Should I feel guilty? - page 2

I work in a large facility. We have many residents with dementia. Most of them continue to say they want to go home. We change the subject and try to distract them until they think of something... Read More

  1. by   joanna73
    As many of you know, it's pointless to try to reorient a dementia patient. Basically, we are visitors in their world. Telling the truth is only going to agitate them, and then you're dealing with a potential crisis. I tell white "lies" regularly at work, and have learned not to feel any guilt over it. The other night, I had a resident who refused to go to bed until I called his ride. I got out his chart, dialed my phone number from the nsg station, and said, "Your ride isn't answering." He happily said, "Ok thanks. I'll go to bed then. Nite!" Lol, potential situation avoided.
  2. by   Kittypower123
    We have a nice hispanic gentlemen at our facility whose wife died a few years back. He asks about her all the time. When his family is here, they "remind" him of her passing. When they leave, we are left with hours of agitation and grief to deal with. When they are not here, we tell him something like "She went out the store." or "She's visiting a friend." Before long he moves on the something else and forgets he was looking for her. I am a HUGE fan of "Therapuetic Fibbing."

    So, no, do not feel guilty. We are supposed to provide the best quality of life possible for the residents. Causing anxiety and agitation with the truth does not provide the best possible quality of life.
    Last edit by Kittypower123 on Dec 2, '12 : Reason: added content
  3. by   JZ_RN
    I had a patient who continually requested help to get up out of bed and go downtown to work on some things for her job because they HAD to be finished or she needed to get upstairs to the apartments of her other friends or don the road to see family members. Luckily I worked night shift so I could tell her, oh no, it's too late now you don't want to wake them or, there's no bus to take us downtown right now, we'll have to wait until morning. She usually accepted that. I didn't want to tell her she was never going to see those people again because most were dead or that she hadn't worked in 30 years. How does that help her?
  4. by   CT Pixie
    You have no reason to feel guilty.

    I routinely have to 'lie' to residents in order to proctect them mentally and physically. I have one particular resident who will start agitated b/c her husband (who died at our facility years ago) is 'going to be home soon" and she 'needs to get dinner started' or he's picking her up etc , this always happens around dinner time at the facility. My 'lie' is always, "oh Jane, Don called earlier..I am so sorry, I forgot to tell you, but he said that he's having a burger with the guys after work and he said not to worry about supper tonight." If "Don" is going to pick her up, its always 'oh Jane he called, the roads are really bad and he doesn't want to risk an accident." always works like a charm.

    If she goes on about not having any money, or a place to stay if Don can't get her..I tell her Don paid for her dinner with us and he also 'rented' a room for her. If she goes on about she's leaving, I ask her how, she states a car. I tell her the roads are closed own right now, the roads are very bad due to the storm. Seems to work, even on evenings its 80 degrees and skies clear with stars out. Many times I've told her I am 'stuck' too but as soon as the roads open, the roads are clear of snow etc, I'd be more than happy to give her a ride home.

    Lies? Perhaps, but it comforts them. We 'lie' to our children about the Easter Bunny, Santa Claus and the Tooth Fairy...and no one feels guilty. So if a 'lie' makes my resident's life a bit happier or makes them less agitated..then to the 'lie' I go with never a thought of feeling guilty.
  5. by   JZ_RN
    We did have one man who was just moved to our facility because his wife has passed, he would ask when the funeral was, even afterwards. I would always tell him that it was 2 weeks ago and that it had been a beautiful service. Then he'd ask to see pictures of his wife and children, and I'd get the book out for him. He always knew she was gone, but his short term memory wasn't so great. It distressed him worrying about the funeral.. he had been her sole caretaker I think.
  6. by   JZ_RN
    CT Pixie-I regularly used snow/storms as a reason some residents had to stay. Another gentleman always believed his dead wife was on vacation. I would tell him her flight must be delayed because of the snow or the lightning when he believed she'd be arriving that night. One woman always asked about the picnic and I told her that I'd be getting the food from the store in the morning. This went on for months. She never remembered the next day.

    To think back on it, I lied a lot. But it was more kind to give them a reason that won't make them upset then it was to be 100% truthful.
  7. by   NurseDirtyBird
    I think reorientation has its place, like for meals and bedtime. "You had breakfast this morning, right now we're having dinner. That's why you have meatloaf instead of pancakes."
    Playing into their reality also has its place. "Sure, let me give you a tour of our "hotel." We have well-appointed luxury rooms for all of our guests. This one will be yours. No need to worry about money, the bill has been taken care of in advance by your daughter. Yes, we saw her, and you must have done well with raising her. She thinks an awful lot of you. Sure, let me give you a tour of our "hotel"..."
  8. by   Rubz
    Quote from TheCommuter
    What the OP did is called therapeutic lying, which is recommended in middle and late stage dementia. It is much more humane than continually reorienting the demented resident to a much more painful reality.
    The one thing that I was recommended... Get to know your patients... You have to know your patients' stage of dementia in order to use the therapeutic lying.
  9. by   nrsang97
    I really think you did the right thing OP. I just don't have the heart to reorient them to a painful memory.
  10. by   CapeCodMermaid
    I usually don't ever feel guilty if I make someone happy even if it's just for a minute. She asked me again today...I told her tomorrow and was rewarded with a glowing smile.
  11. by   Simply Complicated
    I think we've all done it. We had a patient one time in the hospital, who used to be a chef. She was convinced she was in a hotel, and was not happy about the quality of the food. She kept insisting on talking to the chef, and refused to tell anyone else what we could do to improve her food. This went on for like 2 days. We finally had one of the male nurses go in and pretend to be the Chef, and have a talk with her. He told her he'd "put a word in" for her, and we were able to make a couple notations about her meals. From then on she was happy, and even wrote a thank you letter to the "Chef".
  12. by   SaoirseRN
    Sometimes it is less traumatic to them to not tell the truth. You made her happy for however long she remembers. Had you said "you aren't going home" you would have had a different result. Many times it is kinder not to tell the truth.
  13. by   thenursemandy
    When I first started my career I tried to do what we were taught to reorient. After many pt outbursts I came to the realisation that it gives them peace if I "play along", so I changed my approach. Re-orienting a dementia pt that their spouse is dead or that they can't go home 10+ times a day is like torturing them repetedly.