Never Argue With Dementia (and Other Nuggets of Nursing Wisdom) - page 6

by VivaLasViejas Guide

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It never fails....you're walking down the hall to check on your new patient when you hear an aide loudly attempting to persuade sweet, confused, deaf-as-a-post Ethel to get into bed "BECAUSE IT'S NIGHTTIME AND EVERYONE IS GOING... Read More


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    I had a dementia patient who treated his wheelchair like a dragcar. He'd pretend the brake was his stick shift and he'd move his feet accordingly, only bad thing was that he had a very fowl mouth when he wasn't winning. For is safety and ours, I'd section off an area of the dining room for him to race in.
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    Now THAT is creative...way to go!!
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    I loved this article. I worked in LTC for a while and actually enjoyed when I was asked to float to the memory care unit. I have also had the opportunity to experience a few of these too. Lol we would wait inside for our "Roberts " because we know he would be awful upset if he came to get you and you were outside in the cold. Lol but we left word with such and such friend /family member and he knows exactly where to get you. In the meantime would you like to have a cup of tea/cocoa with me! It was
    so rewarding to see tha you helped someone where ever their mindset was to avoid
    irritation and you got to hear a few good stories. I also had the opportunity to do a
    Little private care with an elderly woman. She was 100y rs old!
    Everyday that I would go to her house I was a new Friend, or I was the nice
    nieghbor who came to visit. She just couldnt believe that there were still people
    that were so caring! I would get to hear the same stories several times a day
    sometimes she would remember a little more detail! I wouldnt trade those
    opportunities for the world!
    Last edit by TrishaDL on Jun 28, '12 : Reason: errors
    tayloramaRN2be and VivaLasViejas like this.
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    Love love LOVE this article!
    I think its sometimes cruel to "reorient".
    Why on earth would you tell a little old woman sitting happily in the hallway, waiting for her husband, that he is dead?
    Either she's going to argue with you, or she is going to remember and cry for hours!
    Let her stay there. Work your reason for needing her to go somewere or do something into her reality. It's easier and she is happier that way.
    tayloramaRN2be, SHGR, and VivaLasViejas like this.
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    Thank you for posting this. Ive recently graduated and THIS is the kind of things that I like to read from a forum. You are honest and funny too! Now I know a little more about what to expect in the work place and how I can manage a patient like Ethel. Thank you very much, I enjoyed it!
    VivaLasViejas likes this.
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    I'm so glad you stopped by here. You sound like the kind of nurse all elderly, demented people need. Welcome to ALLNURSES.COM and to the wild, woolly, and wonderful world of nursing!!
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    I love the trips dementia patients could take you on. I took care of one woman who thought she was the DON of the LTC she lived at. If she got a hold of the phone, she would tell the caller who she was, the DON. She also sent home a brand new CNA because he hadn't gotten his CXR done for TB screening, not knowing any better, he started to leave. She was hilarious. Whenever she was "in trouble" she would tell me to call her by her alias name, Maryanne Trebanowski, so no one would know it was her.
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    Quote from ixuzus
    Absolutely spot on. When I was working as an aide I found that I got far more cooperation when I wasn't challenging their perception of reality.


    There was one aide I worked with (eighteen, maybe nineteen years old?) who insisted on trying to reorient everyone and was forever leaving residents in tears. One evening I tried reorienting her. I kept insisting that it was really 2064 and she was an old lady and should act her age. The RN we were working with, who hadn't shown any hint of a sense of humour previously, joined in and confirmed that was indeed 2064 and added that we were in a lunar base as 'no decent person has lived on earth since the late twenty-forties'. I don't know if she got the point we were trying to make but she did start to get fairly angry after a couple of hours of this story. In hindsight it probably was a bit juvenile but I was getting so fed up with her upsetting people who were off in their own little reality, happy, and not hurting anything.
    Juvenile?!? I think it was genius! I just may use that tactic someday!
    SHGR and VivaLasViejas like this.
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    Quote from al586
    Juvenile?!? I think it was genius! I just may use that tactic someday!
    If you do decide to try the tactic then I recommend replacing the calendar in the nurses' station. It makes an excellent prop. All of the major office programs will allow you to create a calendar for any year quickly and easily. Just make sure that you pick a year where the days of the week fall on the same dates as the current year or there may be more confused people than you anticipated. For extra points throw in a holiday or two nobody has heard of and add an image of a futuristic car. Google images is your friend.

    When you see the shadow of doubt cross their face and they just for a second contemplate the possibility that you may be telling the truth or go sneaking off to independently verify the date you know you have won. Whether they actually learn anything is yet another question.
    kbrn2002, SHGR, VivaLasViejas, and 1 other like this.
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    I have worked with patients that needed to "get to work"... so I politely told them, oh, no you just woke up early, they're still closed. I'll get you up when it's time to go. They never remember. Your family (who either are dead or never come or some other craziness) are supposed to be here? If they are dead I usually will just say, well, I haven't seen anyone come in yet, I'll bring them down if I see someone, or, if they are alive but just not coming, I'll say, Oh, the highway is all backed up! I don't know when they'll be able to get here. You're going to a barbeque today! Well, I'll go look for some food to pack and take with you! One man wanted to look for his steak from 2 years ago. He was adamant, very angry and upset his nurse wouldn't let him go. wheeled him to the kitchen, emptied the contents of the fridge onto the table and said, nope, no steak, sorry. That calmed him down. I left a note on his menu though, so guess what he had for dinner the next night?

    If their reality is safer for them or more pleasant than mine, why not let them live in it. They hardly remember things you say, and I try not to outright lie if I don't need to (there's one man whose wife just died, he goes in and out of reality, more in than out), I always say, Oh, I'm so sorry, remember the funeral we had 2 weeks ago? I know it must be so hard, but she was such a good woman." Or if you have a family that will get involved, the family sometimes comes to explain that so and so is dead, but they provide much comfort just being there. Pictures help. I sometimes will go along with the more innocent situations. The washer is overflowing and leaking everywhere! OH NO... let me go look for some towels, you stay put so you don't slip on the suds, I have shoes on and you don't! Sure, I'll get your (pillow) handbag so you can look for some lipstick. I've got the baby upstairs so that it's quiet for her, everything is okay though. I've even assured patients their food wasn't poisoned by eating a small bite. See, it's safe for me! One lady thought the floor cleaner was bombs in "the war!" I put up her bedside buddy pillow and then put pillows all around her (high fall risk, especially when agitated) and said "there, you're protected now, I'll go and stop them, I'll get you when it's safe, stay here" to which she replied, "Okay, be careful, those b******s are tricky! Sure, I'll call your work and tell them you'll be off today because you fell, no problem. Your son is the president? Well, can he get me a raise? I'll ask him next time I see him! Sure, I saw the doctor's "non-existent" son. His wife and baby are doing well, heard he got a promotion!

    The fun times outweigh the sad usually. I loved the patients in LTC. Too bad I couldn't stay in that dreadful work environment. =/
    tayloramaRN2be, teeniebert, SHGR, and 1 other like this.


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