A gentle approach to dementia... - page 2
OK, truth-in-posting: I'm preparing a presentation for relatively new nurses on dementia. I wanted to include input from the allnurse experts on creative ways that you deal with confused patients,... Read More
Apr 27, '03These are some great ideas!
I work acute care and my best advice to simply make sure that you always treat them with respect. You may think they are completely nuts but any patient with a fluctuating LOC or who is confused d/t an acute illness will remember how you treated them when they come out of it.
Apr 27, '03Guess I have a simple rule when it comes to geri-psych pts..DO UNTO OTHERS AS YOU WOULD HAVE THEM DO UNTO YOU...that Jesus...he knows sum stuff 'eh ? Every time I find myself getting frustrated/aggrivated with a pt r/t his/her mental illnesses I make myself stop..take a deep breath (or 10)..maybe even take a 5 minute break..then return with a calming smile...all the while remembering this pt could be my grandparent or family member ..or for that matter, ME in 20-30 years...how would I want to be treated in the situation? or want my Granny to be treated? works every time for me.
Apr 27, '03I worked in LTC for 23 years and have seen and worked with many dementia residents. All of the above responses are wonderful. The use of a baby doll is wonderful. These residents who kept children or had lots of children and grandchildren will take these dolls and for them they are real. Also the dementia bear with a tape recorder built in is wonderful. It comes with soothing tapes that you can play while the resident cuddles the bear. I have only come across one resident that I was at a total loss for what to do for her. She wanted to pat and did not keep her hands clean, even with staff washing them. She stood and walked almost continously. It was very difficult to find the right things to keep her occupied. Our only resourse that constantly worked was food and she could not eat all of the time. We were lucky that she responded to some of the office staff and they would take her to their office and she would sit in their office and go to sleep. I would not trade one minute for the time I spent in LTC. I loved everything about caring for the residents. However, paper work is a killer of good nursing measures in LTC.
Apr 27, '03One thing that we are always taught to do with demented pts is to reorient them to reality. I think that this hurts a lot more than it helps in many situations.
For example, when I worked LTC, a pt whose spouse had died years ago might ask for him. I've seen nurses and CNAs respond with comments like "Mrs. Jones, your husband died five years ago. Remember?"
This upsets the pt, and for what? They won't remember it and will be again asking where their husband is in a few minutes. The response I prefer is "I haven't seen him, Mrs. Jones, but if I do, I'll let you know."
I've had male pts who think I am their wife. i.e. "Margaret, what are you doing still up? Come to bed." In the past, I have responded with a smile and something like "Mr. Jones, I am not your wife. I'm the nurse."
This has served only to get them upset, wondering where they are, and why would they be needing a nurse. After I gained more experience with demented pts, I found that saying something like: "Okay, George. I've got to finish up in here. I'll be in in a few minutes." to be much more calming to the pt.
I am not lying to the pt, as I will be in to check on them in a few minutes. They usually respond with something like "Okay." and that's the end of that.
I think that in many cases, using "reality orientation" is overrated and ineffective.
Sometimes, pts may be in pain, but can't verbalize it. I would often give pains meds to pts who yelled out or continually tried to get oob, with good results.
When all else fails, (with violent pts) Haldol, Ativan, etc. are sometimes the only ways to go.Last edit by Hellllllo Nurse on Apr 27, '03
Apr 27, '03This is a great thread for me to read right about now. I am in the process of getting certified as a cna as this is required fir the nursing program I have applied to. I am looking forward to the experiance yet I wish they taught us more in class about interacting with patients with dementia. I really appreciate all of your suggestions......
Apr 28, '03Tied up this weekend, then came back to more great responses. Thank you for benefitting the nurses I'm teaching with your wisdom and experience. I agree that reality orientation is not as effective as we once believed, especially with the chronically ill. Thank you very much for you help. :kiss Nursemouse
Apr 28, '03[QUOTE]Originally posted by Hellllllo Nurse
[B]One thing that we are always taught to do with demented pts is to reorient them to reality. I think that this hurts a lot more than it helps in many situations.>>>>>>>.I think reality re-orientation is not appropriate with dementia pts-it's cruel and ineffective-I though it was not being taught any longer? Nothing worse then telling some 85 yr old alzheimer's pt that her mother died.....