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

by VivaLasViejas Guide

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A veteran RN and nursing director shares a few tips and tricks of the trade, which have been hard-won through years of work as a nurse and even more years of study at the University of Hard Knocks, from which no one ever truly graduates.

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

    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 TO SLEEP!"

    Ethel, for her part, is equally determined that she's going outside to wait for her husband on the front porch: "My Robert is going to be home any minute. He'll be so upset if I'm not there to meet him." Insistently, she strips off her hospital gown, spies the bag containing her personal items slung over the back of the wheelchair she arrived in, and begins to dress herself again. "What time is it?" she inquires as she searches frantically for a clock and nearly topples over in her haste to put her shoes back on. "I really must go........"

    Now, if you went to nursing school in the 1990s like I did, you were probably taught to try re-orienting Ethel to the current time and place. Back then, a common response to an exit-seeking patient might have been: "Oh, no, Ethel, you can't go outside, it's 9 PM and freezing out. You're in the hospital, honey. Let's put your gown back on---"

    WHACK! Sweet little Ethel belts you upside the head with a tiny fist that feels like steel, then lets fly with a primal scream that could pierce the ears of a statue two blocks away. The aide activates the emergency call system and attempts to restrain the 90-pound wildcat, only to meet with a similar punch to the midsection; but within 10 seconds there are enough personnel in the room to take down an NFL offensive lineman. A co-worker produces a Posey vest and some soft restraints, and a few minutes later this elderly lady whose only 'crime' is dementia is fastened in bed, crying for her long-dead spouse with only the sitter at her side for company.

    This scenario didn't have to happen. Thankfully it happens less often nowadays, but only because some nurses questioned the "conventional wisdom" and decided it was better to join the confused elderly in their reality, rather than try to yank them rudely back into ours. I look at it this way: if the life you were living back in 1952 with your husband and children was happier than the nursing-home existence you're enduring now, what's the harm in staying there if you want?

    I've taken so many interesting trips and seen more distant lands with Alzheimer's patients, and other victims of dementing diseases, than I ever have in real life. I've been to Austria and Germany with one gentleman who's still fighting the Nazis in his lively memory; traveled to parts of Russia and survived a Siberian winter with the fellow who spent the final months of his life in my assisted-living facility; even patrolled the highways with the very first female deputy ever hired in the state. Now why did anyone ever think that dragging these folks back from their glory days was the right thing to do?

    Take-home lesson: Arguing with dementia is like trying to teach a pig to sing---it never works, and it annoys the living daylights out of the pig.

    Here are a few more nuggets of nursing wisdom for you, if you want them.

    1) When a patient tells you he's going to die---even if his vital signs are stable and he looks healthier than you do---believe him.

    2) People are more than just a set of diagnoses. Say it's the year 2030, and you're the admissions director of a long-term care facility. A file lands on your desk, and you're asked to evaluate a prospective resident who's got a history of alcoholism, diabetes, HTN, irritable bowel syndrome, GERD, asthma, arthritis, morbid obesity, frequent kidney stones, herpes simplex, UTIs, venous stasis, chronic low back pain, and bipolar disorder II. This is a classic example of what healthcare professionals call a 'train wreck', and you decide not to accept this patient, knowing no one could blame you for it.

    Guess what? You just turned away someone you already know pretty well from visiting allnurses on a frequent basis.

    3) Do what you love........and if you can't manage that, love what you do. I cannot overemphasize the necessity of having a passion for this work, because if you don't---if you do it only for the paycheck---you will more than likely become cynical and jaded. The job is simply too hard for the average nurse to keep going, year after year, decade after decade, when there are too few rewards for all the blood, sweat, and tears we put into it. There has to be a higher purpose to it (and I don't necessarily mean a religious one) for most of us to survive it with our bodies and minds intact.

    So, if you don't like the job you have---or have the job you want---go out and get another one. Being satisfied with what you do for 8 or 12 hours out of the day isn't everything, but it IS a big thing.......and believe me, your patients (not to mention your friends and family) will thank you for it.

    Embrace life. Embrace your profession and be proud of it. And never forget to allow the Ethels of the world to at least look out of the window, so they can see for themselves that it really is nighttime.......and know that Robert has arrived home safely.
    Last edit by Joe V on Jun 23, '12
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  4. About VivaLasViejas

    VivaLasViejas joined Sep '02 - from 'The Great Northwest'. Age: 55 VivaLasViejas has '17' year(s) of experience and specializes in 'LTC, assisted living, geriatrics, psych'. Posts: 24,747 Likes: 34,171; Learn more about VivaLasViejas by visiting their allnursesPage


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    66 Comments so far...

  5. 14
    "WHACK! Sweet little Ethel belts you upside the head with a tiny fist that feels like steel, then lets fly with a primal scream that could pierce the ears of a statue two blocks away. The aide activates the emergency call system and attempts to restrain the 90-pound wildcat, only to meet with a similar punch to the midsection; but within 10 seconds there are enough personnel in the room to take down an NFL offensive lineman."

    Name:  this-benedict-cumberbatch.jpg
Views: 1121
Size:  27.5 KB

    Love you. Love your brain.

    Would you mind terribly if I gather your sparkly creative thoughts around me like so much eiderdown and slip into a blissful yummy writing induced coma brought about from consumption of your article?

    I have just grand mal seized all over the like button, alas, it will only permit me one.

    Please, ma'am, may I have some more?
    Imarisk2, DSkelton711, NF_eyenurse, and 11 others like this.
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    Both of ya'll are crackn' me up! Very cleverly written, both of you and great article Viva, I totally agree!
    DSkelton711 and VivaLasViejas like this.
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    Such a true article. Being in LTC and working with dementia residents, I gave up sticking to reality orientation a looong time ago. I'd rather help Ethel get dressed and wait for her Robert 'who is delayed because of the freezing weather outside, but we'll wait a while'.

    And I learned to LISTEN when they tell me, 'call Bubba in Boston, it's time'. Again a looong time back, my lol in CCU on 3-11 was stable. I didn't perceive anything alarming - but she gave me goosebumps with that request. Right away I called Bubba in Boston with a heads up; it would take him about 10 hours to get here (hosp in central NJ) and he'd be on his way. I learned he arrived a little after breakfast and then his mom passed.

    Another nugget is the giving of something beyond the facility-provided basics of life - food, clothing or shelter. Like sleeping caps (so my lols don't wrap toilet paper around their new hairdo's), a chocolate chocolate DD donut for a special treat, a loaf of cinnamon raisin bread with a tub of spreadable butter (pt-labeled in the pt refirg), paying the tab for a shave & haircut for a shaggy lom, and acknowledging military service with an old time vet of the greatest generation.

    It's these little unexpected things that keep the spark of satisfaction and fulfillment in nursing for me.
    tayloramaRN2be, TrishaDL, itsmejuli, and 14 others like this.
  8. 1
    Quote from CheesePotato
    "WHACK! Sweet little Ethel belts you upside the head with a tiny fist that feels like steel, then lets fly with a primal scream that could pierce the ears of a statue two blocks away. The aide activates the emergency call system and attempts to restrain the 90-pound wildcat, only to meet with a similar punch to the midsection; but within 10 seconds there are enough personnel in the room to take down an NFL offensive lineman."

    Name:  this-benedict-cumberbatch.jpg
Views: 1121
Size:  27.5 KB

    Love you. Love your brain.

    Would you mind terribly if I gather your sparkly creative thoughts around me like so much eiderdown and slip into a blissful yummy writing induced coma brought about from consumption of your article?

    I have just grand mal seized all over the like button, alas, it will only permit me one.

    Please, ma'am, may I have some more?
    CP, you just made my day, and it's only one o'clock in the morning!!!! Coming from someone whose writing makes mine look like a sixth-grader's essay on "What I Did On My Summer Vacation", your comments mean a great deal to me.

    I also thank PetstoPeople and amoLucia for their input--glad y'all enjoyed it.
    TrishaDL likes this.
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    I really liked this article. When I first became a CNA I worked in LTC it always made the residents more agitated when we'd try to bring them back to reality. So I would just go along with their stories. It made everything that more easier and I didn't see any harm in it. Some of their stories were really interesting.
    tayloramaRN2be and VivaLasViejas like this.
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    I just started as a CNA a few months back. Thanks for this! I was actually taught to reorient residents to the present, but that has Never worked! I go along with what the resident is talking about. I wonder what nursing school will teach me about this? Just started that, too.
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    Dude those dementia pts have some awesome play places they live in. Sometimes it is fun to dive into their world and just go with it. I once had the pleasure of taking care of a king with a pet monkey, the duchess of yorkshire, and many many other equally notable nobles over a year. Great times.
    pseudomonas, sebig001, Hoosier69, and 3 others like this.
  12. 3
    Thank you for sharing what I believe to be true about not needing re-orient our patient's to a reality that is terrifying for them. I hope you continue to enjoy your travels and time with your patients, I know I will enjoy mine.
  13. 2
    i was intrigue right from the start when i saw the tittle of this article, which pulled me in to savor it's contents. needless to say, dementia has many layers which we have discover only the surface, dementia is not a specific disease it's an overall term that describes a wide range of symptoms. furthermore, dementia declines the memory or other thinking skills. therefore, what viva las viejas has accomplished with this article was captivating and created a surreal mood by giving the reader a tour of this debilitating disease in a smart, witty, and informative way and for that i commend her thank you for sharing it with us.....aloha~
    DSkelton711 and VivaLasViejas like this.


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