Never Argue With Dementia (and Other Nuggets of Nursing Wisdom) - pg.3 | allnurses

Never Argue With Dementia (and Other Nuggets of Nursing Wisdom) - page 3

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... Read More

  1. Visit  leslie :-D profile page
    #26 5
    as a nsg student, i was inevitably kicked off my psych rotation on the locked units, because i defied my instructor's direction in reorienting to reality.
    i just couldn't and wouldn't do it.
    instinctively it felt so wrong...
    and there was no way in hell i was going to try and persuade an end-stage aids pt (with encephalopathy) that aliens weren't going to take his baby (as he clutched onto a doll).
    i wasn't going to try and persuade a paranoid schizophrenic that i wasn't one of the "good guys"...
    that i was a sn named leslie, and you my dear, are locked in a psych unit because you're a sick, sick person.
    trust is imperative in caring for one with brain disease, and any type of reorienting, only appears as a lie to them...
    exacerbating their tendency for paranoia, agitation, bewilderment, etc.

    i promised the end-stage aids pt, that nothing would happen to his baby, as i tenderly took it from him and cradled it.
    i reassured the acutely paranoid schizophrenic, that yes, i was one of the good guys.
    it made them feel much better, it made me feel better...
    and irritated the living **** out of my instructor.

    win/win/win.

    thanks for this article, viva.
    i hope all newbies and students heed your advice.

    leslie
  2. Visit  minnymi profile page
    #27 4
    I had a lady keep insisting there were gnats swarming above her in the bed. At first I told her I didn't see any gnats. She wouldn't stop worrying about the gnats though. Finally, I said, "oh yeah....i see them," and I proceeded to swat them away with my hand and proclaimed, "there...they're gone." She looked at me and said, "are you crazy? that's not going to do anything!"
  3. Visit  Five&Two Will Do profile page
    #28 1
    Quote from minnymi
    I had a lady keep insisting there were gnats swarming above her in the bed. At first I told her I didn't see any gnats. She wouldn't stop worrying about the gnats though. Finally, I said, "oh yeah....i see them," and I proceeded to swat them away with my hand and proclaimed, "there...they're gone." She looked at me and said, "are you crazy? that's not going to do anything!"
    That is hilarious!
  4. Visit  VivaLasViejas profile page
    #29 1
    Quote from leslie :-D
    as a nsg student, i was inevitably kicked off my psych rotation on the locked units, because i defied my instructor's direction in reorienting to reality.
    i just couldn't and wouldn't do it.
    instinctively it felt so wrong...
    and there was no way in hell i was going to try and persuade an end-stage aids pt (with encephalopathy) that aliens weren't going to take his baby (as he clutched onto a doll).
    i wasn't going to try and persuade a paranoid schizophrenic that i wasn't one of the "good guys"...
    that i was a sn named leslie, and you my dear, are locked in a psych unit because you're a sick, sick person.
    trust is imperative in caring for one with brain disease, and any type of reorienting, only appears as a lie to them...
    exacerbating their tendency for paranoia, agitation, bewilderment, etc.

    i promised the end-stage aids pt, that nothing would happen to his baby, as i tenderly took it from him and cradled it.
    i reassured the acutely paranoid schizophrenic, that yes, i was one of the good guys.
    it made them feel much better, it made me feel better...
    and irritated the living **** out of my instructor.

    win/win/win.

    thanks for this article, viva.
    i hope all newbies and students heed your advice.

    leslie
    Now that's what I call WINNING all right!!!

    I love to hear these stories........makes me feel we are doing something very, very right. Thank you, everyone!
  5. Visit  Pets to People profile page
    #30 1
    I always wondered as well, why in the world we try to bring them back to our world? It's not like it's so great lol, but anyway, and we know for a fact that they will only go back; does that rollercoaster not cause them more stress?

    Even in class when it was discussed it seems no one has a real answer as to what to do when a dementia pt takes a vacation, some of our instructors said to re-orient, some said to just try to ignore it and dance around the truth without bring them current or validating their delusion...I say that's where they want to be, then might as well join them.
  6. Visit  SHGR profile page
    #31 3
    Quote from VivaLasViejas
    In my way-back days, there was a 100-year-old lady in the LTC where I worked who had been a night-shift LTC nurse herself. The poor thing had outlived two husbands, all five of her children, and even a couple of grandchildren. But she'd worked nights for 50 years, so she went on rounds with me, making her "nurses' notes" on a clipboard and advising me on when I should go find the doctor. I'll never forget the night she greeted me with a big hug and a kiss on the cheek, excitement in her eyes, and a packed suitcase: "My daughter's coming for me! She's picking me up after I get off duty and taking me home with her, isn't that wonderful?" She passed away three nights later.
    Wow. Goosebumps and tears on that one!! My goodness. You are the awesome, Viva!!
  7. Visit  Stephalump profile page
    #32 1
    Quote from VivaLasViejas
    In my way-back days, there was a 100-year-old lady in the LTC where I worked who had been a night-shift LTC nurse herself. The poor thing had outlived two husbands, all five of her children, and even a couple of grandchildren. But she'd worked nights for 50 years, so she went on rounds with me, making her "nurses' notes" on a clipboard and advising me on when I should go find the doctor. I'll never forget the night she greeted me with a big hug and a kiss on the cheek, excitement in her eyes, and a packed suitcase: "My daughter's coming for me! She's picking me up after I get off duty and taking me home with her, isn't that wonderful?" She passed away three nights later.
    Love this and the original article! Thanks, Viva!
  8. Visit  FORTHELOVEOF!!!! profile page
    #33 2
    They do teach this in my nursing school now. With dementia patients we call it "living their truth" but we ALWAYS reorient mental health patients with no history of dementia.
  9. Visit  minnymi profile page
    #34 1
    Quote from VivaLasViejas
    In my way-back days, there was a 100-year-old lady in the LTC where I worked who had been a night-shift LTC nurse herself. The poor thing had outlived two husbands, all five of her children, and even a couple of grandchildren. But she'd worked nights for 50 years, so she went on rounds with me, making her "nurses' notes" on a clipboard and advising me on when I should go find the doctor. I'll never forget the night she greeted me with a big hug and a kiss on the cheek, excitement in her eyes, and a packed suitcase: "My daughter's coming for me! She's picking me up after I get off duty and taking me home with her, isn't that wonderful?" She passed away three nights later.
    one thing i've learned is that when people start begging for god or saying they see loved ones who have passed.....brace yourself bc it's getting ready to happen! if they're a DNR it's not so bad, but if they are....not good times ahead.
  10. Visit  mysonsmama profile page
    #35 2
    Great article and responses. I did find it really interesting that so many people had recent instruction that required reorienting demented residents to the present. My instructor demanded just the opposite. She told us to take that trip with them and appreciate all the experiences/stories you hear and become a part of.
  11. Visit  EmTheNewRN profile page
    #36 3
    Quote from Hygiene Queen
    Oh...
    That is the worst!

    I did have one patient who got excited when we told her that her husband, Joe, was coming to visit.
    She would giggle and get in a dither and insist she had to "put her face on" for Joe.
    We would help her put some lipstick on and reassure her that she looked pretty.
    It was so cute!
    But Joe was her second husband and she would sometimes forget that.
    So, she would have periods where she would travel back to when she was married the first time (to a man who had cheated on her).
    She would fret and, literally, wring her hands over how she thought he was cheating on her.
    Reassurances otherwise did not work. This was a real experience and she was time-warped right back into it... not even remembering Joe.
    The pain she was experiencing was heart-breaking and there was nothing we could do, but she did get a lot of hugs.
    It is so rough when their reality is not one that is comfortable to stay in. I'm very early in my first LTC job and had a woman who was reliving fear (related to what my gut tells me was a very real long-past sexual assault). I've been encouraged to redirect without making up lies that might compound the situation so when she told me to warn the CNA in the hallway to be careful I said that we in the hall looked out for each other and were looking out for her to keep everyone safe, and howabout your evening peanut butter sandwich? She gave me a great big kiss, stopped fretting, and settled down with her snack. It gave her a few minutes of peace, at least :/
  12. Visit  EmTheNewRN profile page
    #37 1
    Quote from Maremma
    Now if we can just convince the schools to start teaching this preferred method of handling dementia we would ALL be in a much better place! I do the same thing with all dementia patients. It is such a drastic difference in the way they respond to others that try to force them "back into reality" than the few of us that do not.
    I wish my school had given me info about it! My first day on the floor for Med-Surg I, I was in the hospital before daybreak with a sundowners lol. She was distressed: she was outside, she was in the wrong hospital room, there was a hallway in her bathroom with a janitor inside, her clothes weren't in her closet. When I asked my instructor how I should handle it, she replied "How do you think you should handle it?" Umm, I've had no training in dementia care and was hoping you could provide me with some evidence-based care info. The best anyone could suggest was to reorient her.

    I learned more about dementia care in the 4-hour orientation video at my LTC employer than I did in my entire nursing education.
  13. Visit  animal1953 profile page
    #38 3
    Thanks you Viva!! This reminded me of an event in a LTC when I was doing clinicals.We had a resident in the dinning room suddenly go catistropic, saying " I've lost my baby" and the regular staff telling her she didn't have a baby, which really cranked her up. Our instructor went over to her, took her hand and calmly said "it's ok, we found your baby. It's safe". She wnt form 60 to 0 in 2 seconds. All she needed was reassurance that her baby had been found. It's amazing what getting into their world will do to help them.

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