Confused residents are upsetting to me

  1. 2
    Just started at a ltc facility. I have previous nursing experience in L&D and in psych, but I have never worked with the older, confused population. The patients who are confused are upsetting to me. I don't know what to do with them or for them. I only have one more day of orientation left and then I am on my own. To make matters worse I don't know the residents well enough to really know who is confused and who is not. I don't know what to do with them when they are asking nonsensical questions to me while I am charting and one is sitting with me. Do I engage them in the conversation....ignore them (which just seems really really wrong to me) or what, what do I do? Also I don't know what to do with the residents who just call out for help for no reason and there seems to be nothing I can do to help them. I want to help, or distract or do something for them but I just do not know what to do. It really is very unsettling. I am tearing up just typing this. ANY ideas would be helpful. Thanks
    drmorton2b and CaLLaCoDe like this.

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  2. 18 Comments...

  3. 10
    It can be uncomfortable and upsetting at first. Don't try to "correct" them...just go with what they are saying. ftmp. Some residents, you can "reorient", but not always-sometimes it upsets them more. You can kind of redirect them, to an activity, or food, or the medicine... Just listen, and you can say things like "oh really? yes, you're right..." whatever. They move onto other topics quickly, or just nod off, IME... As you get to know them, it will be easier. Follow the lead of what your coworkers do too. And listen...sometimes they say some amusing things (not that it's appropriate to laugh *at* them, but you just never know what they'll come up with next).

    Simple confusion/forgetfulness can often be dealt with via redirection, reminding, reorienting... true full blown dementia-just going with the flow of what they are saying tends to work better, while you are working.
  4. 6
    I just along with what they are saying. If they think someone is coming to see them then ask questions about the person, or ask questions about what they are going to do once the person comes.It makes no difference if the conversation is complete fantasy or completely in their imagination. Just be patient, kind and cheerful and make sure they are safe.
    Esme12, Debilpn23, teeniebert, and 3 others like this.
  5. 1
    When patients are in confused states, the best way to approach them is the same way you would work with a psych patient who is in a psychotic break, or a manic or delusional state. You want to reorient and redirect. You want to be a calming presence, and ask simple "yes or no" questions. Reorient to person, place, and time. Sometimes, often times, these patients just need a caring hand to hold, or some assistance to get to a group activity. You don't need to and can't actually solve their problem, the dementia. It's there and it's getting progressively worse, they may have issues with medications like risperidone, like restlessness or sedation. Don't try to solve these issues, just try to be a calming presence, and do your best to meet their needs.

    It sounds like this job may not be a great fit for you.

    Nursing has so many different applications. There is no reason to work in an area that you don't click with. If you enjoyed psych or L&D, why not look for work in those areas?
    Mrs. SnowStormRN likes this.
  6. 9
    I actually find these particular groups fascinating and delightful. While the various manifestations of their confusion can seem bizarre, they also provide some insight into the workings of the human mind.

    As for practical tips, I'd say attempt re-orientation if it will help the patient. Most of the time, however, it's probably progressive dementia, and I personally believe doing whatever is comfortable for the patient is the best -- whatever that is calming and comforting for them. As someone said, do not laugh "at" them, I take a great offense to that. But, enjoy the moment "with" them.

    When they call out for help with no reason, there actually IS a reason in their mind. I feel that it's often loneliness and fear, especially with their decreasing cognitive ability, a lot of things (external or internal stimuli) can be frightening for them. Simply being present (talking, touching, keeping company for a while) can help. They might call out for help, and then not able to tell you why they called out, which often lead to nurses' frustration. But remember there always is a reason. It's difficult to address their needs given our workload, but what can we do but try?
  7. 0
    I would love to work L&D again! I am in a rural area and the nearest L&D is over 80 miles away.....not many options here. I hope I grow into this position. It is all very new to me still I have only had 3 days orientation.
    When I say it is upsetting to me I don't mean annoying upsetting. I really do like the residents. Let me give one specific example. One of the residents calls for help a lot of the day and every one just walks past her room peeks in at her to make sure she is fine and just keeps on going about their day. Sometimes they will bring her out to the nurses station or give her a magazine or a cookie and usually it doesn't help. It just kills me to walk right past her room or listen to her call out while she sits with us. Yesterday she stopped in the middle and said "whats wrong with me?". It is just heart breaking and it makes me feel helpless. I think I am also having a hard time adjusting to working with physically ill people. I know that sounds strange for a nurse to say that but L&D is pretty much healthy young ladies and the psych experience I have was at a boys home (8-18 years old) and except for a handful of diabetes those boys were physically healthy too.
  8. 0
    Thanks all for "listening". Please keep the suggestions and resources coming
  9. 5
    Dementia patients are hard to get used to...at first. They have become some of my favorites. Some of them have an almost child-like quality and innocence, yet they have lost many of the filters we use in day to day relationships, so they are very open and honest. Not all, but most.

    I do understand your feelings, it can be emotionally draining to answer the same question a million times a shift in the same happy voice, and just wait till you answer it day after day, month after month. But these people are depending on you to care for them.

    Some nurses cannot imagine working with sick children, or broken bones, or some hate OB-GYN. But someone also loves all those areas. Do your best with where you are. You will learn so much in LTC. SO much! You ARE making a difference and the families will appreciate what you do as well. Here are some web sites to check out.


    http://www.helpguide.org/elder/alzhe...r_problems.htm

    http://alzheimers.about.com/od/careg...rientation.htm

    http://www.stacommunications.com/cus...pril03e/14.pdf
  10. 1
    I have to say, I Love LTC! I know that some of the confused patients can be, tiring. It can be frustrating because there isn't anything you can do for them but be there. The others have said, try re-directing them if they yell out, re-orienting a dementia or alzheimer pt isnt really going to work, so going along with it is best. Reassure them, and also learn from them. Their delusions can tell you alot about their past, what they were like before, ask them questions about what they are talking about, its pretty interesting a lot of times.
    You will meet all kinds of characters in LTC. When you go to work, just remember you are there helping this mom, dad, grandpa/grandma deal with losing their independence, can you imagine what that must be like? That should get you through the shift. Just keep reminding yourself, "how would I react if I was slowly, progressively losing all my 'faculties' ".

    As for the other people who just walk by the room of the yeller, its because they know this person and that he/she yells all the time. You peak in the room and see if they are in any immediate danger, then go on about what you are doing. Its just knowing your patients. I would personally go into the pts room, ask them what was wrong, talk to them about it and if there was nothing I could do I would document it and go on. There should be a behavior book/chart at your facility for the yellers (hitters, kickers, biters, wanderers, midnight shoppers ). Its sad to just "let them yell" but honestly most of the time whatever you do is going to either just irritate them more or lead them into another delusion/episode?. You will get used to your pts and their behaviors, it won't take as long you might think either. Good Luck and enjoy your residents, they were once you!
    Forever Sunshine likes this.
  11. 2
    There are several residents in the facility I work at that yell all the time and then can't tell me why they're yelling. One yells "Nurse" repeatedly and another yells "Somebody help me." I could see it being upsetting to new staff members when employees are not rushing into these resident's rooms. When a resident is yelling continuously, I peep in his or her room periodically and make sure they haven't fallen out of the bed or something and then go about my business. If I went in every time they yelled I wouldn't be able to get anything else done.
    DizzyLizzyNurse and taalyn_1 like this.


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