pacify or orientate? Alzheimers... - page 6

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
    I fear that Jesskanurse will be one who just has to learn the hard way. I'm the same age as she is. I wish I knew everything too.
  2. by   leslie :-D
    Quote from 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???
    my only hope is that jesska is confused, and that she thinks this therapeutic lying is taking place in the pts' early stages of their dementia.

    btw jesska, any experienced nurse will tell you that a pt almost always experiences their grieving in the early stages.
    it's in the early stages that you can apply reality orientation, and that you can tell them they have a progressive dementia.
    yes, they have the right to know.
    especially when their agitation and depression actually serve as masks for fear.
    they know 'something's' wrong and they deserve answers.
    so please keep in mind, that much of the grief work has already been done by the pt.
    and to work through grief in late stage dementia?
    are you serious in thinking of this as realistic?

    if you had a pt w/late stage alzheimers, who is distressed and combative, what are you going to do?
    first you're going to rule out pain, hunger, thirst, being wet or soiled.
    if behavior still persists, frequent 1:1, quiet place, reassurance.
    a nsg asst that has been looking after him, reports he misses his (dead) mother.
    a nurse (w/whom the patient feels safe) will assess and try to explore.
    pts' mother was supposed to come and pt is frantic, still waiting, worried sick.

    now, what's the next step, since all interventions so far, have failed?
    granted, the agitated pt may calm down for 30 sec, and then he'll go on his frantic search again for his mother.

    are you the nurse going to look directly at your pt with warmth, concern and quietly tell him his mother is at church: and she will see him tomorrow? and perhaps you will have him follow you on your med pass for a bit, until you're satisfied that pt is feeling better?

    maybe a prn if there is residual restlessness?

    even if you did give a scheduled or prn med, it may take effect but it still does not mean he's not thinking about his mother.

    what is the harm in putting your pts' mind at rest?

    nsg in a ltc environment is unlike any type of nsg.
    these residents often look at the staff as their own family.
    and much of nsg has also taken a protective wing of their residents.
    it is a mutually caring and trusting relationship.

    you need to learn that whatever you have learned in nsg school is only a foundation.
    it is your experiences in the real world that make one a true professional.

    i truly hope wherever you work, you enter with an open mind.
    these old nurses will teach you a thing or two.
    your nsg assistants will also teach you more than you could ever hope for.
    use your colleagues and your staff as invaluable resources.
    keep your eyes and ears open; and sometimes, your mouth closed.

    i don't know what else to tell you.
    you've heard it from many experienced and competent nurses here on the bb.
    and still.....

    be well.

    leslie
  3. by   rnmi2004
    Quote from Jesskanurse

    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.
    This thread is talking about people who have progressive deterioration due to physical changes in the brain. These people are not going to become "more functionally independent" no matter what interventions staff employs.

    Please read & re-read earle58's post with the goal of understanding why so many people who have worked closely with this population for so many years have decided that "therapeutic lying" is an appropriate technique to use.
  4. by   KScott
    I love this thread. One, for the great information regarding dementia and two, for the wonderfully explicit example of bullheadedness. Brain anomalies are so fascinating to me! :wink2:
  5. by   ktwlpn
    Quote from KScott
    I love this thread. One, for the great information regarding dementia and two, for the wonderfully explicit example of bullheadedness. Brain anomalies are so fascinating to me! :wink2:
    *****!
  6. by   Nascar nurse
    Quote from KScott
    I love this thread. One, for the great information regarding dementia and two, for the wonderfully explicit example of bullheadedness. Brain anomalies are so fascinating to me! :wink2:


    NOW THAT IS THE FUNNIEST THING I HAVE EVER EVER EVER READ ON THIS FORUM. You are brilliant. Is anyone else thinking "troll"?
    :roll :roll :roll :roll :roll
  7. by   UM Review RN
    Quote from Nascar nurse
    NOW THAT IS THE FUNNIEST THING I HAVE EVER EVER EVER READ ON THIS FORUM. You are brilliant. Is anyone else thinking "troll"?
    :roll :roll :roll :roll :roll

    I hate to say this, but I've known quite a few people like this IRL, so I'm guessing no troll. But if troll she be, what kind of person indulges in this kind of behavior?


    Form your own opinion. I have mine.
    Last edit by UM Review RN on Aug 30, '06
  8. by   P_RN
    Dear hearts and gentle people let's stick to the fascinating topic, and let's make a real attempt not to get into a one on one with a particular poster. Sometimes it takes a tap on the shoulder to get someone's attention and sometimes you really want to use a brick......let's use neither. Address the topic.

    We all know opinions are like....uhhh...noses ...everybody has one.
  9. by   -Midget-
    I've been reading this thread for a while now, and just decided to finally reply to support this "theraputic lying." My grandma has dementia, and before she was placed into a nursing home, my grandpa and I took care of her for a few years. At first, I was convinced I had to orient my grandma back to reality, as was my grandpa. All this did was cause a lot of frustration for all involved. I then figured out that out of the three options I had--telling her the truth, ignoring her, or telling her what she wanted to hear--the latter worked the best. She'd ask about her brother, who's been dead for a long time, and I'd told her I hadn't seen him. This, and many other situations, were easily resolved by telling her something to put her at ease. Now that she is in the nursing home, she talks about going to the store, or Wisconsin, and a while ago she talked about going to Las Vegas. :d We've had some very intersting conversations. ;-) LOL
  10. by   barbyann
    When i was a CNA, many years ago, I worked in LTC. There was an elderly man admitted with ALZ. He had been an Admiral in the Navy and one of the few possesions he brought with him was his Navy dress uniform. He was not happy at his placemnet and was a wanderer. One day I heard commotion at the doorway and was told that the Admiral (in his full dress uniform) was in the parking lot and he would not return to the facility. They had been trying for quite a while to get him inside. The decision had been made to restrain him and put him in a wheelchair to get him inside. I asked to please let me try before any restraints were used. I ran out to the parking lot yelling "Admiral, Admiral, there is a huge problem in the galley and it requires your immediate attention" "Please follow me". He saluted me and we headed inside. He looked delighted to be needed. All the staff was tired from their pegging and pleading. I was the hero for the day.

    Answer-bring yourself to their level of thinking.
  11. by   RebeccaJeanRN
    Whenever possible, I think kindness should be the rule. If this means that when trying to 'validate' a patient's feelings or concerns, and you find it doesn't work so you just allow the patient to think you are their long dead best friend, so be it. I have only worked very briefly in clinicals with Alzheimer's patients but I had a grandmother who had it. The awful thing is that her suffering was very real to her. She BELIEVED that she really needed to get some schoolwork done for class (she used to teach many years before) and all sorts of other distressful intruding thoughts. When Alzheimers patients are distressed, they really ARE distressed. The cruelty of this disease is that the patient is often haunted by compelling thoughts that are distressful (I need to go meet my husband, I need to get to class, I need to go get Aunt Sally, I need to find that recipe, I don't know where I am, I don't recognize that food...). Its like they can't make sense of their world and are so upset by their own confusion. I think that whatever we can do to make them feel comforted, less fearful, and enjoy their days more...should be the goal. What matter that they know the right year or right time for a fleeting moment? Far more important is that they are not afraid and feel at peace in their environment. I don't know what its like to live in a constant state of confusion and stress, but I can recognize distress and torment when I see it. I think we have to allow that the best therapeutic technique may be different for each patient. Nurses who simply say what a patient wants to hear may not be lazy, but may know that orienting or orientating (my medical dictionary says both are correct), is not a successful approach for alleviating stress for that particular patient.
  12. by   sanctuary
    RebeccaOne, you are absolutely correct. The patient's response is the best guide in directing the nursing intervention. When people are in late stage dementia, the only compassionate goal is the patient's comfort. I started this work in 1963, when the focus was on "reality orientation". We would inform people that the spouse that they were looking for was dead, had been dead for several years, and watch the melt-down over and over. Finally, we began to understand that s/he would NEVER get it. That meant a re-ordering of our thinking, and revision of the goals. When we concentrated on the patient, and their level of comfort, and made it the primary goal, we worked (sometimes with other family members) to find the path of most comfort. Women looking for children were asked where they went when they tried to get out of chores...Then we used the story from the patient's life. Husbands were frequently "helping a neighbor." Wives were "putting up food." There was an immediate improvement in the energy level on the units. Staff stopped getting screamed at, or slapped, and patients could join in activities if the demons were temporarily at rest. Even those who had to ask the same question every few minutes were less distressed in general. Patients are always the best teachers. It is not being lazy to investigate 47 wrong answers before the correct one is found, nor lazy to have individualized responses for each patient, and remember what to say to whom. It is much harder to do that than to just tell everybody that they are wrong, about the date, the situation or their fear. That's probably easier.
  13. by   ktwlpn
    Quote from P_RN
    Sometimes it takes a tap on the shoulder to get someone's attention and sometimes you really want to use a brick......We all know opinions are like....uhhh...noses ...everybody has one.
    (-spewing coffee all over my keyboard- ) I know it makes me less of a person but please pass me the brick. Seriously though I think the reason why parts of this thread have gotten a little "testy" is because so many of us really feel a passion for working with these patients..There really is an art to communicating with those afflicted with dementia.I'm sure that the rest of you who have found your niche with them have experienced the same kinds of frustrations throughout your careers as I have.I've worked acute care and been unable to give the time to these pts that they needed and instead had to resort to restraints,medications and my least favorite method - the dreaded geri chair in the hallway of the hospital.I've seen them loose their dignity.I've worked in plenty of LTC settings that also did not address their special needs in an appropriate manner. I have seen the effect that short staffing with poorly trained nurses and cna's has on this population (even loud ancillary staff can set off the entire unit) I've worked with staff whose behaviors had an adverse effect on the residents-I have had to complete the incident reports for these staff memebers when they got hurt. I've spent countless hours trying to comfort and re-direct a resident after a staff member has snatched their stockpile of coffee cups or stuffed animals because they felt they had to be in control and could not take the time to communicate...It's frustrating and sad.The unwillingness of many to attempt to learn the techniques to communicate with these people properly is just a symptom of the bigger problem.To many in our society these people just don't matter any more.........I don't believe that......I do believe that karma is a *****.....
    Last edit by P_RN on Aug 31, '06

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