tips for dealing with dementia

  1. I work on a secure unit with a great staff-problem is the evening and some of the night shift.Many nurses in this facility are "old school" and think that there is a pill out there to control these resident's behaviors...I believe that keeping them safe and hydrated ,maintaining opitimal level of functioning as long as possible and protecting their dignity while supporting their loved ones is just about all we can do....What difference does it make if one refuses to get in bed at 9 pm in a night gown? Will she die from it? So what is she wants to crawl on the floor and "scrub"? I get down there alongside her till she tires out...Scream at bath time?-skip it til tomorrow...I realize that sun-downing is a problem(why do you think I work 7 to 3?-my momma didn't raise no fools!) I know that there are steps the staff can take to alleviate it-and most don't want to hear it-they want a quick fix-a pill...Which we all know often leads to further problems...We have a new admit that was great for the first 2 days and started getting a bit agitated the evening before last---I was told by evening shift-"We'll call YOU later and you can come in when she starts" Believe me-they are well staffed-3 nurses to 39 with 3 or 4 aides---Someone could have come from behind the desk to do a little hand-holding...Anyone know of any web sites with some good info? I need some teaching tools...I think it wil be accepted better then if I attempt a verbal inservice with this bunch...a few of them think they know it all....Of course one still thinks that reality orientation is where it's at...When she hears "Mom! Where are you?" She is apt to say-"Your mother has been dead for 50 years" I think that is cruel.....I usually go with "Taking down the wash-let's get a cold drink and sit down for a minute" Usually works for me......How can I convince some of the others?
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  2. 21 Comments

  3. by   KlareRN
    ktwlpn-

    You are the kind of nurse most of us would like to clone to work on our dementia units. Too many are too quick to pop a pill than to take the time to be human. I agree that if a person doesn't want to be in bed at 10pm; let them be up. In fact- get them a snack and help them find something on the television or a magazine to look at. Better yet- put down the magazine you are looking at and have a conversation with them. No- they may not understand the meaning of the conversation and they may not remember it even took place; but for that short period of time you are validating their value as a person. Too many times these folks are people who may have worked 3rd shift- or never got up before 10am...then they become confused and we force what we think is right for them and tell them what to wear, what and when to eat, when to bathe. when to go to bed or when to get up, not wearing a nightgown to breakfast, etc....

    It takes a special person to be able to work on secured units. I believe it is the most challenging area in any facility. The behaviors can escalate quickly and the repetiveness of the daily routine can be draining. Unfortunately it sounds like you work with a difficult bunch that may need to work in another area. Telling a confused resident that their mother is dead is not only cruel- but can be verbal abuse if it causes any anguish or mental distress to the resident (even for a minute).

    We are also careful about our choice of words for that same reason. Our babies wear bibs- our residents wear "clothing protectors"...our babies wear diapers- our residents wear "incontinent briefs" etc...

    Your local alzheimers association may be able to supply you with some teaching materials or at least point you in the right direction. Good luck to you- I hope you can continue to make a positive difference in the lives of the ones you care for...

    KlareRN
  4. by   Tookie
    I use a really good local site for both inforamtion and as a useful resource for students - this is excellent - they have a lot of 'help sheets - particularly for people just learning about the disease
    please let me know if this is of any use

    For dementia

    www.alzvic.asn.au

    then go to the helpful information and to help sheet s- they have loads of handouts and many different subjetc s- l have made up a folder from this

    If the website isnt OK (I am not sure how to refer websites onto people - type in Alzhiemers Association Victoria Australia

    Hope this helps - this is so important - keep up your good thoughts and actions - l want to be looked after by people like you if l ever get into this situation myself - l wish every nurse/thought your way

    Hang in there
    Tookie
  5. by   nakitamoon
    ktwlpn,,,,, you can come work with me anytime,,,,
    I agree 100% with you and Klare RN,,,,,, Staff coming to me all the time,,,, fix this ,,,,,, I remind them,,,, this is why the have thier job,,,,, use you imagination and compasion,,,,,
    Also think it does me good to enter the pt's world for few moments,,,, forget about reality,,,, does both the pt and I good,,, Moon
  6. by   adrienurse
    Contary to what people think, psychogeriatrics is a very challenging field to work in and is NOT for everyone. I suspect the nurses you are discribing lack the temperament as well as the insight needed to properly care for these people. It is just unrealistic to expect these people to be quiet and do as they are told -- It's just not gonna happen, the comprehension is just not there! The sooner they "get it" the better off everyone will be. Please continue to set an example for all of us.
  7. by   night owl
    This is a great thread! I too often wondered "what's all the fuss about?" When some one refuses their meds, or refuses to go back to bed, (I work nights). If they want to be up so what? I will be that person someday...Give them a snack, sit and converse with them, walk with them, let them watch TV or read. Some make such a fuss..."Get back to bed, you don't belong up at this hour!", which sometimes angers them and then the battle begins...I always intervene and say, "Let him go, he's alright" As long as he's not trying to leave the building, it's ok for him to be OOB. Alzheimer pts do alot of walking day or night as long as they're not hurting anyone or themselves, let them walk.

    I try to set the example and hope that other staff members will pick up on it, but it doesn't always sink in. The thing is, they were taught these things in their orientation classes...I think it all boils down to having alot of patience when working with the demented patient. Too many short fussed people want a quick fix so they don't have to deal with them for too long. Lack of patience in this type of setting ultimately leads to patient abuse. If they don't have the patience, they shouldn't be working with the demented...simple. Maybe when hiring employees for an Alzheimer's unit they should give them some kind of a test to see how much patience they really have. If they fail, they don't get hired...It just might save someone from from being abused.
  8. by   skl0923
    Let's all hope that we have the patience also to remember some of the following:
    Is this new behavior for this resident.
    Have the medical needs been addressed, (UTI, URI)
    meds reviewed, et cetera?

    Has this nurse been working too many hours
    Does she have a new patient load?
    How many residents is she trying to "supervise".
    How many staff is she supervising.
    Is administration addressing the nurses needs?
    We sometimes forget that nurses are human, and once in awhile they also are short of patience.

    Just had to address all this myself. Worked in long term care past 5 years, and I love it, and my patients. I was short with a resident last week and reported, out of context...alzheimer patient that cannot walk attempting to get out of bed, even after medication per hospice protocol...CNA's nowhere around, patient thinks I am her daughter...doesn't stop talking while you are trying to get her to lay down, husband insists she is in bed...et cetera.
    New administration..now have 30 residents on days and evenings. I have been telling DON that it is too much, cannot take extra time to sit with resident to calm them down, usually do not take more than three 5 minute breaks, sit and eat while charting.
    have to spend 1hr to 1.5 hr twice a day in dining room and pass meds to 30 residents, on dayshift. Spend precious minutes trying to find staff to address residents needs. Phone rings all the time.
    Nursing supervisors position eliminated, desk clerk position eliminated. We have to now do total care for 30 residents.
    Went to HR to see what would happen, if I reassigned while on workers comp? Injured tailbone was told no light duty for Nurses..behind on monthly paperwork for past two months. On the verge of nervous breakdown, broke down in HR.....can't work like this any longer.
    Scared to death state survey will walk in....!
    Been working 13 shifts every two weeks for over a year.
    Did not get vacation last year just too short of staff.
    New Staff Development Coordinator trying to get caught up on CEU for survey/HCFA...pulls us off the floor for 45 minute in service one whole week...refused to go to last two, just can't get med pass done in time if I do.
    Ready to give it all up..............just can't cope with this any longer
    Do not want to be this kind of Nurse..short of time and patience, have to be aware of every minute to get things done, no time to do treatments, monthly summaries, care plans, admission assessments and paperwork, too many things being missed!
    Phone doctors, fax doctors, transcribe orders and labs and whatever else comes up, dietraty orders, pt/ot orders and their asking me to look at resident because they are doing this or that.
    Dealing with family inquiries, other nurses demanding I do this or that, usually their admission paperwork.
    Can't imagine why I thought I could give good patient care!:imbar
    Sorry...but you touched my button, and yes I have 5 days off and am using it to assess myself. May need to look elsewhere for work. Checking it out!
    Last edit by skl0923 on Jul 16, '02
  9. by   adrienurse
    Sounds like a hellish experience. It's these kind of expectations that ruin geriatric nursing for everyone. Administration needs a really good reality check. It's under these conditions that nurses get burnt, disasters with patients happen (newspapers just love to report these), staff members get physically hurt and the facility fires scapegoats -- not necessarily in that order. Are there any other options of employment for you. Psychogeriatrics can work! Only took me 4 years and 3 jobs for me to realize this. I really have a good job now -- so they do exist.:kiss
  10. by   ktwlpn
    Originally posted by skl0923
    Let's all hope that we have the patience also to remember some of the following:
    Is this new behavior for this resident.
    Have the medical needs been addressed, (UTI, URI)
    meds reviewed, et cetera?

    Has this nurse been working too many hours
    Does she have a new patient load?
    How many residents is she trying to "supervise".
    How many staff is she supervising.
    Is administration addressing the nurses needs?
    We sometimes forget that nurses are human, and once in awhile they also are short of patience.

    Just had to address all this myself. Worked in long term care past 5 years, and I love it, and my patients. I was short with a resident last week and reported, out of context...alzheimer patient that cannot walk attempting to get out of bed, even after medication per hospice protocol...CNA's nowhere around, patient thinks I am her daughter...doesn't stop talking while you are trying to get her to lay down, husband insists she is in bed...et cetera.
    New administration..now have 30 residents on days and evenings. I have been telling DON that it is too much, cannot take extra time to sit with resident to calm them down, usually do not take more than three 5 minute breaks, sit and eat while charting.
    have to spend 1hr to 1.5 hr twice a day in dining room and pass meds to 30 residents, on dayshift. Spend precious minutes trying to find staff to address residents needs. Phone rings all the time.
    Nursing supervisors position eliminated, desk clerk position eliminated. We have to now do total care for 30 residents.
    DON stated just last week "I can't understand why these nurses can't get all the paperwork done. If they would just shut up and quit complaining they could use that time to work"
    I asked her Friday when she wrote me up, this "Can you take the cart and let me follow you to see if I can learn what I am doing wrong?"
    When I left that day went to HR to see what would happen, if I reassigned while on workers comp? Injured tailbone a week ago, when new chair dumped me on the floor. She also told me there is no light duty for Nurses..even though we are behind monthly summaries (54) for past two months. On the verge of nervous breakdown, broke down in HR.....can't work like this any longer.
    Scared to death state survey will walk in....she has me off 5 days, and then on a straight 8, with weekend supervisor duties (12 hrs)
    next weekend! This is light duty.
    Been working 13 shifts every two weeks for over a year.
    Did not get vacation last year just too short of staff.
    New Staff Development Coordinator trying to get caught up on CEU for survey/HCFA...pulls us off the floor for 45 minute in service one whole week...refused to go to last two, just can't get med pass done in time if I do.
    Ready to give it all up..............just can't cope with this any longer
    Do not want to be this kind of Nurse..short of time and patience, have to be aware of every minute to get things done, no time to do treatments, monthly summaries, care plans, admission assessments and paperwork, too many things being missed!
    Phone doctors, fax doctors, transcribe orders and labs and whatever else comes up, dietraty orders, pt/ot orders and their asking me to look at resident because they are doing this or that.
    Dealing with family inquiries, other nurses demanding I do this or that, usually their admission paperwork.
    Can't imagine why I thought I could give good patient care!:imbar
    Sorry...but you touched my button, and yes I have 5 days off and am using it to assess myself. May need to look elsewhere for work. Checking it out!
    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>I had to double check your location-sounds like the l.t.c. I left last fall...Don't sacrifice YOUR HEALTH AND CAREER for this place....I am so happy that I left...I am now at a county run facility-we are the best staffed facility in the area and the bottom line is salary and benefits.We have some of the same b*llsh*t as any other place but the money and bennies are quite attractive and we do have the staffing.When I leave at the end of the shift I KNOW that my residents were well cared for by the aides and that I actually had the time to check out each and every one of them myself...We do have bad days but usually I have time to for some interaction with individuals and it's great...I am on a 40 bed unit-never less then 2 nurses and usually 3-a unit clerk Mon through Fri-usually 6 aides and often 7-and now and then even 8! Get out as soon as you can before you are so burned out that you HATE nursing....And learn to say NO!-don't let anyone guilt you and don't make your self a martyr.....
  11. by   GPatty
    I agree soooooo much with you ktwlpn!

    Why do we have to do a "reality check" on folks who are no longer with reality and won't ever be again? Why can't we hold their hands and talk to them "in the past" where they are?

    Wish there were more like you in charge of dementia units everywhere....really I do......

    God bless you
    Julie
  12. by   adrienurse
    Reality orientation is never a good idea for people with dementia. It leads to anger, frustration and more confusion. It is better just to validate their feelings, their questions and just let them keep looking for whatever they are looking for. Redirect prn when you see agitation is building. Try to engage them in a task, change the subject etc. Gets easier with practice.

    Good luck!
  13. by   skl0923
    went back and edited some of my post
    d/t another post here about someone being reported to their facility................that would do it for sure!

    Go back to work tomorrow. We'll see what reception I get
    REally need to find outlet to vent, I guess..not recreational!
    If you know what I mean.
  14. by   Tookie
    ktwlpn
    l found this an interesting thread - just a question did you have a chance to check out the dementia site in Australia l suggested and what did you think - how would it compare with your own online information that may be available
    I too would be interested in any sites you or others might recommend - have searched and found some interesting sites - however always like to learn more
    Tookie

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