pacify or orientate? Alzheimers... - page 4

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   lovingtheunloved
    Tell my 88 year old resident who constantly looks for her mother that her mother died in 1964. Then watch her grieve all over again. Watch her cry hysterically and refuse to eat and say she wants to kill herself. Hey, why not "reorient" her on a daily basis, as she forgets the conversation every day. THAT is unethical.

    (and someone at work got the bright idea to do this for four days before she figured out maybe that wasn't the greatest idea.)
  2. by   Jesskanurse
    Quote from michelle126
    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.
    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.
  3. by   cathy54
    To Jesskanurse: May we please have some background. It would be very helpful to know where you are coming from. Also, in dealing with alzheimer's patients/residents, I always have to keep in mind that there IS the book way and then there is reality. I have seen nurses really upset an already upset p/r by telling them the truth to the point of medication. Not a good thing.
  4. by   UM Review RN
    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.

    Experience certainly is not everything. Therefore, since you find this topic so interesting, I challenge you to try volunteering on an Alzheimer's unit and putting these textbook theories into practice.

    If these theories work, we're all willing to learn how to use them to best help our patients.
  5. by   lovingtheunloved
    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 think it is wonderful that you are so educated at such a young age. However, dealing with this kind of resident is something that school can't teach you. I know at least my school can't.

    I have worked with many psych nurses who had lots of education, but no experience working with dementia patients, and they learned very quickly how to "pacify."

    My mother has a masters in psychology. She does not know how to care for dementia patients. There is a difference between knowing about the disease and caring for the person with it.

    When my DON was a floor nurse, her viewpoint was very similar to yours. She was trying to tell a resident that this was the nurse's station, not a bus counter, she could not buy a ticket to South Dakota. That nurse had to report off to the DON and go get a tetanus shot because the resident bit her.

    You sound like a very learned person. Please be open minded as well.
  6. by   flashpoint
    Not to get off topic again, but orientate can also mean to orient. Orient is more common, but orientate is not inappropriate.

    http://66.161.12.81/search?q=orientate

    A lot of your posts seem to have a bit of mean-spirit to them. I'm not really sure what that is about.
  7. by   CoffeeRTC
    I'm not sure why I'm so facinated by this thread?

    Oh...maybe because I was in your shoes 10+ years ago. Fresh out of my BSN program at age 20(also with great instructors, great nursing program in large university setting in which I was exposed to the best hospitals,etc) I took a job in a long term care facility. (years ago...there wasn't much of a nursing shortage and I told myself....I hate psych...lol). Boy was I wrong in thinking that there would be no "psych" pts to take care of and that everyone was doing things all wrong. Well, LTC has come a long way since then.
    Education vs experience.....hmmm? I'm gonna go with both. You live and learn everyday. I applaud you for coming to these forums to gain further knowledge and a better understanding of the demented pts. Really I do. Please keep and open mind to what is being posted and use your education in gaining valuable experiences in your nursing career. If you are really interested in this subject, many ltc facilities would love to have a pt or prn nurse...think about it.
  8. by   ktwlpn
    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.
    Practical experience IS a large part of learning how to communicate with these pts.Walk onto a secure dementia unit with all of your degrees and this mindset and first you'll likely get bitten,scratched or clocked in the head and next-you'll be asked to leave the unit for some specialized training because you'll have the whole place in an uproar...As I have stated plenty of psych nurses are not experienced in caring for dementia pts-nor does a master's in psychology make you a better communicator with these pts.These are not like your patients in ICU-you can't manage their care by titrating their drips-Dementia is not logical..You may find this topic interesting but you are demonstrating a closed mind.You seem to want to "stir the pot" instead of learn from those of us with many years of experience in dementia care............IMHO experience when people in this type of discussion start to rely on picking apart someone's grammatical errors it's because they don't have anything else to back up their opinion....For the OP-check out the links I've provided-also go to your library for books like "The 36 hour Day" and Relax...Your residents can read your tone of voice and body language.Also you'll set the tone for the unit-read about environmental controls.Learn how helpful soft music,calm quiet tones and aroma therapy can be....You can help the cna's carry out their duties and you can also help family and friends have meaningful visits by facilitating communication..Encourage them to be WITH their loved one-not to argue with them.Also you will find that more and more loved ones of Alzheimer's disease and related dementias are educating themselves.Chances are good that if you try "re-orientation" with a little old lady in front of their family you'll likely be reported for verbal abuse....
    Last edit by ktwlpn on Aug 29, '06
  9. by   leslie :-D
    Quote from 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.
    now i'm curious.
    if you had a pt who recently suffered a painful, anguishing death and their spouse asked you if their loved one suffered as s/he died, your answer would be?

    you have received consistent responses from sev'l, experienced nurses.
    may i suggest you have much to learn.
    and it's the type of education that cannot be found in a textbook or by virtue of earning a degree.

    now, if you would be so kind in answering my question about your pt that died a horrible death....

    leslie
  10. by   romie
    A few months back a resident of mine would pace the unit anxiously asking everyone to help her find her sister Rosa. Then some well meaning staff and her family reminded her that her sister died. For weeks after that, this resident would pace the unit anxiously asking everyone to help her find her dead sister. "have you seen her? She died and I have to find her coffin." sob sob, cry cry. Reality Orientation at its best.

    I really like this thread and the diversity of opinions and experiences. Even experts and the literature on the topic is pretty well divided on issues of reality orientation vs. therapuetic lying vs. validation therapy.

    Sometimes beating around the bush and only stating facts can help. "Have you seen my mother?" asks resident. "No, I haven't seen your mother" replied staff. It is not a lie ( I haven't seen the residents mother, though I assume she may have died years ago), and I don't perpetuate the delusion.

    " I have to go home and make dinner" says anxious resident. "Why don't you stay here and have dinner with us?" replies staff.

    I find that any sort of verbal redirection works best when paired with an actual change of environment and redirection to a new activity.
  11. by   Nascar nurse
    Quote from romie
    Sometimes beating around the bush and only stating facts can help. "Have you seen my mother?" asks resident. "No, I haven't seen your mother" replied staff. It is not a lie ( I haven't seen the residents mother, though I assume she may have died years ago), and I don't perpetuate the delusion.

    " I have to go home and make dinner" says anxious resident. "Why don't you stay here and have dinner with us?" replies staff.

    I find that any sort of verbal redirection works best when paired with an actual change of environment and redirection to a new activity.
    I absolutely agree with these approaches too. Again, it's all about finding what works well for each individual and realizing that what works one moment, may not work the next. I take great offense at someone who has never actually done the job (only read about it in a book) to come off as the expert. I would never ever claim to be more knowledgeable about the care of an ICU patient than an actual ICU nurse w/ years of experience - just because I read about it in a book.

    Those of you so against therapeutic lying.. ever told someone their new hairdo looked great when it looked horrid?, ever told your signif. other "No honey you don't look fat in that outfit?, etc. Don't you get it.. sometimes it's about sparing other peoples feelings, demented or not. It's not about being cruel and not about being lazy.

    Ok, I will try to be done now.. this thread is far to frustrating
  12. by   casi
    When a dementia resident is searching for their children, the first thing I do is find out how old they are (adult, child, teenager) I’ve made the mistake of getting the wrong age which adds to agitation (“My son is too young to be married!”). Then I try to get them talking about their children to see if it distracts them a little. Sometimes reminiscing about their 5 year old son helps quite a bit. If that doesn’t work I’ll try, “Their in bed”. I assume that if it’s 3am their son or daughter is in bed, so it’s a truth. When that doesn’t work I’ll jump into the therapeutic lying.

    One thing I’ve found is if what they want is simple enough like making dinner, I’ll give them a loaf of bread and peanut butter to make sandwiches. Simple activity that keeps a resident calm and engaged.

    When you try to orientate a dementia resident it only adds to their anxiety and agitation. Next thing you know you’ll have to medicate and that becomes unsafe. When you have a resident who’s still rather agitated because you won’t let them go home and rather sedated from whatever you had to give them to try and calm them down, you are asking for a fall.

    Sometimes lying is the best way to keep your resident safe and happy.

    One of the first things I was taught concerning dementia residents is enter their world, don’t try to make them come to yours. That will never happen.
  13. by   P_RN
    One of the first things I was taught concerning dementia residents is enter their world, don’t try to make them come to yours. That will never happen.
    Casi that is perfect.

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