Confused residents are upsetting to me

Forever Sunshine, ASN, RN · May 28, 2011

I don't know what to do with them when they are asking nonsensical questions to me while I am charting and one is sitting with me. Do I engage them in the conversation....ignore them (which just seems really really wrong to me) or what, what do I do?

Aw I love when they come sit with me when I'm charting. It gets very lonely behind the nurses station sometimes. Give them a snack. Let them type on the computer. (They love this one)

One night I had a resident sitting with me. Basically I was almost sitting on top of her to keep her from getting up. She kept trying to get up saying, "I have to get out of this place and go find a job." So one of the CNAs went to another phone and dialed the extension pretending to be a future employer. I had the resident answer the phone and they talked for a good half hour. It tired her out too and she went to bed after that. lol

Pixiesmom, BSN, RN · May 28, 2011

Remember they are just people and the more time you are with them the more you will get to know them. Give yourself some time to get used to it . You cant fix the confusion and watch how other nurses and aides handle it and it will help you learn.. We are all nervous in new areas. Good luck.. Some days it is frustrating and other days you will laugh alot..

Excellent advice!

You will soon learn more about them and know how to better interact with them. Caring for people with Alzheimer's and dementia can be tiring and frustrating at first but as you get to know them and their personalities it will be easier.

CompleteUnknown · May 29, 2011

Sometimes a lil creative thinking can make a big difference. One ladies anxiety issues (manifested by"help.help.help."repeatedly) were calmed by the addition of a soft stuffed dog. (a pet lover she was!)
Music from his younger years helped soothe another agitated elder.
Finding out that Mrs"Smith"needed regular sips of water..
The solutions are as varied as your residents.If you have an activity department, try picking their brains for ideas and clues.Find your most sensitive and devoted aide, ask their advice. Somethings work some of the time, and not others.
Good luck, happy thinking! It will take some time, but I hope you grow to love dementia as much as I did !
cheers!
Raincity

This is great advice. :)

Here's a link to a powerpoint about the 'Need-Driven Dementia Behaviour Model' and person centred care.

http://www.changechampions.com.au/resource/Dr_Lynn_Chenoweth_-_Employing_the_Need-Driven_Dementia_Behaviour_Model_(NDB)_and_Person-Centred_Care_(PCC)_to_improve_care_and_well-being_for_persons_with_dementia.pdf

SneakySnake · May 30, 2011

Thanks for all the links and advice! I am already feeling better about work :) Still have a lot to learn but its getting better.

arabstarRN · May 30, 2011

While in my Geri rotation and doing clinicals at the LTC facility, there was a patient who CONSTANTLY yelled "NURSE!", and I am not saying this is the case with all yellers because it obviously isn't, but she had a BAD UTI that had gone undiscovered (This place wasnt exactly a 5 star facility) and once she began treatment and it started to clear up, she decreased her yelling and became happier... she couldn't tell anyone she had a UTI, she didn't know she did. She was confused, as UTI's often cause older people to be, she felt the pain but she couldn't pinpoint where it was so some didn't take her seriously on her pain (which is just UNACCEPTABLE IMO, confused or not, pain should be investigated to try to find a cause if a patient states they are in pain but can't pinpoint where) Sadly, the UTI returned shortly after it cleared up and I heard from my instructor that the person died within a couple months of our clinical ending. The staff was annoyed with her because of her yelling, Many of the students would stop and talk to her, try to assess her and help her out, it was my instructor who recommended she be tested for a UTI. So sad that this lady had an issue for so long and no one seemed to know.

Anyway, kind of lost track there. Some just yell because of their disease causing them to be irrational, and some yell because they have an issue that may not be known, and some yell because they are simply irritated and don't want to be there lol, is what my findings have been.

gentlegiver, ASN, LPN, RN · May 30, 2011

When patients are in confused states, the best way to approach them is the same way you would work with a psych patient who is in a psychotic break, or a manic or delusional state. You want to reorient and redirect. You want to be a calming presence, and ask simple "yes or no" questions. Reorient to person, place, and time. Sometimes, often times, these patients just need a caring hand to hold, or some assistance to get to a group activity. You don't need to and can't actually solve their problem, the dementia. It's there and it's getting progressively worse, they may have issues with medications like risperidone, like restlessness or sedation. Don't try to solve these issues, just try to be a calming presence, and do your best to meet their needs.

You can not reorient a dementia patient, you can redirect, but, not reorient. As dementia takes them, it removes the last years to the earliest years. I have had many patients ask where thier parents are, it would be beyond upsetting to tell them thier parents have been dead for X number of years and that they are 89 years old, when in thier minds they are in thier teens or younger. I usually just go along with thier conversation, ask them questions about what ever thier talking about. I never lead the conversation, just follow.

HurricaneCasRN · Jul 13, 2011

You can not reorient a dementia patient, you can redirect, but, not reorient. As dementia takes them, it removes the last years to the earliest years. I have had many patients ask where thier parents are, it would be beyond upsetting to tell them thier parents have been dead for X number of years and that they are 89 years old, when in thier minds they are in thier teens or younger. I usually just go along with thier conversation, ask them questions about what ever thier talking about. I never lead the conversation, just follow.

Make sure you have a history. As as aide I had a patient with Parkinsons and alzheimers. Late70s or early 80s I think. The first time she asked for her mom, I thought she was clearly having behaviors. Of course, duh. The woman herself was in LTC.Her mom MUST be long gone, right? Yeah, her mom died LAST WEEK. She was approaching 100 years old. But, she was in better shape, so I understand, than her daughter. There was a picture of the giant cake that she sent to her daughter in the facility for her birthday.

Overall though, I'm all about feelings not facts. Except when they ask. I PERSONALLY have a hard time with not being honest when they ask direct questions. "Where am I?" "When do I go home?"