I work on a tele floor, but lately I have been getting patients whose medical diagnosis is "Alzheimer's, waiting for placement." I'm a new nurse, so I'm not sure how common this is, but what has been happening is that a family suddenly decides that they are no longer going to care for their family member who has dementia, and brings them to our ER. The ER doc admits them, and then the nurses essentially become their babysitters until a spot opens up at a nursing home or whichever LTC facility is most appropriate for them. These patients hardly ever have any sort of medical illness (other than diabetes).
Best case scenario is they are pleasantly confused, won't stay in their rooms, try to take their gowns off in the hallway, poop in weird places, etc. Sometimes I try and get them back in their rooms, and I'll stay in there to do my charting. Sometimes I'll let them sit at the nurses station and give them some towels to fold or some other sort of project, which will generally keep them occupied for about 15 minutes.
The worst are the ones who accuse me of holding them hostage, and are constantly crying or yelling about something. Nothing will keep these patients occupied.
We can't put them in a roll belt or any other kind of restraints unless they are violent or are actually TRYING to leave the hospital, not just wandering. The doctors might have some anti-anxiety meds ordered PRN, and while that might (or might not) make them less anxious, it certainly doesn't keep them from getting up and wandering around. When I've asked for something stronger, I've been told that they don't sedate for "nurse convenience," and we can't get a one on one sitter unless the patient is suicidal.
The other nurses I work with pretty much just say we gotta deal with it and hope nothing bad happens. Since these patients pretty much need to be watched 24/7 I'm doing good just to give the meds to my other patients. This is frustrating when I have ventilated patients, or patients on insulin drips...and I'm having to chase someone's confused, but otherwise healthy, mama down the hallway before she busts up into someone's room, or wanders outside in the middle of the night.
Since restraints and extra sedation don't seem to be options, does ANYONE have any tips/advice on how to get these people to stay put or calm down? Or on how to convince their doctor that the 1mg PO Ativan q6h isn't really cutting it? I am at a loss, and they are driving me insane.
Oct 16, '13
by Esme12, ASN, BSN, RN Senior Moderator
Unfortunately they are a necessary part of nursing. Many physicians will place them on telemetry floors because the staffing is better. They need a specific amount of time inpatient to be eligible to be evaluated for long term placement....an expensive requirement of medicare.....it used to be 3 days.
There isn't much you can do. I caution you about closing doors for a patient that is confused can get in a lot of trouble behind closed doors and can be considered a form of restraint and certainly NEVER lock them
Seven categories of elder abuse have been described by the National Center on Elder Abuse (NCEA)
, formerly the National Aging Resource Center on Elder Abuse. Categories include the following: Elder Law Abuse Law & Legal Definition
- Physical abuse is defined as any act of violence that causes pain, injury, impairment, or disease, including striking, pushing, force-feeding, and improper use of physical restraints or medication.
- Psychological or emotional abuse is conduct that causes mental anguish. Examples include threats, verbal or nonverbal insults, isolation, and humiliation. Some legal definitions require identification of at least 10 episodes of this type of behavior within a single year to constitute abuse.
- The miscellaneous category includes all other types of abuse, including violation of personal rights (eg, failing to respect the aging person's dignity and autonomy), medical abuse, and abandonment.
They are exhausting to be sure.....their habits of stooling in odd places and eating or painting with feces is a brain dysfunction associated with dementia
An article on AN discusses this.
Coprophagia And Scatolia In Demented Elderly Residents
Last edit by Esme12 on Oct 16, '13