    I call them therapeutic lies. I even had a resident's family tell me I was going to hell one day because I told a resident so many lies.
    "I'll meet you in Hell!" Gene Hackman to Clint Eastwood in "The Unforgiven"

    Yeah. Well, if telling little therapeutic lies is a pre requsite for entry into Hell, I guess I'll meet you there, JB2007.

    The DSMIV defines a delusion as a false fixed belief in spite of evidence to the contrary. However, in spite of this definition, I've seen many Nurses attempt to show psychotic delusional Patients "The Way". It makes me wonder- who's MORE delusional? Which one of you are running the train? And, who's shovelling the coal?

    Dave
    teeniebert, Purple_Scrubs, JB2007, and 2 others like this.
  12. Visit  rn/writer profile page
    8
    You decide what to do based on what is best for the patient.

    In the case of a dementia patient, you accord them the respect due an adult, but you filter and adjust information the way you would with a young child. If they supply characters and situations, so much the better. Work with what they give you. Meet them where they are and tell them what will ease their hearts and minds.

    Previous posters gave wonderful examples of working within the patient's frame of reference.

    It may help to rethink what you are doing and recognizing that you are connecting in order to comfort rather than lying in order to deceive.

    Practitioners who insist on telling and re-telling unpleasant truths to ease their own conscience are taking care of themselves at their patients' expense.
    JB2007, flyingchange, Debra ACRN, and 5 others like this.
  13. Visit  86toronado profile page
    4
    I've got to agree with the nurse you work with. Going along with the patient's delusions can be a whole lot better for them (and you as their nurse) in the long run. I've seen too many elderly dementia patients get combative, and eventually need to be sedated just because some nurse insisted on "re-orienting" them, when in fact they probably haven't been "oriented" in years. My approach of playing along with them usually results in a pleasantly confused elderly person enjoying a "cocktail" (cranberry juice and ginger ale) before "heading out to dinner" (at four in the morning).
    teeniebert, JB2007, tyvin, and 1 other like this.
  14. Visit  DizzyLizzyNurse profile page
    2
    Quote from Davey Do

    I think the first time I did this was in my first job in a LTC Facility. A woman in her 80's was concerned about her parents. I was relatively sure they were no longer living. So, I said, "Your parents are taken care of." It calmed her down.

    Dave
    Just wanted to say be careful! I had an 80 year old resident who wanted me to dial the phone so she could call her mother and I thought she was confused. Turns out her mother was 100 and living in a nursing home in another state!

    That nurse was correct. What if you were looking for your spouse/parent and the person you asked told you they were dead? How would you feel? Would you believe them? Or would you think something was seriously wrong and people were lying to you? Or if your child kept telling you that they aren't your child? Or your mother kept telling you she wasn't your mother? (I've had plenty of residents who either thought I was their child or their mother - I just play along.)

    I had a resident who used to get combative with personal care until it was her birthday and I wished her a happy birthday. She smiled, relaxed, let me do what I had to do. From then on every day was her birthday!

    As long as it keeps them happy and relaxed and you aren't denying them anything, who does it hurt?

    We call this "therapeutic fibbing" at my work.
    JB2007 and flyingchange like this.


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