pacify or orientate? Alzheimers... - page 5

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 casi

    One of the first things I was taught concerning dementia residents is enter their world, don't try to make them come to yours.
    there you go.
    enter their world.
    if i chose not to "lie" and told them their mom died 50 yrs ago, who's actually doing the lying?
    according to my pts' perception, I AM!
    afterall, their mom isn't dead!
    it is my job to DO NO HARM.
    so in my interventions, should i opt to keep my pt safe, w/o fear, w/o distress, w/o agitation, then yes, i shall lie.
    and better still, my pt believes me.
    trust, security, comfort, beneficence.
    furthermore, all the truth-telling in the world not only serves to harm my pts' well-being, but it will do nothing to ameliorate their cognitive function.

    when you first meet your pt, it's perfectly appropriate to tell the truth; reality testing...it's a needed assessment tool.
    but once it is determined the severity of their dementia, then you revise your plan of care to reflect your pts needs and abilities.
    therapeutic lying should never be your first intervention.
    but the bottom line speaks for itself.
    you do whatever it takes to make your patient feel safe.
    and such are the actions of a sensitive and experienced nurse.

    leslie
  2. by   lovingtheunloved
    Quote from earle58
    there you go.
    enter their world.
    I much prefer to enter their world. It's usually a whole heck of a lot more interesting than mine.:spin:
  3. by   txspadequeenRN
    Well your not using your resources very well. Experience is a major plus when dealing with dementia/alzheimers patients. You can read about it and consult about it all day long but until you play the game you shouldnt knock what works. I have been a alzheimers nurse in a locked facility for years and Im here to tell you that you do what works. If mama is coming this afternoon ...guess what she is. Because there is no way Im going to tell her she is not coming only to have to a very agitated and distressed resident. There is no sense in that, it is unethical in my opinion to place your patients in this state. When all you have to do is agree with what they are saying or just acknowledge what they are talking about. I will redirect to time, place and self but im sorry if you dont agree , I will never orientate to the truth if it will damage my resident in the end.





    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.
  4. by   Jesskanurse
    Quote from txspadequeen921
    Well your not using your resources very well. Experience is a major plus when dealing with dementia/alzheimers patients. You can read about it and consult about it all day long but until you play the game you shouldnt knock what works. I have been a alzheimers nurse in a locked facility for years and Im here to tell you that you do what works. If mama is coming this afternoon ...guess what she is. Because there is no way Im going to tell her she is not coming only to have to a very agitated and distressed resident. There is no sense in that, it is unethical in my opinion to place your patients in this state. When all you have to do is agree with what they are saying or just acknowledge what they are talking about. I will redirect to time, place and self but im sorry if you dont agree , I will never orientate to the truth if it will damage my resident in the end.
    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.
  5. by   UM Review RN
    Quote from Jesskanurse
    Sometimes that anguish is therapeutic for them.
    :trout:
  6. by   ktwlpn
    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.
    :deadhorse A nurse can only learn and grown when willing to do so and maturity is key.I will say again that we are talking about pts in LTC-THEY ARE IN THE LATER STAGES OF ALZHEIMER'S AND OTHER DEMENTIAS.........What don't you get about that? Believe me-after working with these patients for a few years you DO learn what works and what doesn't....Have you checked out any of the links posted in the thread? Done any additional research on your own? When you grown up you'll see that there is more to the world then your black and white...
  7. by   leslie :-D
    some of her statements are deeply concerning.
    i have nothing more to add.

    leslie
  8. by   CapeCodMermaid
    I would like to know how much Jesskanurse has in working on a dementia unit. I'd never hire her to work in my building.
  9. by   Natkat
    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. >snip<

    P.S. The correct term is 'orient,' NOT 'orientate.'
    Oh, thank you for saying that. It was bugging me to see that. It has only been recently that "orientate" has been "allowed" to be used and I don't think it's right to dumb-down language instead of insisting on using it properly. I will never accept "irregardless" as a word either.

    As for therapeutic lying, I stop just sort of that by giving a non-commital answer. We have a patient who always tells us she forgot to clock in. I always tell her "it's alright, everything has been taken care of." It's true, everything with regard to her care has been taken care of. I didn't say anything about the clocking in part, but reassurred her that there is nothing to worry about and let her interpret that however she wants. It usually keeps her happy.
    Last edit by Natkat on Aug 30, '06
  10. by   leslie :-D
    Quote from CapeCodMermaid
    I would like to know how much Jesskanurse has in working on a dementia unit. I'd never hire her to work in my building.
    i don't think she has any experience.
    if she does, God pity her frightened, disoriented pts.
  11. by   CapeCodMermaid
    Oh,wait....I just read back. Jesskanurse says she has psych nurse friends and a friend with a Masters in psych...hmmm...my father was a radiologist. Does that give me the knowledge I need to read CT scans???
  12. by   irish_std/n
    Quote from Jesskanurse

    P.S. The correct term is 'orient,' NOT 'orientate.'
    acutally both words are correct!!
  13. by   indigo girl
    Quote from earle58
    there you go.
    enter their world.
    if i chose not to "lie" and told them their mom died 50 yrs ago, who's actually doing the lying?
    according to my pts' perception, I AM!
    afterall, their mom isn't dead!
    it is my job to DO NO HARM.
    so in my interventions, should i opt to keep my pt safe, w/o fear, w/o distress, w/o agitation, then yes, i shall lie.
    and better still, my pt believes me.
    trust, security, comfort, beneficence.
    furthermore, all the truth-telling in the world not only serves to harm my pts' well-being, but it will do nothing to ameliorate their cognitive function.

    when you first meet your pt, it's perfectly appropriate to tell the truth; reality testing...it's a needed assessment tool.
    but once it is determined the severity of their dementia, then you revise your plan of care to reflect your pts needs and abilities.
    therapeutic lying should never be your first intervention.
    but the bottom line speaks for itself.
    you do whatever it takes to make your patient feel safe.
    and such are the actions of a sensitive and experienced nurse.

    leslie
    Right on target as usual, leslie.

    I work in dementia units almost nightly as an agency nurse.

    It is heartbreaking to hear a woman in her eighties insisting that her children are home alone, and she must go to them. She is sobbing and trying to get us to understand. She can not believe that this is not really happening. If trying to orient her is making her more agitated, clearly this is not an appropriate intervention. Trying to orient her causes her even more emotional pain. It is more respectful and helpful to be in that moment in her reality, and go from there.


    Years, and years of taking care of these patients in many different units has convinced me that our job is not to try to force our reality on them. It truly, can not be done. It does not help. It makes their situation worse, and this is not OK. I am there to care for them, not harm them, that is my job. When it becomes clear, and this does not take long, that the patient can not be oriented, you have to move on to the next intervention. You take your cue from their behavior.

    Experience is the best teacher. If you haven't done this type of work, researching the work of those who have is useful, that and actually getting out there, and working in one these units with staff who do this work every day.

    Nursing and caring for real human beings, requires us to make judgement calls that are not what we learned in school unless of course, one has been lucky enough to be exposed to an instructor who has had actual experience with the type of dementia we are talking about here.
    Last edit by indigo girl on Aug 30, '06

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