Dementia Dramatics

Ruby Vee, BSN · Mar 4, 2018

So I'm a CNA and I have been for over 6 months. I've been working at an Assisted Living Facility and I absolutely love my patients and geriatrics. My only problem right now is that my facility is not a dementia care facility, but we are constantly getting demented residents. One of these residents has been under my care since I've started working and, although I care about her very much, her dementia is progressing quickly and it is affecting my motivation to go to work. She has become violent and screams at me during NOC shifts. I used to be able to handle her very well, but now that she cannot recognize me and her dementia symptoms are taking control of her, I cannot handle it any more. I know that the term for it is "compassion fatigue", but I'm really disappointed in myself when I feel like screaming back at her. Does anybody have any advise for keeping my sanity while also helping her keep calm?

Ah yes, the demented patient. I've had my share of them in ICU but we can restrain and medicate them. You can't. And then there was the month I took care of my mother at home before we could get her into an ALF. Mom had Alzheimer's, and she was a very, very busy lady. The moment I'd take my attention off of her for a minute, she'd be shoving wood into the woodstove until the stove-pipe glowed red and I was afraid the house would burn down. Or she'd shove rags into the drains and turn on the taps. Or she'd turn on the gas stove and forget to light a burner. Or she'd run outside to "feed the chickens" (the last of whom was Sunday dinner about twenty years before) wearing nothing but her night gown. In January. In Wisconsin.

My very best advice is to find the humor in the situation. When sufficient time has passed, some of the things your patient says and does will be hilarious. Honest!

The only way I was able to deal with my mother or demented patients (and visitors) at work was to tell myself this was going to be a great story someday and imagine how I'd tell it. Although that has it's downside, too. When the visitor wandered out of her son's room, stripped naked and squatted to poop in the middle of the hallway in full view of patients, visitors, staff and the security cameras, I got the giggles and couldn't stop. When the patient's wife crawled into bed with her husband to "give him some comfort" and didn't realize she had the wrong patient, I couldn't tell the manager (and risk management) without a chuckle or two. When the demented patient got into an argument with the Alaris pump, I had to let the CNAs deal with it and they still remind me of the time I laughed until I cried, sat down on the floor and couldn't get up again. I bought them lunch from the deli down the street, so they forgave me.

Try not to argue with your patient. If she says the sky is purple, it's purple. If she says she has to get to work right now, you might be able to convince her to sit down with you and wait for her ride. I'm sure other LTC nurses will have far better ideas than mine, but redirection sometimes works.

And if all else fails, laugh. Go home and write about it in your journal to preserve the details for when you decide to share the story on AN.

litbitblack, ASN, RN · Mar 4, 2018

If she is starting to have aggressive behaviors that are progressively getting worse does the doctor know about it? She may be on medications for dementia that she no longer needs but causes her brain to be overactive (previous experience with this). I would definately let the nurse know so they can follow up with it. When checking on her at night make sure you introduce yourself in a lighted room and if she refuses or gets highly agitated back away and try again. She may also be at a point where she is not appropiate for assisted living

ruby_jane, BSN, RN · Mar 5, 2018

So I'm a CNA and I have been for over 6 months. I've been working at an Assisted Living Facility and I absolutely love my patients and geriatrics. My only problem right now is that my facility is not a dementia care facility, but we are constantly getting demented residents. One of these residents has been under my care since I've started working and, although I care about her very much, her dementia is progressing quickly and it is affecting my motivation to go to work. She has become violent and screams at me during NOC shifts. I used to be able to handle her very well, but now that she cannot recognize me and her dementia symptoms are taking control of her, I cannot handle it any more. I know that the term for it is "compassion fatigue", but I'm really disappointed in myself when I feel like screaming back at her. Does anybody have any advise for keeping my sanity while also helping her keep calm?

You're absolutely right, it's compassion fatigue. Kudos to you for recognizing it in yourself. Don't be disappointed in yourself....but also - is there something new that's wrong? Yes, it could be progress in the dementia, or maybe it's an untreated UTI or something else that's causing it. Just a thought. My perfectly sweet grandma went psychotic and started having hallucinations - wasn't her dementia, was a UTI. Hang in there.