Should I feel guilty?

  1. 5 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 else.On Friday when I was getting ready to leave, one of the residents wheeled up to me and asked "When can I go home?" I her "Tomorrow". Her face lit up, she grabbed my hand and told me she was going to light a candle for me and tell the big man upstairs to watch over me. I thanked her and off she went down the hall smiling until she ran into another staff member and asked him when she was going home. Thank goodness he said "Tomorrow." i hate to lie, but I'm pretty sure God'll forgive me this one.
  2. Visit  CapeCodMermaid profile page

    About CapeCodMermaid, RN

    CapeCodMermaid has '30+' year(s) of experience and specializes in 'Gerontology,med surg,home health'. From 'It's not on any chart....'; Joined Nov '02; Posts: 5,550; Likes: 8,066.

    36 Comments so far...

  3. Visit  sharpeimom profile page
    8
    I've never worked in a SNF, but we had some dementia pts. in the psych hospital where I worked. Our staff told "tomorrow" or "when your family comes home" or something similar because reorienting never seemed
    to work.

    I think it's a lot more humane than letting them just worry and dither.
    poppycat, redhead_NURSE98!, wooh, and 5 others like this.
  4. Visit  Meriwhen profile page
    3
    With my dementia patients, I try not to lie...note the word "try." The reality is that sometimes it's just better--and like sharpeimom says, more humane--to say something like "tomorrow" or "really soon" or another vague answer to those with dementia, than to hit them with the truth. Definitely let their family know the score though.

    Don't feel too guilty about it.
  5. Visit  artsmom profile page
    1
    I have to do this too- you made her smile and 20 seconds later she forgot. Had you said no, you would have made her feel badly, and she still would have forgotten it. I think you did the right thing.
    RunnerRN2015 likes this.
  6. Visit  Ruas61 profile page
    12
    It was a kindness, someday we all will be going home tomorrow.
  7. Visit  mappers profile page
    1
    When my mother's Alzheimers was progressing, my sister felt the need to correct all the mistaken memories she had. Once at a family dinner, she corrected some tale mom was telling that wasn't accurate and mom got very upset, tried to leave, actually got car keys and tried to drive away. She had not driven in years. I asked my sister why she just didn't let my mom tell the story wrong. It wasn't hurting anything. She said, "But she is wrong! The story happened to me and she is wrong!". Sigh....My sister (also a nurse) I think was in the old school, "you must reorient the patient" mindset, plus had her own issue to work through of Mom forgetting her childhood.

    I'm not really sure this post is relevant to the OP, but for some reason, it brought it to mind.
    DSkelton711 likes this.
  8. Visit  sharpeimom profile page
    7
    Thank you, Meriwhen. I was taught as a nursing student to never lie to a patient, even a confused senile one, but that just seemed wrong on so many levels. I remember the day that lesson was really driven home
    for me. A very old, very demented man had asked when his wife would visit next. She was dead and I reminded him. He cried and cried for days. I felt horrible and after that, told him what the others told him...
    that she was visiting her sister ___ for a few days, and he'd be fine.
  9. Visit  MarggoRita profile page
    1
    Sharpiemom, your story reminds me of two different residents I cared for, both Alzheimer's, the first a lady who had lost her husband and per family request we were instructed to tell her the truth when she would ask about him. Each time she would cry and mourn his loss all over again. This is what her family wanted for her even though it broke our hearts to see her hurt repeatedly, per the family...she would have wanted to miss him and feel his loss because she had loved him so much. The second, a gentleman who had lost his wife, and per family when he would make a statement to the effect of his wife would be joining him for dinner or something similar, we were to play along and let him believe she was still with him rather than let him hurt again. I could understand both perceptions, such situations should be resident specific.
    sharpeimom likes this.
  10. Visit  BostonTerrierLoverRN profile page
    1
    I learned the laundry folding trick from one of the guides, and I owe them a car wash! Great Advice!!

    I try any kind of diversion possible dealing with a dementia sufferer, and never attempt to reorient chronically confused patients, it is amazing how they can fixate or obsess about somethings all day! Okay,... I can confess to:

    I had this little sweet lady who wanted to go back to the home(they miss their friends), and I kept telling her, "But Ms. Doe, you just got here! Will you stay with us just tonight?" She would relent, especially when she saw how much laundry I had
    sharpeimom likes this.
  11. Visit  TheCommuter profile page
    10
    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.

    http://allnurses.com/geriatric-nurse...ia-754397.html
  12. Visit  MoopleRN profile page
    2
    There's no point in trying to reorient. Ever. The patient, like the customer, is always right! Having said that, I don't have a problem lying to my residents. My lies aren't meant to trick or fool them, my lies comfort them and eventually (hopefully) lead to other avenues of focus. I actually get a great deal of personal/professional satisfaction when this happens. I NEVER feel guilty about it. It's simply a way for me to provide compassionate care for my resident. Since s/he can't be in my world, I'll be in hers/his and give the support needed.

    In this particular case, while I'm on my soapbox, I wouldn't reply "tomorrow". I'd get get her to talk about home and bring up those comforting memories (lead to another avenue of focus!). Those kind of conversations calm/reassure her (yay!) and I'll often learn something new about her history that I can use to lead to a different focus the next time!
    sharpeimom and joanna73 like this.
  13. Visit  Dezy profile page
    1
    I read something somewhere saying that there is no harm in playing into a patients fantasy because their situation can be so depressing. I would like to think this kind of thing is for the best.
    DSkelton711 likes this.
  14. Visit  BostonTerrierLoverRN profile page
    7
    Lie to me. Tell me I am being held in safety from all my fans who would overwhelm me. But whatever you do, please don't tell me:

    "Boston, your in the nursing home. Your tied to your chair because you are flight risk, and you have mittens on because you pinched a nurse when she dropped her pen. You are in a diaper because you are bowel and bladder incontinent. Alas, you'll get your dentures at supper because it really disturbs the residents when you take them out and lick them!"

    No, indulge me in a fantasy. I have faced reality all my life. What good is it going to do me now when I don't know if I'm winding my butt, or scratching my watch? For God sakes I thought the Mexican guy cutting the grass today by our unit was my Son!


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