dementia patients

shawng007 · May 6, 2003

miss jkm, I am a nursing assistant with a local hospital in northern new york. before working as a NA, i worked as a sitter, mainly with elderly confused patients to prevent accidents and to keep them from pulling out catheters, saline locs and other equipment. i know that dealing with dementia is very frustrating and can be very challenging, and it takes a special person with a kind heart and a lot of patience to deal with. i feel also that it can be very rewarding as well. there is much literature on dementia, but experience dealing with patients takes time. maybe if you havent done so already, you could arrange to spend some time there to interact with the residents and get a feel of what is involved. put your heart into it and you can accomplish many things, and the rewards can be great. many people lack understanding of the elderly in general, and more so with dementia. take care and God bless.

shawn galloway:roll

ChainedChaosRN · May 6, 2003

MissJKM...please do not be hesitant to work with the dementia resident. They are our mothers, fathers, grandmothers, grandfathers, aunts and uncles. You may encounter all types, slightly confused to very agitated and striking out. Some that just need minimal ass't with ADL's to those that can do nothing for themselves.

The best advice I can give you is to treat them with dignity and respect. Even the most demented are able to recognize kindness and compassion. Always talk to them as an adult...sometimes you might need to just keep it simple. Touch is ever so important and a smile. The demented patient is "us" who have lost their way. Treat them as you would want to be treated and you will be a jewel in their eyes.

adrienurse, LPN · May 6, 2003

I have been working in inpatient care on a dementia unit for the last 2 years. It's not for everyone, but those who love it, love it a lot. My advice is simple. Take the lead from them. Just go with what they're talking about, climb into their world. This is a skill that comes with time like any other in nursing. Probably the best advice I ever got is to never impose your reality on them. There is nothing more disrespectful. If they are "having tea with their grandmother" and they're perfectly happy, let them.

Oh yeah, remember these things:

1. Promise me you won't be one of those nurses who medicates people just so they sleep at night (see #3). If they need to be awake at night and they're not disrupting anyone, leave them alone.

2. Remember that there is no medication in the world that stops calling out and wandering. It's just a part of the disease and there are other ways of dealing with the situation. See #3.

3. If someone is agitated, look at basic needs first. They're agitated because they're trying to tell you something. Ask yourself: Are they hungry? Are they in pain? Do they need to go to the bathroom? Are they tired? Are they just overstimulated? Think Manslow's Heirarchy of needs.

Any questions, I'm always here. Good luck!

GAstudent · May 7, 2003

I agree with the above. I work in LTC and love it. I see pt with everything. I have one little old lady who is 90 years old and talked to no one but her sister. Well when I first started that lady just wouldn't let me take VS, change her, or anything. Well i had to think of something to get to know her and get her to know me. Well I looked around her room and she had pictures of horses everywhere. She has a picture of her on a horse at a young age. So I started talking about horses and got her to respond. I told her that I have a horse named Misty (I don't have a horse at all, only riden one once, but hey it worked) Well the lady told me her horses name and how she loved them and wishes she could ride them again one day. Now on a daily basis we discuss horses. I have another lady who I tell her who is on her pictures in her room. When I got there (I was doing CNA clinicals) and I left notes in the pt rooms so that when the family came in they would put names on the back of pictures to help me tell the pts who they were in the pictures. Some residents love this. I know all about another resident who is 97 and where she use to work and her husband and her daughter in law and that is what we discuss. Get to know your pts. You will be surprised what they know and what they don't. Dont look at this as a bad thing. Let the pt help you help them. As said above don't give them meds to make them sleep, if they want up to walk at night or sit in a chair then let them. It's your job. I had one man in clinicals that wanted some coffee and I was unsure if I should give it to him. So I asked his nurse and she said "Lord no, he would be up all night." this was at 9pm. I told him that he could not have any. We said to sneak him some, well I was scared and said to his nurse that he wanted it. She sais no. So I nicely went into his room and said that the coffee machine was not on and there was not a fresh pot. He said well I guess I'll just have to drink Sprite. I was scared because I did not know if he could have it and instead of flat out saying NO and not making anyone mad I said there was not any, so he said fine , not a big deal. Think of what you say and do before you do it. Just because someone else doesn't want to deal with them doesn't mean anything. If they want it and they can have it, then give it to them. Always think of how you would feel. Respect the pt and their rights. Good Luck.

GAstudent · May 7, 2003

This could bring windows of oppurtunity, when you finsih with school..keep tha this in mind.

Ellen · May 7, 2003

In the hospital, the first thing I do when a pt seems particularly agitated I always offer tioleting first, then change of situation - i.e.bed to chair, chair with lock table, even recliners. Sometimes I get an Aid to take them for a wheelchair ride. Of course, I check all the obvious things first like pulse ox, did they throw their O2 on the floor? And I really try to understand their needs, sometimes you have to use your powers of understanding to interpret what they are trying to say in a very round-about way.

ava'smomRN · May 7, 2003

thank you all for responding. i did have to take care of one resident with dementia during my clinicals but it was just for about an hour and i was surronded with about 5 other people. im still a little nervous but with your advice i think i will do just fine. my fear is i like my residents to know me so that we can have a relationship and with dementia i know there confused. but i want them to know that i care for them. will they know??

Nurse Ratched, RN · May 7, 2003

They know when you care, Jkim :). I know because they can spot the staff that don't and they are usually the ones who really have a hard time with people with dementia.

They may not remember your name, but they have an impression of you - whether they feel comfortable around you or not; whether they sense you care or not. I had the pleasure of caring for a darling little lady for about 5 years who had Alzheimer's. She got long past the point of being able to put my name with my face, but she retained a positive association with both until nearly the end and always responded well.

Good luck. Geriatrics can be a wonderful and rewarding field.

perfectbluebuildings, BSN, RN · May 7, 2003

Good luck JKm- I worked with several patients with dementia over the summer, and I found it very rewarding. I do not have much to add to what previous posters have already told you except to agree that YES, pts with dementia certainly can tell if you care. I was at clinicals one day helping a CNA give a lady with advanced dementia a bed bath. The lady was moaning and upset at the beginning of the bath, but by the end was calm and ready to go to sleep, and I know she could sense the deep caring I could see in the CNA, in the loving way she spoke to and touched the patient. It is little things, like touch or the caring tone of your voice, that make it so obvious to someone no matter how "out there" they may be that this person CARES about them. And from the way you are asking this question and thinking about this it is obvious that you do care, a lot. I hope you have an awesome experience- remember as always to keep a sense of humor too! :)