dealing with confused patients

Specialties Geriatric

Published

I work at a nursing home and last night there was a resident who was convinced the building was on fire and needed to get out. I was trying to calm him down, telling him there was no fire. Then the nurse came in and was telling him she was calling the fire department and he needed to stay in his room for now. This surprised me a little bit, and I thought about how I am in my third year of nursing school, and I never learned how to deal with situations like this. Do you tell them they are confused?? or go along with it?? I almost feel like if they are so sure of something, its almost offensive to them to say they are wrong, but I don't really know what the best way to handle it is!

Specializes in School Nursing.

This is a touching thread. I have not worked LTC and I think the creative and "therapeutic lying" techniques you all use are wonderful. We have to meet the patients where they are, after all, even if that means stepping out of our reality and into theirs when the situation calls for it.

Kudos to all of you!

Specializes in LTC, Hospice, Case Management.
I dont call them white lies or fibbing. I call it Jumping realities. One of the first questions I ask a dementia patient is how old are they, because then I know where they are in their life and can make my statements accordingly.

This reminds me of a demented little lady I took care of years ago. She had a big family outing coming up and a couple of us worked on sprucing her up for the occasion. We took great pains to do her hair, paint her nails, put make up on and dress her up in her nicest clothes. We were so proud of how good she looked so we took her to a mirror so she could see for herself. One look in the mirror and she burst into big tears and just sobbed. We were very confused because we thought we had done so well. When we finally got her calm enough to talk and us asking "What is wrong" She cried "You made me look soooooo old but I'm only 25 (years old)". Poor thing - we never took that into consideration when we took her to the mirror (was admittedly hard not to laugh).

Specializes in Gerontology.

I used to have to lie to my Mother.(she had Alzheimers). My Dad would need breaks, so he would bring her down to my place (I live about a 4 hours drive away) and then go stay in a hotel. He would also go to sportman's shows, woodworking shows or whatever. So I would tell her that I was worried about him driving in our city traffic so I was making him stay at a hotel close to where the show he wanted to go see was.

My Dad got the break he needed without my Mom knowing that he needed a break. And I got to spend some very precious time with my Mom!

If the patient asks for her long deceased spouse, I simply say "If I see him, I will send him in to visit".

Throughout college, I swear I was taught to "re-orient" all confused patients. I started working as an RN at a nursing home, and I pretty much extensively follow through with the creative fibbing approach for many patients now. For the patients that say they are heading home a couple times a week, I tell them I need to call the doctor for the final order to go home and that they should get their bags ready. For the resident that wants to ride the bus, I take her to her room and set her down in her recliner and say the bus will be there in 5 minutes. For one resident, she was taste-testing home-made pudding instead of taking medication. It's weird, because I would have the same conversation every time I tried to get her to take the medications.

Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.
I am a night shift nurse, and I live almost 300 miles away from my grandmother, and I don't get there to visit often. Fortunately, my grandmother thinks that I am the night shift nurse for her hall in the nursing home, and once the nurses there realized *I* was a nurse, they started playing along. It's a small town, they know enough about me to be able to tell my grandmother things about my life and my family (pretending to be me, of course). My grandmother also thinks the handyman of the facility is my brother.

Every night she thinks I'm there, taking care of her. Every day, she thinks my brother is there, keeping the place running.

It used to upset my mom, that my grandmother couldn't recognize my brother and I, and she would try to reorient her. Now she understands how much peace and comfort it brings my grandmother. I also pointed out that, they must be taking good care of her, because I don't think my grandmother would let "us" get away with anything but kind and patient care.

What a nice story. Really :)

We talked about this in nursing school. Learned that the approach should be asking them what led them to this idea. In real life it's different. You can't reorient someone in a matter of minutes. It's all about safety, administering the right medication ahead of time, and trying to distract by introducing a new safer stimulus that would not feed into the delusion, while still sticking into reality and attempting to re-focus the pt. It's still a trial and and error up to now for me too.

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