pacify or orientate? Alzheimers... - page 8

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   greenfiremajick
    "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."

    If I knew that every time the boy told the truth, that it would upset and agitate the person he was telling it to, (thereby making their lives more difficult and stressful) --then I advocate for therapeutic lying. I dunno, I just think that orienTATING a patient should be done if it is in the best interests of the patient...If it isn't in the best interest of that patient, then why be so anal and force your take on reality on to them?? Plus, forcing the patient to face "reality" could be worse than your idea of what is proper...Who knows what these people have been through that they cannot tell us?

    Think about this: That 12 yo boy has done something stupid and almost got hurt. He's normally a well behaved conscientious young man but this time he made a big mistake that would worry and upset his Mom to no end. Would he need to tell her? I think that if he DID tell her, it would be more to assauge his own guilt than for his Mom and her own good because he knows how upset she would be......Sometimes we need to know how to roll with the punches, go with the flow, or whatever other cliche we can think of....Therapeutic lying is for the good of the patient.....I think that what you're advocating would be for your own good, so that you could tell yourself that you did all the right things today, in view of your morals...Your version of crossing your T's and dotting your i's....Sometimes we need to cross our i's and dot our t's....



    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.
    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."

    Continue to re-orient your client. Why? It's respectful, it helps combat dementia, and redirecting can help rebuild short term memory.


    P.S. The correct term is 'orient,' NOT 'orientate.'
    Last edit by rn/writer on Aug 31, '06
  2. by   RebeccaJeanRN
    Just for the record: BOTH orientate and orient are actual words and both can mean the same thing. Look up 'orientate' in Merriam-Webster's paper dictionary (yes, paper dictionaries still exist), and you will see 'orient' for the definition (because it means the same thing). Dictionary.com lists 'orientate' the same way (says it means 'to orient'). Compact Oxford English dictionary states that "orientate is another word for orient". Must I go on? The American Heritage Dictionary of the English Language, fourth edition, says the transitive verb form of orient is orientate and it means 'to orient'. Orientate has another meaning, which is to turn someone toward the East, but its more well-known meaning is 'to orient'. So can we agree to end the discussion of whether orient or orientate is the proper word? Geesh.

    You say to-may-to and I say to-mAH-to...

    [And we wonder why the world can't solve the Arab-Israeli conflict...]
  3. by   leslie :-D
    i just googled "therapeutic lying" and received many favorable responses.
    the only ramification mentioned, was if the pt remembers what you said, and so, remembers you lying.
    but this would have obviously taken place in its' early stages, where this intervention should almost never be used.
    but we knew that already, yes?

    leslie
  4. by   emeraldjay
    I work as a CNA in a LTC facility, so that experience is what I draw from. I prefer to go with whatever works. As nurses we asses and treat and evaluate the response to said treatment. Maybe I have a simplistic view of the world, but when we discover that reality will not work on a pt living with dementia, why keep on trying. We don't keep feeding the depressed psych patient the same med that turns him/her suicidal just because the med is the current "right" treatment. We advocate for a different type of med, right? We don't give out antihistamine-sulfonomide cocktails to pt's with UTIs when they are allergic to sulfa drugs, do we? So when reality does more harm than good, why would we insist on inflicting that treatment repeatedly?

    Anyone remember ADPIE? Assess, Diagnose, Plan, Implement, Evaluate. I like to think that a happy and calm patient is less of a danger to themselves and others, than one in distress or anxious. I've only had three patients that genuinely scare me, and that was because their behavior would change rapidly, without any obvious triggers.
  5. by   P_RN
    Stay the course friends. Good healthy debate.
  6. by   CoffeeRTC
    Quote from greenfiremajick
    "....Sometimes we need to cross our i's and dot our t's....
    Exactly!!
  7. by   Nurse_Pauline
    I have a 27 yr history with dementia residents, both as a cna and a LPN. Currently Im involved in a 60 bed long term care dementia unit,and managing that is quite a challange. My father in law also had Alzheimers Disease when he passed, so I have had a bit of experience. Personally, I think it can be almost cruel to try to reorient these types of residents. Some traumas are tough enough to live thru once, never mind multiple times. When im older i want to be the pleasantly confused little lady wandering happily thru the halls. And I hope to god no one tries to reorient me. No matter what books or teachers say, whatever keeps my residents comfortable is what I will do.
  8. by   Multicollinearity
    Quote from Nurse_Pauline
    Personally, I think it can be almost cruel to try to reorient these types of residents. Some traumas are tough enough to live thru once, never mind multiple times. When im older i want to be the pleasantly confused little lady wandering happily thru the halls. And I hope to god no one tries to reorient me. No matter what books or teachers say, whatever keeps my residents comfortable is what I will do.
    Same here.
  9. by   fleur-de-lis
    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.
    Those resources seem like opinions to me, where is the research that backs up your position? I did a very quick search of guidelines.gov and found this quote from the American Psychiatric Association (APA).

    "Cognition-oriented treatments, such as reality orientation, cognitive retraining, and skills training, are focused on specific cognitive deficits, are unlikely to be beneficial, and have been associated with frustration in some patients" (From http://www.guidelines.gov/summary/su...px?doc_id=1428)

    Here is another quote: "Avoid arguing or attempts at reasoning with the resident; such attempts tend to escalate agitation" From http://www.guidelines.gov/summary/su...px?doc_id=6221

    The writers of these guidelines have more degrees than you and your friends combined. I would refer to resources such as these before arguing so strongly for your position. Just my 2 cents.
  10. by   greenfiremajick
    Quote from fleur-de-lis
    Those resources seem like opinions to me, where is the research that backs up your position? I did a very quick search of guidelines.gov and found this quote from the American Psychiatric Association (APA).

    "Cognition-oriented treatments, such as reality orientation, cognitive retraining, and skills training, are focused on specific cognitive deficits, are unlikely to be beneficial, and have been associated with frustration in some patients" (From http://www.guidelines.gov/summary/su...px?doc_id=1428)

    Here is another quote: "Avoid arguing or attempts at reasoning with the resident; such attempts tend to escalate agitation" From http://www.guidelines.gov/summary/su...px?doc_id=6221

    The writers of these guidelines have more degrees than you and your friends combined. I would refer to resources such as these before arguing so strongly for your position. Just my 2 cents.

    :yeahthat:

    what she said...thx for doing the real research on this fleur!!
  11. by   onlyanrn
    Why would you even consider lying to a patient? It seems very cruel to me! Think about the poor patient, desparetly wanting to see her mother and jsut being out off and pacified by staff. What a horror! The kind thing to do, is to explain to the patient that she is quite old and that her mother died years ago. Hold her hand and give her postivie feedback when she grieves, but don't ever lie.

    For uou jesskanurse, orientate is in fact a word and it is proper use of the term. Orient is just as proper. Also, dearheart, the word nurse isn't always caplialized, I see you do that quite often. And it is anyway, not anyways!
  12. by   rn/writer
    Please, let's set the grammar and usage issues to the side. This thread is challenging enough without getting derailed by semantics.

    onlyanrn, what is your background/experience with dementia patients?
    Last edit by rn/writer on Sep 2, '06
  13. by   joyflnoyz
    [QUOTE=onlyanrn]Why would you even consider lying to a patient? It seems very cruel to me! Think about the poor patient, desparetly wanting to see her mother and jsut being out off and pacified by staff. What a horror! The kind thing to do, is to explain to the patient that she is quite old and that her mother died years ago. Hold her hand and give her postivie feedback when she grieves, but don't ever lie.

    onlyann, what is your experience with dementia patients?

    As for "lying" FIRST DO NO HARM

    For the 85 year old dementia patient looking for her father every night- *HER* reality says he is alive. IF I tell her "daddy died years ago" That causes her incredible distress and pain (harm) It is the first time she has heard that news.
    (and what about the fact that she will probably not believe me, because she spoke to him not 30 minutes ago??) I have taken "cakes out of the oven"; checked on the babies, told a patient "I haven't seen your father, but when I do, I'll tell him where you are"

    To tell someone her parent is dead, when she truely believes he is alive is just plain cruel.

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