pacify or orientate? Alzheimers... - page 12

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   squeakykitty
    This is a very interesting thread. I would really hate to be the one who reminded a resident that someone they loved died. That would just hurt them a lot, telling them that to bring them back to reality, and having them grieve all over again. And, some people with dementia won't come back to reality no matter how hard someone tries,(I worked with one), others are just slightly confused, and just need a little orientation.
  2. by   flashpoint
    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.
    It is not a matter of not respecting you...I certainly see your point, but I know that the textbook way to do things isn't always the best way for everyone. I believe that textbooks are a guide, not an absolute...what works for one person, may not work for the next person. When I worked at the hospital, we had a lady who came to the ER about once a week with a migraine. Narcotics didn't help, migraine meds didn't help, NSAIDS didn't help...what did help was a GI cocktail. No one knows why the GI cocktail worked, but we gave her one for nausea one night and the migraine went away. Should we not give the GI cocktail for a migraine because that isn't what it is for? I know it's not the same thing as pacifying an Alzheimer's patient instead of forcing them into reality, but it is just an example of doing what works instead of what the books say or what makes sense to us. I try the textbook way of doing things first...if it works, great...if it doesn't, I need to come up with plan B.
  3. by   nsgmjr
    This is from Potter and Perry's Fundamentals of Nursing 6th edition, page 254. "Validation therapy is an alternative approach to communicate with a confused older adult. Where reality orientation insists that the confused older adult agree with our statement of time, place, and person. Validation therapy accepts the confused older adults description of time and place. Older adults with dementia are less likely to benefit and more likely to become agitated by the caregiver's insistence on the "correct" time, place, and person." As far as nurses being lazy who use this therapy according to Potter and Perry, " The statements and Behaviors are believed to represent an inner need or feeling. The appropriate nursing intervention is to recognize or reinforce that inner need or feeling." From my own experience this is true. And this is what new RN are being taught. I have to believe that this statement in Potter and Perry is based on research and knowledge.
  4. by   nsgmjr
    Actually it is in the textbook only they give it a less contraversial name. The new edition of Potter and Perry's Fundamentals of nursing calls it "validation therapy." According to the textbook, it is of no benefit and more likely to agitate the older person with dementia or alzheimers. They too seem to believe that the dementia patient should not be challenged or disputed. This is what they believe the nursing intervention should be. "To recognize and address their inner need." They also believe, as do I, "That by listening wiht sensitivity and validating what is expressed reflects respect, reassureance, and understanding." So keep up the good work!
  5. by   nsgmjr
    sorry i double posted.
  6. by   Nurse_Pauline
    "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."

    This is great. I applaud your innovation and your imagination. In the end you need to not restrain nor overmedicate a resident to calm them. Both of those interventions can cause more harm then good and I can not imagine anyones God not wanting a calm secure resident. And you validated her feelings at the same time. Bravo. And if i could ask Jesska why she felt this is so unethical? Because it was a lie? A lie that resulted in the resident actually getting some rest(not to mention the other residents) without overmedicating, having the resident or another resident fall because she needs to get the "collection plate" or whatever? By having the resident maybe say to herself "hey He hears me! great!" Is all that so bad and wrong? I am really trying to understand why someone would feel this way,without making you feel disrespected or attacked. But when you think of some of the outcomes that can actually HARM a resident by not telling the truth, or by being a little creative......isnt it better for the resident,and isnt that why we are all nurses? To help and care for our residents in the best possible manner?
  7. by   grace90
    I worked in LTC as a CNA before becoming a nurse. One patient was particularly agitated one day, and was sitting in her chair yelling that she was stuck in a pool and couldn't get out. After a few minutes of listening to her, I walked up and took her by the hand and told her I would help her out of the pool. As she stood up (she was able to walk with assistance) I told her we were stepping out of the pool and that she would soon be out of it and as she took a few steps I told her she was getting out of the pool. Then I walked her in a circle and then as I helped her back into her chair I told her she was safe and dry now. She told me thank you and was quiet and calm again.
  8. by   ktwlpn
    [QUOTE=Jesskanurse] 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.
    QUOTE] You've got to support your view with some facts and you have not been able to do so. Lack of experience in dementia care also does not add any credibility to your opinion...Sorry if you feel "dis-respected" It's because you are not adding anything to the debate. I've been in situations similar to the post above and resorted to pretending to be the Lord-When a resident is so agitated that she is SOB and her b/p is elevated because she thinks she missed church or devils are after her I'll do ANYTHING I can to comfort.They usually won't accept a PO med and I don't like to have to hold a little old lady down for an IM....
  9. by   KScott
    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.
    God would surely inspire someone to make a sick person feel safe and whole. He works through everyone, whether you agree with them, or not.
  10. by   leslie :-D
    Quote from KScott
    God would surely inspire someone to make a sick person feel safe and whole. He works through everyone, whether you agree with them, or not.
    amen.
  11. by   RebeccaJeanRN
    Quote from KScott
    God would surely inspire someone to make a sick person feel safe and whole. He works through everyone, whether you agree with them, or not.
    Huh? j/k Kind words but not sure what you meant exactly. If you meant that people can be a little nicer on this thread, and allow for the fact that all of us are really coming from the same place, which is wanting to provide quality care for our fellow mankind, then I agree. If, however, you mean that everyone does well, no matter what, due to inspiration given from God, well then...no nurse would ever kill a patient on purpose with a lethal injection, and yet we know THAT has happened in the past!

    Hey all, its starting to seem like we're beating a dead horse here, and even getting a bit testy while we're doing it...no?
  12. by   slinkeecat
    I must say that everyone's posts are interesting and insightful.
    I would just like to say one thing...
    EVERY BEHAVIOR HAS MEANING.
    I have a background in LTC, PSYCH, and MED/SURG, ICU etc
    I think it depends on the stage of dementia...
    There are many wonderful things we have learned thru evidenced based practice...
    all the older nurses...can you remember when A&OX3 was the goal come hell or high water and we were told that we must attempt to re-orient. ???

    I am not a proponent of LYING,but I do agree that you need to be in the moment of the patient/resident's reality. Tell the truth....who's truth??
    the patient/resident's truth.

    Behavior problems.... all behavior has meaning. You must recognize this...

    I had a pt who would toss his M&M candies on the floor, in the hall way daily at 5am...dump his dinner tray in his bed, hide food..... staff would get so annoyed at this gentlman and he would become combative when he saw them getting the broom and dust pan to clean the mess.... one morning, he tossed the m&m's and I tried to redirect him by getting him to come with me to get coffee in the nurse's station and I was talking w/ him as we got coffee... I asked him so how was his morning? and told me that he was doing all right, i asked him so what were you doing with that sack there? he told me he just got done feeding the chickens and when we rounded to corner he said ... "look they ate it all " We talked about his farm life as a boy.... this went along way to understand why he poured his milk and dinner tray on his bed..... he was slopping the hogs.....
    We got activities to do gardening w/ him and daily walk w/ bird seed to fill feeders and etc..... no more "behaviors".....
    This man was a successful lawyer.... we had really no idea of his humble beginnings and Alzheimer's took him back to that palce in time as a young man...
    Who am I to argue.... Validating them...."you miss your mom, huh, tell me about her?" way more therapuetic then "she's dead!"

    Jesska nurse... I so hear your point. But I also know that there comes a time when a nurse has to use good compassionate nursing judgement rather than a text book answer... making a patient more combative, agitated is unsafe for other residents and staff. Sometimes you have to do the greater good and put your text book away before that resident "brains" you with it.

    I think you are a wonderful caring nurse and the others are too....a difference of opinion is to be expected... I am so thankful that there are nurses who really "get" and understand dementia and adjust their care to the individual's needs.
    I probably would find you to be a top notch nurse to take care of me if I needed a bandaid... meaning you probably have got great clinical-technical skills.....
    But when I am old and demented... I'll be the flashy chick in purple w/ a red hat tossing those damnable nursing text books at you....lol
    lol..... I loved everyone's posts..... All Nurses ROCK!!!!
  13. by   ktwlpn
    That's a great post-and a nice place to end my participation in the thread cause I think it has outlived it's usefulness...Hand me a shovel,it's time to bury that horse.....(I'll catch you all in another forum)

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