pacify or orientate? Alzheimers... - page 14

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   anichols
    i've worked locked alzheimer's and psych. they are in no way the same, excepting the acting out. and this seems to be what the lady posting seems to be missing. the degree and friends she cites as her reasoning are the same as many others have...who have different opinions. perhaps she needs experience, or perhaps just a reminder that certainly she herself has had cases where the textbooks did not cover the scenarios she may have seen and she has had to adapt the theory to the case. that too, she will hopefully recall, is taught along with the theories. perhaps if someone had not used the label "lying", thus making her feel she needs to be defensive at being labeled as amongst those who are dishonest? perhaps if another more politically correct term were used?
    on her behalf, she is most likely coming across as argumentative not because she is actually so but because it is her way of trying to explain her viewpoints and respond to others who have not yet found the "magic words" needed to give her a clear grasp of the picture...she is (hopefully) trying to work it out by re-iterating the areas she is stuck on until she can have the resolution needed. much like an alzheimer's patient, come to think of it.
    as for reminding someone of a death and making them re-live it for therapuetic reasons in this given instance?...specifically against the do no harm, as it causes medical issues (ie--hr, b/p, et cetera). also, they may have dealt with it just fine before--before they "became" a newly-wed again, or before they went back to being 40 again. re-opening it to make it fresh, when they honestly for organic reasons cannot recall--not just blocking or disassociating--it, to be hashed through, forgotten, and then reminded again and again and again. sorry. unending grief cycle is in no way therapuetic. it is simply cruel.
  2. by   bradleau
    That is so true. Same with DT'S, I will joke or be serious and help look for those snakes or spiders that are in the bed with the patient. But the day I actually FIND snakes or spiders I tell the patient up front to be prepared to hear me scream!
  3. by   lpn1972
    Quote from Jesskanurse
    Experience isn't everything. I just know how to use my resources and happen to find this topic interesting. My resources include include a 4 year college degree, great psych nurses, and friends with masters degrees in psychology.

    I'm sorry I have to disagree with you! Experience IS everything.
    I don't like the term "therapeutic lying" because as far as the pt is concerned you are NOT lying. I think trying to re-orient a dementia pt is cruel and abusive. Have you ever sat with a 100 yr old pt after telling her that her Mother/Father etc is dead? I will NEVER tell my pt's that. I would much rather tell them that they have gone shopping, they're sleeping what ever. In the dementia's pt's mind they're loved ones are alive telling them that they are dead is in a way LYING to them.

    Please tell me Jesskanurse what do you do when re-orientating your pts results in an increase of agitation? Do you medicate? Restrain?
  4. by   elizabeth321
    Reorienting alzh pts is old school and inappropriate...it has been well documented that it is no longer appropriate.

    Liz
  5. by   CaperLPN
    Hi Everyone,
    I've been a member here for over a year and this is the first time I've felt compelled to post a reply to any thread.I've recently completed a re-entry to practice course and I've been offered a position at my workplace as an in-charge LPN. (25 residents,4 staff). My response to the Director of Care... keep me off the Alzhiemers units (of which we have two) and I'd consider switching over.There are 11 units in total,I'm willing to work the other 9.Still waiting for her reply.I am not comfortable dealing with this type of resident and don't think I should have to work these units if I choose not to. I am at the top of the senority list,with at least 20 LPN's below me to be scheduled for those units.If I choose to lose a shift because I don't want to work those units,then tough luck for me,I've no complaints about that. These residents are not the type I wish to work with,I don't think this is a bad thing,for instance,I'm very comfortable with palliative care. Many other's have chosen to specialize in certain areas,so,what makes me any different? Anyone have any thoughts on that?
  6. by   twotrees2
    Quote from Lfransis
    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 far. (should I be?)

    Mrs. X is driving me crazy. For my three days she has asked to call her daughter to come get her.She is going home, looking for her car, easily agitated,etc.
    The aides pacify her: "Mrs. X your daughter is at work, you can call her when she gets home from work" " your going home after lunch" This goes on all day.

    I am new with Alzheimers behavior. I am new at being a nurse.
    I don't feel good about telling her she can call her daughter to get her
    "after she gets off work" , or that she is going home.
    Is this not implanting the idea even futher, possibly even creating a cycle?
    Any advice/ suggestion?
    in the dementia's the resident is not in the here and now- they are in their here an now which is usually the past somewhere - there is , in my opinion, no reason we cant go to their here and now and help them to calm. if you try to orient them to our here and now they will likely get even more agitated and escalate to even further states of agitation. it all depends on thne resident and how far along in thier dementia they are.
  7. by   pyrolady
    UMMMMMMMMMMM, sorry Jesskanurse, I (as well as many others) disagree. A person with Alzheimer's only gets agitated when you try to make them understand something they are no longer able to do. Actually, our lady who runs around the building just to calm her patient and make sure she is content has the right idea - and is to be complimented on her originality - you go the extra mile. Reorienting someone with Alzheimers does NOT help build long term memory, ten minutes after you tell them, they no longer remember what you said.

    I used to have two lovely laides in the same room who had dementia and they had the same argument every night - to leave the light on or not. Right when you think you got it settled, walk out of the room, and opps - there goes the same argument again. Next night - yup, same thing.

    Another lady loved to come by my desk during the midnight shift every twenty minutes, "has the train come yet??" "Nope Violet, you just missed it." "Well, when is the next one due?" "Oh, about half an hour." Violet would go back to her room and unpack, then REpack her suitcase and come on out for the next train. Sorry - reorientation would have REALLY upset both Violet AND her travel plans.

    You have to have a special love and understanding for victims of dementia - my mom being one of them. I only tried to re-orient her once - it was the day she thought I was my niece (her granddaughter) - it broke my heart to know that mom didn't know me. So all of you special nurses out there working with these people - thanks from me. I appreciated your love for my mom before she died, and the patience you showed when she didn't know who she (or I) was anymore.
  8. by   twotrees2
    Quote from Jesskanurse
    Well, first off, taking care of a patient with dementia IS taking care of a patient with a psych issue. Psych can be found everywhere, not just in behavioral health facilities.

    What should we do as Nurses? We need to allow the patient as much ability to function independently of staff as possible to be considered therapeutic. If you have a patient that is constantly asking you the same question and you continue to feed into their delusion, you are not assisting them in being more functionally independent. You in fact are allowing them to depend on you, because they may not remember asking the question already, but they will remember that you have helped them in the past.

    Dementia cannot be treated as a blanket disruption in memory. It depends on the cause- to in every case pacify the patient and not attempt to reorient is not being attuned to the fact that not all patients with dementia have it because of the same cause. Also, dementia affects different parts of the brain depending on the cause. To blanket pacify is laziness because it's not keeping in mind any of these factors.

    If therapeutic communication did not work, I highly doubt we would be taught it in Nursing school.
    the OP stated they were on a locked unit - and by the time they get to the locked unit there really is no chance of recovery from the disease or they wouldn't be there ( we have had some come in and once their meds are working they DO get moved cause they CAN be reoriented and dont need to be locked up - if one feels lying is bad - wouldn't they also feel that locking them up is also wrong? i would love to tell the residents the truth - however it likely will as many have pointed out to get even worse or depressed or whatever - lying can be therapeutic - for instance we have one who was a nurse and is always attempting to "take care of" the other residents - we " allow her " to do so - she has charts and things of the like and she sits and helps us do "our work" - though she can not even write anymore ( its all scribbles) she writes up our charts - thus giving her a feeling of usefulness and keeps her happy. i dont understand why anyone would purposely make a resident upset by repeatedly reminding them their hubby or kids are dead or that they are in a nursing home - its not just a nursing home - its their home and that's all that needs to be said - you are home here i will show you your room etc - works great -
  9. by   Sheyen
    Jess, you say we are lying to the resident, but think of this, we are telling the truth, according to WHAT THEY KNOW. A while back I had a resident get up and wander around at 4 am, she was looking for the oatmeal so she could make breakfast for her granddaughter, and get her granddauther off to school, I said *okay, give me a minute and I will help you find the oatmeal.* (I was in the middle of bedcheck), and then I redirected her into the dining room with some milk and cookies. Perhaps I lied to her, but I also validated what she was thinking, and HER reality, and then redirected her in another direction. Arguing with someone who is not of our reality, well it just wont work. I have always compared alzheimers patients to two year olds, number one rule is, DO NOT ARGUE, second, allow them to THINK they are in control, but by redirecting you are the one in control.
    If I have to lie to my residents to make my job easier, and give them peace of mind, that is exactly what I am going to do. As the other one said, it is alot easier to sit down for five minutes and see if we can guide the conversation somewhere, then to allow them to run off thru the building, perhaps hurting themselves or others. If they are approached with the *truth* as the movie says *they cant handle the truth*, so we give them the truth as they see it.
  10. by   twotrees2
    Quote from cotjockey
    Therapeutic communication is one of the latest and greatest theories in dealing with dementia patients...it doesn't mean it works...often it does, but often it does not. If letting a resident believe that I am "Margaret" or having them sign checks or telling them the cows have been milked keeps them from getting agitated and possibly injuring themselves or someone else, I don't think it is a bad thing. Sure you should try to do the "right" thing first, but the "right" thing isn't always the best thing. I'm certainly not saying we should run around all willy-nilly lying to our residents and letting them believe whatever they want to believe just to make it easy for us, but you often have to simply do what works.

    Our town has a home for children with special needs...one of their residents gets pneumonia very frequently and needs to be transported by ambulance. Our protocols indicate that we should administer O2 because of his respiratory distress, but every time we do, he gets EXTREMELY agitated and his SpO2 drops further than it does if we forgo the O2...it is better to try and force the O2 simply because it is the "right" thing to do? I don't think so. Therapeutic communication, validation therapy, reality orientation, etc should be tried first, but sometimes you just have to go with the flow and do what is works to keep your resident safe, calm, and medication free...I hate having to sedate someone because a staff member told them their mother, father, and brothers and sisters are all dead. Sometimes you can't do anything about the cause...all you can do is treat the symptoms.

    oh there is nothing worse than coming on my shift and fining out that they have given every resident that sneezed a pill to calm them or even 2 - gads - there really are people who do that - prn does not mean o it every day to ease your day. sigh.
  11. by   katie258
    Am only a student but have some dementia care experience and it is best practise in Australia to enter from the clients point of view. Like if you have someone who wants to catch the bus you just tell them that the bus has broken down but they can stay here for another night free of charge kind of stuff. I don't think that if a patient is not going to recover normal brain function that reorientation is going to work. It's kind of like palliative care isn't it? You make sure you control the pain but know you can't fix the problem? I don't know if that makes sense but thats what we're being taught at school.
  12. by   medpsychRN
    Interesting post. I work nights on an inpatient psych unit. We are the overflow for the geropsych unit. Not all, but the majority of the dementia patients we treat have an advanced disease.

    These patients come to us agitated. Reality orientation only increases their agitation. Medications are sometimes helpful. But medications don't make the patient any more agreeable to reality. It just makes them sleep...when they work. Ativan disinhibits patients. We use it rarely in cases of dementia. Atypical antipsychotics seem to work best. However, you have to be very careful when dosing elderly patients. They can experience side effects more quickly.

    Restraints are useless and are only used when all else has failed and safety is an issue. If you thought they were agitated - restrain them...it gets worse!

    We use lots of distraction techniques but what seems to work best is walking. I have walked many a mile at night.

    I wish I could say that I know all there is to know about working with dementia patients. I don't. They teach me something new every time. I also wish (really wish!) I had the solution for calming someone. It is a horrible disease and these patients are suffering.

    When it comes to "lying", either directly or by ommission, I have no problem. I'm going to use whatever works. I can spend the night trying to comfort someone or I can spend the night trying to convince them their mother is dead. I may win the war but I sure lost the battle. Am I lazy? PLEASE! Our dementia patients are 1:1. I work hard!

    I am always open to suggestions. May I just say I know nothing about working in the NICU. If I'm getting advice from a NICU nurse, I'm going to believe (and respect) she know's what she's talking about.

    There have been many great posts. Love the milking the cows thing! God over the intercom was brilliant. Can't wait to tell my coworkers about that!
  13. by   sbic56
    What on earth is the benefit of orienting these patients?? Doing so is bringing "ethics" to an absurd level. They are not living in the here and now. There is no sense in orienting them to what they cannot deem as reality anymore in the first place. It would be considered cruel to do so, IMO. They aren't going to remember the interaction in a little while anyway, but they are going to become agitated when they are told they are wrong in the present. The brain is deteriorated to the point where their cognitive function is losing ground daily, so orienting to what is "real" hurts more than it helps. So, yes...go milk the cows and get god to come over the intercom, if it means a better day for the patient!!:wink2:

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