Dealing with dementia residents

BSNbeauty, BSN, RN · Nov 1, 2014

They should not have sent you home. You did the right thing by telling the resident to stop. I hate that nurses are expected to put up with any and everything.

Tenebrae, BSN, RN · Nov 1, 2014

I wouldnt accept that. I think its a total over reaction to send you home.

firstinfamily, RN · Nov 1, 2014

You should have filled out an incident report just in case your finger has some problems later. Just because the pt is demented does not give them the right to inflict bodily harm. What if she had hit you over the head with something?? Does the pt have a history of inflicting harm to other staff or residents? Has there been a recent change in medications? Does this pt have a psych consult? I do not agree with you being sent home. I think someone over reacted and perhaps did not have all the information to make such a decision. I understand that if someone came across the conversation you were having with the patient and they did not have all the information or the cause of the conversation. It is true the pt would not be able to mentally remember what you were telling her and it may be seen as a form of verbal abuse. Try to not get all worried, I am just trying to analyze what happened and what the outcomes may be. You may actually be suspended, if I were you, I would write down your side of events how they happened and use that for a reference. I would also find out what has happened to other employees when they have been physically attacked by patients. There should be some safety net for employees, next time call security if your facility has one, to break up the situation. I can see both sides of this event, I am not sure how far the repercussions will go, but as I have said there should be some sort of safety net for employees. You are most likely not the first person this pt has physically harmed.

ktwlpn, LPN · Nov 1, 2014

Since we were not there we don't know if this was "fair" or not. You may have been loud, bordering on verbally abusive and disrespectful to the resident. I suspect there is more to the story.

In my experience "no" and "you can't" and "stop it" are either meaningless to a dementia resident. They don't understand what you are saying or the words themselves are triggers. Some staff members can often escalate the behaviors of the elderly demented residents by their comments,tone and body language.

Remember short simple sentences and redirection....A better way to handle this would have been to gently pull your hand away and hand her something else to hold if she grabbed at you again-a wash cloth, an empty med cup or a cookie.

These people are someone's mother, father, spouse,grandparent. They are former teachers, engineers, accountants, musicians,. They deserve to be treated with respect and as adults. They are NOT children in a day care.

tyvin, BSN, RN · Nov 2, 2014

What's your position? Many health care workers are not fully trained to deal with dementia patients. It's not enough to be licensed; in-service's in how to deal and react to contact concerns when it comes from a patient with any type of dementia are critical for staff. One thing I like to point out is that you can't reason with them (usually). I observed many instances where staff end up arguing with this population.

Example...at one place I worked as a charge there was a man with dementia (Alzheimer's); he started coming out of his room with a packed luggage bag stating he was going outside to wait for his wife (who had passed). Staff tried to stop him and take him back to his room but it always turned into a big argument involving many staff that were suppose to be somewhere else.

I saw him coming one morning with luggage in hand and I waited for him to turn the corner, I than called him and told him that he needed to go back to the nurses station because his wife was on the phone. Every time I did this, he stopped and went to the nurse's station. By the time he got to the nurse's station he would forget what he was going there for. I would always get in-front of him and welcome him back and ask him to go to his room and unpack his luggage.

Some people have ethical concerns with this type of intervention, but we need to understand that these people are damaged and to cause further misery is just not what I want to do. In almost all cases I also recommend to take family pictures out of their rooms. The pics only cause sadness if they can remember who they are, tends to confuse them. Even if they can't remember, I think that somewhere deep inside they know. Than the questions come of why am I here, why aren't they here, why did they leave me in this place, why can't I go home, etc...

Others think that acclimating them to current person, place, and time helps them...you know what; let them create their own reality, help them create a reality that makes them comfortable so they have the will to go on as best they can.

Sit and listen and agree...trying to make them believe it's 2014 when they believe it's 1968 only confuses them and causes tension. The thing everyone needs to realize is they ARE NOT going to get better; so why argue? Even with the Alzheimer's meds they will still progress in their disease. There's also a big controversy about when to stop and begin or even to treat with them.

These people need to be respected above all else. Do any of you know what some of your people did before they ended up where they are? I think you would be very surprised at the lives they lived before taken by dementia.

Never bend down in front of said patients, even if they're in a wheelchair, like checking feet or tying shoes, do it on the side or you may find your face being kicked or slapped. Being aware of their body positions, hands, etc.. is critical. You need to be observant and than you won't end up with a patient's finger in your face (or whatever happened).

God bless them all...

TheCommuter, BSN, RN · Nov 2, 2014

I don't think it's right I got sent home for telling her she couldn't do that to me. I need some advice!!

Reasoning with demented patients is pointless. Do not attempt to reason with a demented patient ever again. I speak from experience when I insist that it does not work with this type of patient population. Use techniques such as distraction, therapeutic fibbing, or walking away, but do not stand there and attempt to reason with demented Grandma or Grandpa.

With that having been said, my years of working in the nursing home industry have taught me that abuse allegations possess a wide range of interpretation. While there might have been nothing wrong with what you said, an onlooker or coworker who dislikes your tone can accuse you of 'abuse.'

The next time a demented resident grabs your finger or a body part, walk away. Do not engage the demented person in any form, shape or fashion, because you'll be cast on the losing end of an battle that cannot be won.

RNperdiem, RN · Nov 2, 2014

I am sorry to hear of the trouble you find yourself in right now. I once worked with people with dementia too; I know how hard it can be sometimes. There is a book I read called "The 36 Hour Day"(at least I think that was the title). It is a book written for families taking care of people with dementia. It explains very well how dementia affects people and how to get care done without causing an emotional meltdown. People with dementia get easily upset when they feel rushed, or mentally overloaded.

ktwlpn, LPN · Nov 2, 2014

As others have pointed out -you can't "reason" with someone whose "reasoner" is broken.

bluegeegoo2, LPN · Nov 2, 2014

The only real tool we have with dementia residents is re-direction. Attempting to make a dementia resident (or any resident for that matter) see the err of their ways is not only futile, but can easily come across as scolding. Scolding is not only a big no-no, it can be interpreted as abuse whether abuse was intended or not. In no way should we attempt to "correct" them, as that can further escalate behaviors and can toe the line of abuse. I would wager that's why you were sent home.

Any physical contact made by a resident should be met with the staff member immediately but carefully extracting themselves or others from the contact, make sure the resident is safe and out of arms reach of other residents and staff then monitor for continued agitation. Re-direct as needed to defuse the situation. Staff should complete an employee incident report just in case injuries arise at a later time. And of course, always follow facility protocol if contact was resident on resident.

proud nurse, BSN, RN · Nov 2, 2014

I worked on a non-locked Alzheimer's unit of a nursing home for 7 years. The staff of that unit was sent to classes to become Alzheimer/Dementia care specialists. I know a lot of tactics for diffusing situations with dementia residents, but when you feel a perceived threat it is a natural reaction to protect yourself. Some of these residents are very impulsive and can go from 0 to 60 in less than 10 seconds. The situation sounds like it was misunderstood by someone who overheard it. Dementia care employees are held to high expectations, in my opinion. They have to understand that what the resident does is from the disease taking over. Residents could hit, pinch, scratch, spit at, smear feces on employees and it was brushed off. But the minute it was resident to resident, the DON and administrator had to be notified. At the least, perhaps this can serve as a wake up call to management that more training on how to care for dementia residents is needed.

TheGooch · Nov 4, 2014

Since we were not there we don't know if this was "fair" or not. You may have been loud, bordering on verbally abusive and disrespectful to the resident. I suspect there is more to the story.
In my experience "no" and "you can't" and "stop it" are either meaningless to a dementia resident. They don't understand what you are saying or the words themselves are triggers. Some staff members can often escalate the behaviors of the elderly demented residents by their comments,tone and body language.
Remember short simple sentences and redirection....A better way to handle this would have been to gently pull your hand away and hand her something else to hold if she grabbed at you again-a wash cloth, an empty med cup or a cookie.
These people are someone's mother, father, spouse,grandparent. They are former teachers, engineers, accountants, musicians,. They deserve to be treated with respect and as adults. They are NOT children in a day care.

Yep, you can't reason with a dementia patient. From my own experiences with NH most of the people who work with them are not properly trained in how to deal with them and what behaviors are normal. Saves on money to hire the less qualified people.

Arguing with them is pointless which it sounds like the OP did. I like your comment about how they deserve to be treated with respect and as adults and that they are not children in a day care. Too many caregivers think that way. Thanks for saying that.