pacify or orientate? Alzheimers... - page 2

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   flashpoint
    There is a lot of debate about whether validation therapy or reality orientation or 'therapeutic lying' are good or appropriate or whatever. I like the validation therapy technique...when it works. When I spend time reminiscing about something with a resident (for example, one who wants to talk to her father) and a few minutes later, she is asking again, sometimes it is less distressing to the resident for someone to simply tell her that he isn't available right now...this works for this particular resident, but not for all. Sometimes validation therapy doesn't work...the resident wants to SEE her father, not just talk about him and gets agitated when you try to redirect..again, sometimes it is less distressing to simply tell her he isn't available right now. The one I am thinking of gets really upset if you remind her that he died years ago and that she is 96, not 26!

    Reality orientation doesn't always work either...I've seen residents get more upset and confused after looking at a calendar and seeing that it is 2006 than they do believing it is 1948...not always the best answer to let them believe it is 1948, but in the overall scheme of things, does it matter? I would much rather see residents happy in their own world than fearful and agitated when we try to force them into ours.

    I think it is best to start with techniques like validation therapy, but to know when it isn't working and to figure out what will work. One of my instructors in paramedic school always told us that education is learning the rules..experience is learning the exceptions. I think he was right...sometimes you just have to punt.
  2. by   P_RN
    i called my sister from mama's room at the nh. i handed mama the cellphone and she talked w/ sis for about 5 minutes. she handed me the phone back and said what's that?

    mama it's a telephone.

    "oh really i never saw anything like that...."

    and that folks is alzheimer's. she can remember her phone number from 1925, she can recall a monkey my granddaddy had in 1947, but now every 2-3 minutes is a whole new day.

    orienting someone who can't hold on to the orientation is just going to frustrate both of you. i don't like the lying term, or pacifying, but re-socializing seems to work for mama.
  3. by   Jesskanurse
    Quote from michelle126
    So how many years have you worked in LTC? I'll bet almost none?
    The lazy and innappropriate/ illegal way to do it is to restrain and medicate. Fortunatly for my pts this is not an option. I can go on and on about why you are wrong on so many levels, but I'll just let you see how far you get with telling "the truth" to your demented patients.

    Go right ahead... I'm very interested to see what you say in regard to me being 'wrong on so many levels.'

    I want to know how you try to justify lying to your patients.
  4. by   ktwlpn
    Quote from Dalzac
    I use this kind of redirecting all the time. I learned this with my grand mother.
    My great aunt and I went to see her one day and granny said she had just gotten home from a wonderful time in Galveston. She was bedridden in a ltc at the time. My Aunt began to correct her and attempted to reorient her I was a nurse at the time and stopped her. and then asked Granny How is the weather there and was it too windy. and she began to tell me stories of when she was a girl in galveston.
    My aunt was furious and raled at me for an hour. I didnt care My Granny and I had a great day at the beach.
    Oh I LOVE your post.! Sadly that kind of communication is not the norm.Too many family members are like your aunt...I'm glad that you and your g-mom got to enjoy the beach again....
  5. by   ktwlpn
    Quote from Jesskanurse
    Go right ahead... I'm very interested to see what you say in regard to me being 'wrong on so many levels.'

    I want to know how you try to justify lying to your patients.
    You sound a little bitter and angry-are you dealing with dementia in a loved one?
    We are talking about pts with diagnosed dementias.Not the kind of patient you see daily in your ICU...That's the difference .Your patients need to be re-oriented and hopefully will return to their baselines(mental and physical)...Ours are NEVER going to get better-all we can do is help their loved ones accept that and keep them as comfortable as we can for as long as we can.We want to maintain their highest level of functioning as long as possible and maintain their dignity...."Re -orienting" the demented was how it was done years ago-all the studies show that is not effective and is in fact damned cruel....Telling a 96 yr old demented resident that her mother has been dead for 45 yrs is in-appropriate.Not every method works for every pt. every time.We have to be creative....We also have to learn the normally abnormal behaviors for our pts so we can recognize a change that may signal something like a UTI.Your example of the 12 yr old kid going to the park is flawed.The dementia resident won't remember they have been lied to....Every pt has be addressed in an appropriate manner -you have to take into consideration the stages of dementia and where that pt. is at the time....I don't LIE-I validate..
  6. by   CoffeeRTC
    If my pt insists its time to get up and go to work or she must go make dinner....telling her he doesn't work or she doesn't make dinner anymore isn't going to work. Fighting with them and insisting that they understand that they are in a nursing home, its 2006, their mom is dead...etc ain't gonna work. They will become more frustrated and upset and that could last all day long.
    As a previous poster stated...validation doesn't always work. Telling that person...hey...its your day off or I made dinner...etc will. Is it a lie....yes.
    We use very little psych meds, hardly any restraint (maybe a few side raiils or geri chairs) and I've worked in LTC wth very difficult alz pts for the last 10 yrs. Rarely do we have a problem when we treat res with dignity and respect using validation and the theraputic lies.
  7. by   flashpoint
    When I was a brand new EMT, we picked up a lady who had fallen and was very confused. She was combative, crying, yelling, spitting, etc until I walked in the door. Somehow she thought I was her friend Margaret. The EMT in charge started trying to convince her I wasn't Margaret, but I just sort of jumped in and played the role. I talked to her about her grandchildren, asked her what she was growing in her garden, asked her if she wanted me to lock the door when we left, and told her I would get a hold of her family and tell then what happened...and we managed to safely get her immobilized, get her into the ambulance, and get her to the hospital. When we got to the hospital, I waited with her until her daughter got there and she was fine. The EMT in charge was not happy because you should NEVER lie to your patients...I wonder how much harder it would have been to get her to the hospital safely if "Margaret" hadn't shown up.
  8. by   santhony44
    Could someone direct me to a source of information about validation therapy? I don't work LTC so I'm not familiar with that.

    "Back in the day" when I was a student and new nurse, orienting patients to reality was what we were taught. It only took me a short time as a nurse to figure out that it might not work real well.

    We had a patient with MID. She looked exactly like my conception of Mrs. Santa- round pink cheeks, twinkling blue eyes, curly white hair, pleasantly plump. She was also a real Houdini and could get out of a Posey or wrist restraints several times faster than you could put them on. (This was more than 20 years ago when restraints were common). She was very sweet and quite confused, trying to get someone to take her to visit her sister. We reoriented her repeatedly, many times a shift. Then one day it hit me.

    I was telling "Mrs. Claus"
    yet one more time where she was, what day it was, and so forth. She was smiling at me and patting me gently on the arm. She was humoring me!! I could almost read the thoughts in her head: "Poor dear, she's so confused! She thinks this is a hospital and she's a nurse..."

    I've seen plenty of patients get agitated with reorientation, but never another one who made it so clear that I was the one with the problem!
  9. by   CoffeeRTC
    Quote from cotjockey
    When I was a brand new EMT, we picked up a lady who had fallen and was very confused. She was combative, crying, yelling, spitting, etc until I walked in the door. Somehow she thought I was her friend Margaret. The EMT in charge started trying to convince her I wasn't Margaret, but I just sort of jumped in and played the role. I talked to her about her grandchildren, asked her what she was growing in her garden, asked her if she wanted me to lock the door when we left, and told her I would get a hold of her family and tell then what happened...and we managed to safely get her immobilized, get her into the ambulance, and get her to the hospital. When we got to the hospital, I waited with her until her daughter got there and she was fine. The EMT in charge was not happy because you should NEVER lie to your patients...I wonder how much harder it would have been to get her to the hospital safely if "Margaret" hadn't shown up.
    Yes...that is what I'm trying to describ. A lot of times you are thier mom, sister, friend etc. I worked with one aid who reminded a res of her dghter. The dghter was abusive toward the mother and this aid was unable to care for this pt.
  10. by   Jesskanurse
    Quote from ktwlpn
    You sound a little bitter and angry-are you dealing with dementia in a loved one?
    We are talking about pts with diagnosed dementias.Not the kind of patient you see daily in your ICU...That's the difference .Your patients need to be re-oriented and hopefully will return to their baselines(mental and physical)...Ours are NEVER going to get better-all we can do is help their loved ones accept that and keep them as comfortable as we can for as long as we can.We want to maintain their highest level of functioning as long as possible and maintain their dignity...."Re -orienting" the demented was how it was done years ago-all the studies show that is not effective and is in fact damned cruel....Telling a 96 yr old demented resident that her mother has been dead for 45 yrs is in-appropriate.Not every method works for every pt. every time.We have to be creative....We also have to learn the normally abnormal behaviors for our pts so we can recognize a change that may signal something like a UTI.Your example of the 12 yr old kid going to the park is flawed.The dementia resident won't remember they have been lied to....Every pt has be addressed in an appropriate manner -you have to take into consideration the stages of dementia and where that pt. is at the time....I don't LIE-I validate..
    No, I fortunately do not have any family members or close people dealing with this disease. I just happen to take mental health seriously and as a healthcare professional, I am bothered when other Nurses think it's acceptable to lie to patients. I only wish other Nurses had a great psych instructor like I had in school.
  11. by   flashpoint
    Quote from Jesskanurse
    No, I fortunately do not have any family members or close people dealing with this disease. I just happen to take mental health seriously and as a healthcare professional, I am bothered when other Nurses think it's acceptable to lie to patients. I only wish other Nurses had a great psych instructor like I had in school.
    So...what do you suggest? I'm not trying to be rude here, but a lot of your posts do come off as a bit uppity and condescending. You seem to do a lot of correcting and instructing...tell us how we should do it.

    Apologies in advance for sounding like I am flaming...just getting frustrating with people who are have no experience in our world telling us how it should be.
  12. by   cathy54
    Exactly right.
  13. by   ktwlpn
    Quote from Jesskanurse
    No, I fortunately do not have any family members or close people dealing with this disease. I just happen to take mental health seriously and as a healthcare professional, I am bothered when other Nurses think it's acceptable to lie to patients. I only wish other Nurses had a great psych instructor like I had in school.
    You need to understand or at least acknowledge the difference between the psych patient and the dementia patient.There is a BIG difference in the treatment of the 2.You seem to be stuck on what you perceive to be "lying" I really hope this thread will encourage you to seek out some knowledge.Too many nurses don't understand dementia and the challenges we all face when dealing with these pts. Many experienced psych nurses are not familiar with the different types of dementia and the treatments available.Here are a few links to get you started......................http://www.alz.org/ http://www.caregivertips.com/?a=2&kw=alzheimer's http://www.psychguides.com/gagl.pdf (especially the section for caregivers)
    Last edit by ktwlpn on Aug 29, '06

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