pacify or orientate? Alzheimers... - page 17

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
    Quote from cyberkat
    If I have Alzheimer's and someone told me over and over that, no my son Andrew isn't coming because he died a long time ago, that would be so cruel.

    I cannot imagine anyone wanting to do such a thing. THAT would be unethical.

    At the end of my life, let me have the peace of having my loved ones with me, even if it's only in my imagination.
    what's so sweet, is when these (and most others) pts are dying, they really do 'see' those who have already died.
    working in hospice for so many yrs, combined with books i have read by other hospice nurses, it's a very common phenomenon- and always so very comforting.

    leslie
  2. by   Katnip
    I hope so, Leslie, I hope so.
  3. by   txspadequeenRN
    I am coming back into this thread after taking a cooling off period. Please explain to me what experience you have with these type of patients. Because it really sounds like none.


    Quote from Jesskanurse
    Yes, It may be unethical in YOUR OPINION to tell her that... but any ethics board would tell you that you are wrong. As for your last sentence: How do you know what will damage your resident and what wont?? You dont. You are just using your own feelings and displacing them on the patient. You think it will damage her. Who are you to decide this? THAT is why it is unethical. What if there is a stage of the grieving process that she hasn't gotten through just because nurses are uncomfortable seeing her in anguish? I think that is what is happening. You cant have peachy happy patients all the time. Sometimes that anguish is therapeutic for them.
  4. by   txspadequeenRN
    I love the movie but it disturbs me that they went about portraying alzheimers/ dementia in that manner.

    Quote from lilypad2424
    Has anyone ever seen "The Notebook?"
  5. by   Quailfeathers
    I've worked with Alzheimer/dementia pt in a LTC facility and in private duty. There's a wonderful book The 32-Hour Day that has alot of helpful information on pt care/orientation. I agree that in most cases bring an alzheimer's pt into reality only makes the pt aggitated and more confused. I love the cow example; wonderful intervention. You may want to find some creative way of handling the daily confusion BEFORE it happens. Sometime just telling the pt ahead of time "your daughter is at work so I'll let you know when it's a good time to call" will calm your pt down and bypass the behavior all together. Just remember that an intervention that works today may not work tomorrow.

    Working with this particular disease takes getting used to, lots of patience, creativity, and understanding of the disease process/behavior. How these patients are handled makes a big difference in their world.
  6. by   Natkat
    The following is taken right out of the Fundamentals of Nursing Textbook by Potter and Perry.

    "Validation Therapy. Validation therapy is an alternative approach to communication with a confused older adult. Where reality orientation insists that the confused older adult agree with our statements of time, place and person, validation therapy accepts the description of time and place as stated by the confused older adult. 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.

    In validation therapy, statements and behaviors of the confused older adult are not challenged or disputed. The statements and behaviors are believed to represent an inner need or feeling. The appropriate nursing intervention is to recognize and address the inner need or feeling. Validation does not involve reinforcing the confused older adult's misperceptions, but reflects a sensitivity to hidden meanings in statements and behaviors. By listening with sensitivity and validating what is expressed, the nurse conveys respect, reassurance, and understanding. Validating or respecting confused older adults' feelings in the time and place that is real to them is more important than insisting on the literally correct time and place."

    So it seems nursing is coming around to understanding that it is the result that is most beneficial to the patient and not the process. I am relieved to know this.
  7. by   sbic56
    Jesskanurse is very new at all this. I think we need to cut her some slack. Time & experience will be her teacher!
    Last edit by sbic56 on Sep 18, '06
  8. by   rn/writer
    Quote from sbic56
    Jesskanurse is very new at all this. I think we need to cut her some slack. Time & experience will be her teacher!
    I agree. She isn't evil, just inexperienced. Let's shift the focus from scolding her back to finding ways to help this fragile population. I've taken many good ideas away from this thread. Hope I never have to use them (or have them used on me!), but it's nice to know they--and the many caring nurses who use them--are out there.
  9. by   speti4
    I work in a med/surg ward in a rural hospital and we almost always have at least one geriatric/ALC pt on our cencus. They come through the ER because they have fallen, caregiver has burnout, etc. What ever the reason, they can no longer live at home and are waiting for placement.

    The unit is definitely not an environment conducive to utilizing the various philosophies of care I was taught.

    I personally have found the best way is to 'join' them in their reality. If they are agitated and "waiting for mom" -- I would never try to reorient them by telling them that their mom is dead.. I might however ask if they would like a clean gown or sweater while they wait. I would also use any other creative distraction technique. Even therapeutic lying.

    But--with open stairwells and exits, restraining them by using a gerichair has become necessary. Sometimes just parking the chair at the nursing station, reclining it and covering the agitated pt with a heated blanket is all they need.

    With four or more other pts on my assignment it's not for lack of desire, but for lack of time that such a restraint becomes necessary.
  10. by   CapeCodMermaid
    4 other patients!!! Try taking care of 40 on 3-11 as one licensed person with 4 aides and being mandated to use 'as few restraints as possible". Goes to show no matter where we work, we are challenged to provide the best care we can.
  11. by   belfry
    Oh, for Pete's sake!
    Less than a year experience on ICU and you are an expert in dementia care??? Part of being a good nurse is being open to learning from others' experience and getting off your high horse occasionally to see that people who have been dealing with dementia patients longer than you have been alive just possibly may know a thing or two more than you.

    Before I became a nurse I did counseling on an inpatient geropsych unit, worked with HCFA on a grant with non-institutionalized Alzheimer patients, worked as resident care director in a LTC facility, and was on the board with the Alzheimer's Association, leading workshops for families with a new diagnosis and also led a monthly support group. So here is a news flash...what you read in a book last year and heard a lecture on one time does not make you an expert!!! Experience is the teacher here. You can benefit from the experience of others or you can wreak havoc in the minds and hearts of the most vulnerable of patients....whatever feels 'right' to you.

  12. by   speti4
    Quote from CapeCodMermaid
    4 other patients!!! Try taking care of 40 on 3-11 as one licensed person with 4 aides and being mandated to use 'as few restraints as possible". Goes to show no matter where we work, we are challenged to provide the best care we can.
    I hear you...been there, and do that too... Well--on occasion when I work 1100- 2200 PRN at a LTC facility. Then- I have 39 residents with 3 or 4 Care Aides. It is a tough job.

    I was referring to my regular nursing job on a M/S ward where the focus of care is on the acutely ill and is totally not equipped for the demented, but not sick senior. AND have four+ other acutely ill pts.

    I'll use whatever technique necessary to soothe an agitated senior.
    In addition to our place having many exits to the outdoors, we are at the top of a hill and any road a confused senior may take goes dowwwn.
  13. by   rn/writer
    Once again, I need to remind everyone that continued negativity toward Jesskanurse will not be tolerated. State your opinion without referring to her in any way. Members who hold an unpopular opinion need to be prepared to hear plenty of dissenting reactions, BUT they do not need to be ridiculed, scolded, shamed, or spoken of in any other way that makes the discussion personal.

    Members who do not comply with this request may find their posts edited or removed and they may be given warning points as well. This has been an informative and interesting thread. Rather than close it down, I will deal with anyone who does not heed the above request on an individual basis.

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