Interpreting the Unsaid

Having worked in geriatrics for more than a decade it is one of the most fascinating fields of nursing. Due to all the normal changes that take place physically in the human body, coupled with disease processes and psychosocial changes, it is of utmost importance that you get to know your elderly patient very well. Nurses Announcements Archive Article

Interpreting the Unsaid

You should spend time listening to their stories even if it makes no sense to you.

Listening develops a relationship.

This means spending time to chat and reassure patient of your love and care for them and maintaining a positive, warm and confidential attitude at all times.

It takes a longer time to understand the elderly patient as you have to work through all the mood swings, demanding phases and even episodes of withdrawal. Outburst at staff and aggressive behavior is usually not what it sounds like or appears to be rather it is a cry for your love and attention and most often just a call for someone to come and sit and listen, really listen from your heart to what they are feeling and reliving at that said moment

Elderly persons, especially in a nursing home setting, can become very jealous and vie for your attention if for one second they think or believe that you are giving more attention to time to another patient. So the next time your elderly patient has an outburst of negative behavior:

  • Assess the situation
  • Give soft loving words of reassurance
  • Do not be judgmental it makes the outburst worse
  • Reassure them of your love; after all you are the one they relate to on a daily basis
  • It is not a personal attack on you but a cry for your attention
  • Body gait and facial expression can carry a different message if you appear cold and distant
  • Try to carry a reassuring smile; hold hand if possible and remain silent for as long as possible and let them know you are indeed listening to their call
  • Listen to the unsaid words that says, "Tell me you love me and I am important to you"
  • Do not take sides or pass judgment or be critical in any way; what they really need is the reassurance of your love
  • Never tell them that they are rude or naughty in any way rather assure them that all will be well and things will work out

You may try to shift attention to something of a happier nature or an offer of something that you know will settle them and put them in a better frame of mind. You may ask can we go for a walk outside and talk about this or you may ask is there anything you would like me to do for you and follow through as best as you can in the interest of the patient. They like to know that they are the one making the decision and helps to maintain their independence and individuality.

Listen with your heart and hear that cry for your love and attention and in a tender loving way give as much as you can and be consistent. It does not matter what mood your elderly patient is in as a health professional and the caregiver, you have to remain professional at all times and wear that smile, say those loving words and show love no matter what.

It works and to foster this type of relationship with your elderly patient will help their golden years to be the most happiest and fulfilling they ever had and that is the goal of geriatric nursing.

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ann king

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

listening to and interpeting the unsaid is an excellent goal for any nurse, but i find all the references to "soft and loving" and "reassuring your patient of your love" to be somewhat disturbing. after reflecting upon it for 24 hours, and in light of the fact that my mother, mother-in-law and four uncles are currently in nursing homes or assisted living, i find that it still disturbs me. i don't love my patients, nor do i expect the nurses and cnas caring for my six demented relatives to love them, either. communication in a respectful and caring way is certainly desirable and appropriate, but let's get "love" out of the picture. perhaps you could find a better word or phrase to convey your intent.

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Specializes in LTC Rehab Med/Surg.

Nursing home = caring for 30-50 residents at any given moment. Sometimes more. I hate to be negative, I really do, but what the OP proposes simply can not be done. It's been awhile, but when I was a nurse in a NH, I met myself coming and going passing meds, and assessing the emergencies. Perhaps things have changed since I worked in LTC.

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Specializes in Emergency & Trauma/Adult ICU.

I agree that the liberal use of "love" in the OP is ... unsettling. And I also suggest that there is some patronization in there as well. No distinction is made for the subgroup of those with moderate to severe dementia, or those who are currently experiencing emotional distress, but there is the generalized suggestion of speaking in "soothing" tones and not displaying favoritism.

I respect my elders by assuming they possess the coping skills that have gotten them this far in life, until I have reason to alter that assumption. A percentage of those with dementia have regressed to an emotional state where the OP's suggestions may have some merit, and I meet these folks where they are. But I find the overall tone unnecessarily paternalistic.

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Specializes in Geriatrics, Dialysis.
Nursing home = caring for 30-50 residents at any given moment. Sometimes more. I hate to be negative, I really do, but what the OP proposes simply can not be done. It's been awhile, but when I was a nurse in a NH, I met myself coming and going passing meds, and assessing the emergencies. Perhaps things have changed since I worked in LTC.

No, things haven't changed. Higher levels of acuity combined with patient load of 38 to 56 depending on which shift and/or unit worked. I do however have respect for my residents and address their needs, both physical and psychological as well as humanly possible. I too have a bit of a problem with the OP's "love" fest. I am a professional, compassionate nurse but I do not tell my residents I love them, nor do any of my staff. Frankly if I were a family member and heard staff spouting words of love to my parent I would be very offended.

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Is this realistic when LTC facilities put one R.N. in charge of an entire wing? You have time to sit and enjoy the stories of each of your patients while you have meds to give, nurses' aids to supervise, problems to solve, documentation to do, doctors phone calls to make, and meetings with rehab/social services? It's ideas like this that trigger frustration in caring people such as myself. Yes, it would be WONDERFUL to really focus on one patient for awhile and get to know them. But when the LTC industry doesn't budget for it, why tell us about it? Why not write this to managers of facilities? Or appeal to insurance companies and regulators to do something about the insane nurse:patient ratios?

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Specializes in Labor & Delivery, Med-surg.

I appreciate your article and heartily agree. We are the only "family" many of these forgotten people have. Many times those with dementia are supersensitive and vulnerable and needing our emotional support. There is more to this job than getting those pills out on time. Those moments of comforting and "loving" someone in the midst of their anxiety or despair is what makes this job truly worthwhile and the reason I am here at this stage of my career.

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Specializes in Chronic Neurology, Palliation, End of li.

"you should spend time listening to their stories even if it makes no sense to you."

insight like this can not be taught in college it comes from experience and directly from the heart.

it is obvious to me that this is validation therapy (naomi feil 1963 and 1980) you may be familiar with this approach which was developed for older people with cognitive impairments, but which has subsequently been applied in work with people who have any dementia diagnosis from taumatic or hpoxic brain injury to developmental delay. feil's own approach classifies individuals with cognitive impairment as having one of four stages in a continuum of dementia: these stages are mal orientation, time confusion, repetitive motion and vegetation. the therapy is based on the general principle of validation, the acceptance of the reality and personal truth of another's experience, and incorporates a range of specific techniques.

amazing that all it takes its time and patience

and by the way love is not a patronizing act love is a [color=#0645ad]virtue representing all of human [color=#0645ad]kindness, [color=#0645ad]compassion, and [color=#0645ad]affection.

for those of you interested in validation therapy:

[color=#4272db]

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"You should spend time listening to their stories even if it makes no sense to you."

That is so right. During my CNA clinicals, my two partners and I were in charge of three patients. All three had end stage dementia and we were suppose to take care of them which consisted of feeding them and getting them ready for bed.

On the last day of our clinicals, we were getting one of the ladies ready for bed and as we were leaving we told her bye like we have done in the previous days but I guess she sensed that this was our last day with her and the most amazing thing happened.

With broken sentences and facial expressions, she told us how much it meant to her that we were here and everything we do for her and all of the residents. She did not want us to leave and we told her we would come visit she said didn't believe us. She told us how we will be in her prayers and how much she appreciates us so that by the end of the "conversation", all three of us were crying.

For this lady to take the effort to let us know in whatever way she could how much what we were doing (which was pretty much our "jobs") was amazing and totally unexpected. We treated all the patients with the respect and care that we have been taught, we never thought that what we were doing was anything out of the ordinary. So for her to make that effort was so amazing. But most importantly, for us to understand what she was saying when she was only using two to three words to try to explain it was even more amazing and made me realize what people mean when they say that being a caregiver is a gift not something that can be learned.

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Specializes in Geriatrics, Dialysis.
"You should spend time listening to their stories even if it makes no sense to you."

That is so right. During my CNA clinicals, my two partners and I were in charge of three patients. All three had end stage dementia and we were suppose to take care of them which consisted of feeding them and getting them ready for bed.

On the last day of our clinicals, we were getting one of the ladies ready for bed and as we were leaving we told her bye like we have done in the previous days but I guess she sensed that this was our last day with her and the most amazing thing happened.

With broken sentences and facial expressions, she told us how much it meant to her that we were here and everything we do for her and all of the residents. She did not want us to leave and we told her we would come visit she said didn't believe us. She told us how we will be in her prayers and how much she appreciates us so that by the end of the "conversation", all three of us were crying.

For this lady to take the effort to let us know in whatever way she could how much what we were doing (which was pretty much our "jobs") was amazing and totally unexpected. We treated all the patients with the respect and care that we have been taught, we never thought that what we were doing was anything out of the ordinary. So for her to make that effort was so amazing. But most importantly, for us to understand what she was saying when she was only using two to three words to try to explain it was even more amazing and made me realize what people mean when they say that being a caregiver is a gift not something that can be learned.

That is beautiful and I am very glad you were able to have that experience. It is a wonderful feeling to know that you made a difference in somebody's life. Now for the reality check part on my response. There were 3 students caring for 3 residents, makes that a 1:1 ratio of patient care. This is why residents love having students care for them, they get that individual attention that I wish we could give all the time. In the real world however, there is 1 CNA for several residents, on a night shift with lower staffing it is as many a 1 CNA for 38 residents where I work. In order to provide proper care for that many people a CNA is lucky to have 5-10 minutes to devote to each person, and the "independent" residents get zero attention. Sad, but that is the reality of staffing.

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