Never Argue With Dementia (and Other Nuggets of Nursing Wisdom) - page 7

It never'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

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    I worked in an LTC facility where 80 and 90 year old patients routinely wanted to get married (to other patients) in spite of the fact that their wife or husband of 50 year was a regular visitor.

    I can't wait to get old! It'll be so much fun (unless those darn nurses try to crimp my style!)

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    Quote from DanaNP
    I worked in an LTC facility where 80 and 90 year old patients routinely wanted to get married (to other patients) in spite of the fact that their wife or husband of 50 year was a regular visitor.

    I can't wait to get old! It'll be so much fun (unless those darn nurses try to crimp my style!)
    We often joke about what kind of older person we'll be. One nurse, we've decided, will be helping other patients, one will be stripping, another telling stories nonstop, etc.

    I think I'll be like my dear departed paternal grandmother. She was an escape artist. She jumped fences and ran away a few times in her 70s....that's when we decided she needed perhaps a more structured environment than my aunt's house.
    tayloramaRN2be and VivaLasViejas like this.
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    Working my ortho floor, I once had a (demented) patient who was very worried about us nurses and aides. He was convinced there was a murderer roaming the halls, looking for us. I calmed him down by telling him we had called the police and they were on their way, and that all of us had safe places to hide. I thought it was sweet of him to be worried about us!
    tayloramaRN2be and VivaLasViejas like this.
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    The arguement over this kind of approach has been going on for years! Naomi Feil started validation therapy in 1963 and since then others have talked about it being a total approach to dementia rather than a therapeutic session (though I see how it would work in both situations). I researched it for an assignment in my masters degree and it sounds great - the odd time I've tried it out it had a good result - but because no-one can come up with any reliable empirical evidence they can't advocate the teaching of it (well that was the latest article I could find anyway). It all comes down to the boffins in their labs - if they say it's okay then it's allowed. Doesn't matter that there are hundreds of us out there saying it works - that's anecdotal and not scientific (and therefore unreliable).
    I'd rather sit in a bunker for 10 minutes with an army officer and wait until those damn gerries have passed than spend half an hour pulling a screaming old man out from under his bed - wouldn't you?
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    This was helpful.

    We have a little lady or two who goes in and out like that.
    I get to her for dinner.
    "Oh, no - honey. I'm waiting for my husband. He's supposed to pick me up any --"
    So I said something like, "Well - we can meet him at the train station. Let me take you to the train station so you can wait for him to pick you up and we can get a bite to eat there too. So, you won't be hungry. It's way easier to instead of having him come alllll the way around to come get you?"

    She thought it over and said, "Ok..."

    I'll have another resident who will 'out of the blue' just get scared when she's in her room and start screaming for her husband. "Charles! I'm cold. Where's Charles...? Charles! Charles! Help! Heeeeeelllllpppp! Charles!"

    I sometimes don't know WHAT to tell these residents when they go off like that. What can I say, "He'll be right back"? What if she expects it and goes looking for him? I've seen residents look for loved ones. Day after day. It's sad. They get dressed up and wait by the windows or go outside in the courtyard (purse in hand) refusing to eat their meals because their daughter/husband/mother is coming to 'pick them up'

    It's not the case with my little lady. She's about 88 and her husband's been deceased for years.
    So, I just try to redirect her. Get her mind off the matter.
    "Charles...where's charles...?"
    "What's going on, Ms _______"
    "I'm cold. I'm so cold. Take me over yonder. I need Charles."
    "Whose Charles, mama?"
    "Say what?"
    "Who is MR. Charles, Ms _____"
    "My husband."
    I feign surprise. "You're married? I never knew that!"
    She looks up, "Yes..."
    "Oh, how long have you been married?"
    She thinks. "Fifty...two years, I reckon..."
    "I hope to be married that long. My parents have only been married 34 years. So, you've got them beat, huh."
    "I sure do...!"
    Then I have to sit and talk with her b/c she doesn't want to be alone. "Don't leave. You sit right here. Sit down."
    ...and she'll grab your hand and pat it.

    Like that. All in all, I've really been getting a load of practice on my therapeutic communication skills since working with psych pts.
    We have to. We're a no-restraint facility. No 4 Pts. No seclusion. Might have a little Ativan to calm them but it's 0.5 mg.
    So, we have to 'use our words'... a lot. This will sound bad, but 'time outs' help.... too.
    Sometimes, rowdy or riled pts just have to collect their thoughts and simmer down.

    Anyway, as I understand it? You feed into it, I guess, if they're suffering dementia alzheimers...for peace of mind. Because the truth causes pain.
    ...but if they're having schizophrenic delusions,i.e., seeing snakes and beasts, etc...?
    You should try to orient them to reality. To help them understand 'real from not'.
    I tried this after I did my mental health clinial/course in NS.

    "I know that you see the snakes - but I don't see them."
    It worked.
    He stopped saying it for the moment.
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    I have run many a dogs out of the room that were bothering my dementia patients. Other people would argue that they didn't see them, you're at the hospital, etc only leading to increased anxiety because those darn dogs were still bothering them! I will reorient my pt that just get somewhat confused and can be reoriented and I also treat my psych patients differently. I have a daughter who has schizophrenia and I find the most important thing over anything else with her is assuring her that she is safe. Also how I deal with my psych patients depends where in the continuim of rationality they are. One thing I always like to tell new nurses that I learned through my personal experience is you cannot rationalize with irrationality. I read a really interesting article the other week. If I am ever in a nursing home please put me here:

    Please let me eat chocolate!
    tayloramaRN2be and VivaLasViejas like this.
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    thanks so much for sharing, I graduated in 2003 as an LPN and worked full time in a nursing for awhile. Re-orienting the demented was rarely, if ever successful. I agree that the only thing to do is agree with the patient and not argue.
    VivaLasViejas likes this.
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    I know I'm years late to this discussion, however...
    God bless you all... it takes a very special person to do your job.
    I am not a nurse but, both of my parents are in a LTC facility with severe dementia. This issue of reorientation is very real for me; their health is very good (not even general geriatric issues) and we could conceivably carry on like this for years. The difference in their day-to-day mental health is very obvious depending on who is working their ward that day... reorienting NEVER works, and avoidance only causes more distress. The best caregivers take that extra two minutes to listen and placate and cajole. This is a no restraint facility, so they use drugs that specifically warn of dangers in use in elderly patients... very frustrating. Mom is in a locked ward; Dad is on a short hall (as they don't have a ward for males). The issues of reorientating and not letting them visit each other when family isn't there have caused all sorts of grief. Seems like it would be much easier on all involved to take 10 minutes to let them see each other and have a cup of tea than to argue for 3 hours and purposely avoid letting them have contact. Thank you for this article and all the comments; it is so reassuring and feels like validation!
    On the lighter side;
    They are in their 90's and spend most of their time in the 1940's; Mom was an RN and Dad a pilot in WWII. Mom is redirected with 'charts' of her own to review and 'making rounds' and spends her time comforting other patients... when she's not firing the 'girls' and sending exhausted aides home to rest, or 'lazy' aides off to clean "If you have time to lean, you have time to clean!" Dad often thinks he's in an military hospital, and is only redirected with reminders that he needs to 'recover' in order to return to his wife.
    This is such a sad, sad disease.
    Thank you, again, to all of you who choose to help these patients have some peace, and maintain a wee bit of dignity.
    VivaLasViejas likes this.

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