pacify or orientate? Alzheimers... - page 3

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   Elektra6
    One of our residents insists she owns the building and can do what she wants. Last week she tried to get into a resident's room I was doing an admission on and steal her food. I told her this was not her room and to leave the woman's food alone. She punched me and spit in my face. I saw a CNA the other day redirect her from another resident's room by telling her they needed her in the office to sign something. She said, "the checks?", and the CNA said yes. The lady went back to her area without incident. She didn't even ask to sign anything. My experience is that each person is different and you need to individualize your techniques to help them. I reoriented a resident a few months ago who was constantly asking for her husband. I told her this was a nursing home and that her husband had passed away years ago. She cried for the rest of the night like it had just happened. I felt horrible. It may have been correct, but it felt wrong.

    -LTC nurse
  2. by   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.
  3. by   ragingmomster
    [QUOTE= P.S. The correct term is 'orient,' NOT 'orientate.'[/QUOTE]


    Jess, while the word orientate does bother me as does using the word "arouse" when "rouse" is preferable, please keep in mind that maybe you don't know it all...

    from merriam webster dictionary online -
    Main Entry: ori-en-tate
    Pronunciation: 'or-E-&n-"tAt, -"en-
    Function: verb
    Inflected Form(s): -tat-ed; -tat-ing
    intransitive verb : to face or turn to the east
    transitive verb : ORIENT

    Please take a step back from your opinion and listen to what many of these nurses are saying. I am also glad that you had a great psychology professor when you were in school. Perhaps you have forgotten that Alzheimer's is not a psychological condition but rather an organic brain disorder which involves neuron deterioration?
  4. by   UM Review RN
    One of my very favorite dementia residents, "Rose," believed that the locked Alzheimers unit was a big Italian wedding reception. Every evening, she'd approach the staff, apologise for being tired, and say, "This has been a wonderful wedding and reception, but I can't seem to find my son, who's supposed to drive me home tonight."

    We tried everything. Reorienting her made her angry. Telling her the truth made her frustrated. Finally one (horrible, everything-going-wrong) night, I had enough.

    "Have you seen my ride?" she asked me. "I want to go home now."

    "So do I," I muttered as I poured pills, thinking about the three incident reports I had to stay late to write up.

    But the ol' gal's ears worked just fine. She was thrilled that she was not alone in her predicament; someone else wanted to go home, too.

    Later on, I suggested that since it was late and there was a bed here, she should lie down for awhile, and when her ride came, we'd wake her up. She accepted, and this became our MO to get her to bed each night, otherwise she'd wander the halls and cry because she was deserted by her family.

    So what's the greater wrong? To "lie" to a delusional patient and gain their trust and cooperation, or tell the "truth" to a delusional patient and watch them get completely psychotic?

    My choice is ultimately safer for the patient and the staff, and I stick by it.
    Last edit by UM Review RN on Aug 29, '06
  5. by   ktwlpn
    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.
    No-methods for caring with dementia pts. are very different from dealing with psych pts. I believe some of us have pointed out that the approach depends on the pt and their response to it....Alzheimer's currently is recognized as having 7 stages.Aslo what works today may not work tomorrow...However if you follow the basic rules for communicating with these pts. you'll see that re-orienting them can't work.They loose the meaning of language.The more you talk the more agitated they usually become.That's where validation comes in-therapeutic touch,environmental control.Short simple sentences. I really think that if you refer to some of the links you'll understand how your aopproach is wrong.....
  6. by   ragingmomster
    Just a quickie...

    I spent 18 months working in a locked unit with 22 SDAT patients. One lady thought I was her sister.

    Not good considering her sister had stolen her beau back in the 30's.

    The worst was the day that she picked up a heavy metal pill crusher and had it behind me. She was mid backswing with the crusher over her head and behind her back with two hands on the handle about to come down on the back of my head. No one was close enough to stop her from trying to kill me.

    The pill crusher proved too heavy for her and it slid out of her hands and landed on the floor behind her.

    About a week later, after consults with staff and md, we decided to try an apology. I sat down with the pt during a calm period, before she started her sundowning and I gave her a heartfelt apology for taking her boyfriend. It lasted about 2 days. Then I did it again.
  7. by   flashpoint
    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.
    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.
  8. by   CapeCodMermaid
    [QUOTE=Jesskanurse]"Therapeutic lying" is absolutely inappropriate. It is unethical and in my opinion, it implies pure laziness on the Nurse's part. Telling the patient what you think 'they want to hear' does nothing for them therapeutically.
    It's sad that so many Nurses just take the easy way out by 'pacifying' these people.

    "Think of a time you've been lied to. Say your 12year old son said he would be at his friend's house but in reality he went to park to skate with a bunch of kids you don't know. You most likely would be upset that your son lied. If you had dementia, however, you may never remember your son saying where he'd be. He gets home and says, "I had a great time at the park." Whether or not you remember does not change the fact that he lied. It is no different when speaking to a client (patient). They may not remember their daughter isn't coming to get them, but it doesn't change that you lied to them."
    * * * * * * * * * * * * * * * * * * * * *
    You are wrong. It is not unethical to go along with an alzheimer's patient. To continually try to reorient them will only upset them and frustrate the staff. There is, and one would think it goes without saying, a huge difference between a kid telling his mom a lie to get away with some bad behavior, and a caregiver going along with a dementia resident. I suggest you read some of the aforementioned books on dementia. You can not improve the short term memory of a dementia patient.
  9. by   lovingtheunloved
    yeah, sorry
  10. by   lovingtheunloved
    Quote from santhony44

    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..."
    That is THE funniest thing I have ever heard!
  11. by   lovablelvn
    You are wrong. It is not unethical to go along with an alzheimer's patient. To continually try to reorient them will only upset them and frustrate the staff. There is, and one would think it goes without saying, a huge difference between a kid telling his mom a lie to get away with some bad behavior, and a caregiver going along with a dementia resident. I suggest you read some of the aforementioned books on dementia. You can not improve the short term memory of a dementia patient.

    I couldn't agree more, well said.
  12. by   CoffeeRTC
    Not trying to flame or start a mean discusion, but I'm very curious to your background and experince with the alz dementia patients? Have you spent time in a nursing home or in a community setting?
    Dealing with a confused or pt with short term delerium is very different. A previous poster mentioned that there are different forms of dementia...SDAT, vascular...etc Yes these all need to be considered.

    Please enlighten us on your experiences (not school instruction). Maybe the rest of us are missing something.
    Again...not trying to flame, but I'm always willing to learn something new.
  13. by   Jesskanurse
    Quote from ragingmomster
    Jess, while the word orientate does bother me as does using the word "arouse" when "rouse" is preferable, please keep in mind that maybe you don't know it all...

    from merriam webster dictionary online -
    Main Entry: ori-en-tate
    Pronunciation: 'or-E-&n-"tAt, -"en-
    Function: verb
    Inflected Form(s): -tat-ed; -tat-ing
    intransitive verb : to face or turn to the east
    transitive verb : ORIENT

    Please take a step back from your opinion and listen to what many of these nurses are saying. I am also glad that you had a great psychology professor when you were in school. Perhaps you have forgotten that Alzheimer's is not a psychological condition but rather an organic brain disorder which involves neuron deterioration?
    I will refrain from making any sarcastic comments here to respect your post. It was a good effort, but when you are going to quote a dictionary, remember to read the definition first. Orientate IS a word, yes, but it means 'to face or turn to the east.' The way the OP used it was 'orientated' to a situation, and that is incorrect. Orient refers to 'the orient' which historically was used to refer to the east, as in eastern asian countries. Again, I mean no disrespect by reminding you of this.

    Anyways... lets try to get back to the main topic shall we?

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