pacify or orientate? Alzheimers... - page 11

So I have worked my third day as a LVN in a LTC facility. Orientated for one day then turned loose...on the alzheimers lock down unit. 21 residents. A little scary, but I am fairly comfortable, so... Read More

  1. by   leslie :-D
    i'm talked out so i will summarize w/this:

    nobody can rubberstamp any one therapy as an absolute solution.
    i think we all agree that unless someone is in the early stages of alzheimers, reality orientation is futile and even cruel.

    i have researched all of the behavioral interventions used.
    therapeutic lying is indeed widely used and accepted.
    i cannot speak for anyone else, but i utilize therapeutic lying as a last resort.
    validation therapy does not work, even most times.
    it is a viable and realistic intervention but certainly not even nearly, always effective.
    a nurses' interventions should be as unique as are the needs and personality of ea resident.
    what works for one, will not necessarily work for the next.

    i know what my goals are with every single patient i care for.
    and i feel good about myself.
    i can sleep at noc, knowing i gave my personal best.
    as long as i treat ea pt with integrity and respect, knowing that i want to and need to abate any type of suffering, then i've done my job.
    whether we are nsg students or experienced nurses, this is a profession where learning is perpetual.
    the science of nursing is concrete but filled w/new and changing data that commands us to keep up.
    but it's the art of nsg that presents the real challenges, for there are no absolutes.
    when dealing with the ilk of human nature, we try and apply what we were taught.
    most often, this is not sufficient.
    we know that we must treat ea and every pt with benificence and dignity, but no one really ever taught us how.
    that's where the artform comes in.
    our own personal contribution that defines what works and what doesn't.
    as long as my intent remains in parallel with the grace of God, i will continue to do as i do.
    as long as i combine my knowledge base w/literally, my hearts' desire, then my pts and i will both be fine.

    leslie
  2. by   grentea
    When I was in nursing school I met a resident who was rather pleasantly confused. When I would ask her the standard orientation questions, she said that she was on a cruise ship with some friends. She even remarked about how wonderful the food was and how she was treated so nicely by all of the "workers" (her nurses and aides). And this made me think for a minute.....it would be almost cruel for me to assert, "No, you're in a nursing home." So we started talking about this and that and she told me about how she had travelled around the world and taken some cruises in the South Pacific. I will never re-orient a sick elderly person who thinks that their nursing home is a really nice cruise ship. Think about it...that's just awesome! I wouldn't ever take that away from someone. The subject of those who are not quite so pleasantly confused is an entirely different matter which I would certainly handle differently, but in the case of those who are happy in their realities, so long as they're safe, I say let them be.
  3. by   NRSKarenRN
    Working night shift hard to "reorient" patients with dementia.
    One night has women singing gospel songs and crying out for God as "Sunday at church"...attempted reality orientation, talking in soothing tones and telling her it was night time, she was in hospital, etc. Well 1 1/2 hrs later she had entire unit awake.

    Finally tried to reach her on HER level, got on the intercom to her room and said: " This is God speaking. I've heard your songs thank you, now it's time for quiet and sleep as nighttime." My fellow RN's jaw dropped. Within 30 minutes patient was asleep and call lights stopped coming on...other patients were able to get back to sleep.

    Sometimes you just got to be creative in meeting needs without chemicals.
  4. by   Jesskanurse
    Quote from NRSKarenRN
    Working night shift hard to "reorient" patients with dementia.
    One night has women singing gospel songs and crying out for God as "Sunday at church"...attempted reality orientation, talking in soothing tones and telling her it was night time, she was in hospital, etc. Well 1 1/2 hrs later she had entire unit awake.

    Finally tried to reach her on HER level, got on the intercom to her room and said: " This is God speaking. I've heard your songs thank you, now it's time for quiet and sleep as nighttime." My fellow RN's jaw dropped. Within 30 minutes patient was asleep and call lights stopped coming on...other patients were able to get back to sleep.

    Sometimes you just got to be creative in meeting needs without chemicals.

    Oh.... MY goodness. I can NOT believe you don't think is wrong! So you're telling me you basically conned this poor woman into thinking that God was actually speaking with her? I have tried to keep my mouth shut on this forum because I feel like I'm not getting respected whatsoever...but I have to jump in here.

    Have you ever heard of veracity?

    If no one agrees with me that this is unethical, I will be utterly shocked. Seriously.
  5. by   nursejohio
    Quote from NRSKarenRN
    Working night shift hard to "reorient" patients with dementia.
    One night has women singing gospel songs and crying out for God as "Sunday at church"...attempted reality orientation, talking in soothing tones and telling her it was night time, she was in hospital, etc. Well 1 1/2 hrs later she had entire unit awake.

    Finally tried to reach her on HER level, got on the intercom to her room and said: " This is God speaking. I've heard your songs thank you, now it's time for quiet and sleep as nighttime." My fellow RN's jaw dropped. Within 30 minutes patient was asleep and call lights stopped coming on...other patients were able to get back to sleep.

    Sometimes you just got to be creative in meeting needs without chemicals.

    A toast to you for thinking of that! After all other approaches failed, you had the creativity to find what the patient really needed. She could not accept the reality of her situation, and you found a way to enter her world. KUDOS!!!
  6. by   leslie :-D
    Quote from Jesskanurse
    Oh.... MY goodness. I can NOT believe you don't think is wrong! So you're telling me you basically conned this poor woman into thinking that God was actually speaking with her? I have tried to keep my mouth shut on this forum because I feel like I'm not getting respected whatsoever...but I have to jump in here.

    Have you ever heard of veracity?

    If no one agrees with me that this is unethical, I will be utterly shocked. Seriously.
    jesska, your post made me smile.

    i think God knows this nurses' heart as well as her intentions, and He would approve.
    afterall, it was hearing "God" talk to her, that obviously brought her some much-welcomed peace.

    what do you think this patients' view of veracity was? what was "truth" to her?

    and how would you have handled this?

    leslie
  7. by   Multicollinearity
    Quote from Jesskanurse
    Oh.... MY goodness. I can NOT believe you don't think is wrong! So you're telling me you basically conned this poor woman into thinking that God was actually speaking with her? I have tried to keep my mouth shut on this forum because I feel like I'm not getting respected whatsoever...but I have to jump in here.

    Have you ever heard of veracity?

    If no one agrees with me that this is unethical, I will be utterly shocked. Seriously.
    While I disagree with your opinion regarding this subject matter - I'm glad to see you back here posting. Sometimes I think we posters forget that when we continually rub someone's nose in what we perceive to be their mess (14 pages!) we tend to forget that this does not show respect and spare the other's ego enough to continue dialogue. Good to see you back.
    Last edit by Multicollinearity on Sep 6, '06 : Reason: comments not directed at any particular poster
  8. by   Multicollinearity
    Quote from earle58
    i'm talked out so i will summarize w/this:

    nobody can rubberstamp any one therapy as an absolute solution.
    i think we all agree that unless someone is in the early stages of alzheimers, reality orientation is futile and even cruel.

    i have researched all of the behavioral interventions used.
    therapeutic lying is indeed widely used and accepted.
    i cannot speak for anyone else, but i utilize therapeutic lying as a last resort.
    validation therapy does not work, even most times.
    it is a viable and realistic intervention but certainly not even nearly, always effective.
    a nurses' interventions should be as unique as are the needs and personality of ea resident.
    what works for one, will not necessarily work for the next.

    i know what my goals are with every single patient i care for.
    and i feel good about myself.
    i can sleep at noc, knowing i gave my personal best.
    as long as i treat ea pt with integrity and respect, knowing that i want to and need to abate any type of suffering, then i've done my job.
    whether we are nsg students or experienced nurses, this is a profession where learning is perpetual.
    the science of nursing is concrete but filled w/new and changing data that commands us to keep up.
    but it's the art of nsg that presents the real challenges, for there are no absolutes.
    when dealing with the ilk of human nature, we try and apply what we were taught.
    most often, this is not sufficient.
    we know that we must treat ea and every pt with benificence and dignity, but no one really ever taught us how.
    that's where the artform comes in.
    our own personal contribution that defines what works and what doesn't.
    as long as my intent remains in parallel with the grace of God, i will continue to do as i do.
    as long as i combine my knowledge base w/literally, my hearts' desire, then my pts and i will both be fine.

    leslie
    Thank you for this post Leslie. I look for your posts because I learn so much from them.
  9. by   Hellllllo Nurse
    Quote from Nascar nurse
    I like the term "therapuetic lying". Like the others have said.. YOU WILL NOT WIN and you will NOT convince them that their mother is not waiting for them outside. Often times "reality orientation" only serves to agitate a resident. Ya just gotta go with the flow and redirect their attention. .....
    I agree. I remember the old days when we were taught to always "reality orient." I knew after my first day in the real world of nursing that that wasn't going to work.

    I recently saw a movie on cable about a CNA/janitor and an alzheimer's pt in a nursing home. In the movie, the CNA uses "therapeutic lying" in one way, and it backfires on him. He tries the same technique in a different way, and it works.

    the movie is called "Assisted Living." It was very interesting and different. It was very accurate in its' portrayal of alzheimer's pts and nsg home pts in general. The only inaccurate part was that the nurse in the movie wasn't very busy!

    I highly recommend it.
    Last edit by Hellllllo Nurse on Sep 6, '06
  10. by   dijaqrn
    You can't orient a demented patient but you can redirect or distract them. Also, kudos to the creative nurses out there for their therapeutic white lies. I'll need you in a couple of decades!:Melody:
  11. by   Hellllllo Nurse
    Quote from cotjockey
    ...I would much rather see residents happy in their own world than fearful and agitated when we try to force them into ours....
    :yeahthat:
  12. by   santhony44
    Quote from earle58

    i know what my goals are with every single patient i care for.
    and i feel good about myself.
    i can sleep at noc, knowing i gave my personal best.
    as long as i treat ea pt with integrity and respect, knowing that i want to and need to abate any type of suffering, then i've done my job.
    whether we are nsg students or experienced nurses, this is a profession where learning is perpetual.
    the science of nursing is concrete but filled w/new and changing data that commands us to keep up.
    but it's the art of nsg that presents the real challenges, for there are no absolutes.
    when dealing with the ilk of human nature, we try and apply what we were taught.
    most often, this is not sufficient.
    we know that we must treat ea and every pt with benificence and dignity, but no one really ever taught us how.
    that's where the artform comes in.
    our own personal contribution that defines what works and what doesn't.
    as long as my intent remains in parallel with the grace of God, i will continue to do as i do.
    as long as i combine my knowledge base w/literally, my hearts' desire, then my pts and i will both be fine.

    leslie
    Excellent post! Very thoughtful, very true.

    This wisdom applies to every area of nursing, not just LTC.

    Thank you!
  13. by   CoffeeRTC
    Quote from earle58
    jesska, your post made me smile.

    i think God knows this nurses' heart as well as her intentions, and He would approve.
    afterall, it was hearing "God" talk to her, that obviously brought her some much-welcomed peace.

    what do you think this patients' view of veracity was? what was "truth" to her?

    and how would you have handled this?


    leslie
    Now I'm not speaking for Jesska, but with my experience in LTC at least 90% of the newer or newer to LTC nurses would have call and gotten and order for ativan....of course this would be after telling the res that they are in a nursing home etc and getting the pt even more agitated.
    Or maybe they would have dropped everything including the 30+ other patients they are taking care of and spent hrs dealing with trying to bring this pt back to the nurses reality. Hmmm....tell me what will happen to those other pts....the other ones with dementia who are now wide awake in the middle of the night confused as ever????
    HMMMM?

    Sorry...been there and done that and needed to d/c the ativan or haldol orders in the am and of course finish all of the previous shifts work because someone didn't want to "theraputically lie" or pacify.

    BTW, I think my God would approve

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