Never Argue With Dementia (and Other Nuggets of Nursing Wisdom) - page 2

It never're walking down the hall to check on your new patient when you hear an aide loudly attempting to persuade sweet, confused, deaf-as-a-post Ethel to get into bed "BECAUSE IT'S... Read More

  1. by   CompleteUnknown
    Quote from kalex
    love your post. it is so true everything you have written about. Believe it that if they' re going to die tonight they do before your shift is over. poor you as you have code blue!
    for your dementia patients their past is their present, respect it and enjoy their stories more or less... so "make a molehill out of a mountain "
    Make a molehill out a mountain. I've never heard it said in quite those terms before, but what a wonderful way to describe what we should be doing!
  2. by   Lynx25
    I love this! I spent a whole weekend serving the "G--D--- Queen of England", it really was fun, if with perhaps more cursing that I would imagine the Queen using.
  3. by   Maremma
    Now if we can just convince the schools to start teaching this preferred method of handling dementia we would ALL be in a much better place! I do the same thing with all dementia patients. It is such a drastic difference in the way they respond to others that try to force them "back into reality" than the few of us that do not.
    There are some in my facility that are also still mobile. They are currently not my patients and live down other nurse's halls. They will try over and over and over again to get themselves over to my hall though to "hang out" with me and my own dementia patients. Staff from their own hall will (infrequently) come and try to retrieve their own patients and get them to stay in their own hall. One of the patients that just keeps right on coming back to my hall finally had enough. When asked why he wanted to keep coming back over to our hall instead of is own he said "Well they are crazy over there! They keep insisting I am in a nursing home and I live there now!" "They make me so angry I want to belt them one!" "I have work to do and they keep trying to stop me!" Indeed he will belt them one too. I simply hand him paper and pencils and let him "calculate and recalculate" to his hearts content. I tell him the deliveries are all out and the meeting has been rescheduled for Monday. He did a great job this week! He stays calm and non-combative that way.
    ALL dementia patients that I have seen others try to "reorient to reality" have wound up displaying some type of negative behavior due to it. NEVER have I seen it actually work and the patient suddenly accept their actual reality. Pft who would want to anyway?
  4. by   Hygiene Queen

    I learned what I know about dementia patients from two decades of working with this most fascinating and rewarding population.
    I observed and learned every single day of those 20+ years and I can get the most difficult patient to do what I need them to do... but I have to come into their world and I have to work on their timeline.

    Dementia patients require time and we need to learn to work around them.
    If this could only really really happen, I do believe we would see less aggression and agitation.
    Oh, I could write a darn book!

    Has anyone ever seen the old educational film about reorienting dementia patients?
    It was a documentary from the 60's and it brought a tear to my eye.
    It confirmed everything I believe... that reorientation is an ignorant and heartless practice.
    In this film (which was filmed long long before HIPAA) a group of dementia patients were filmed during a session in which they reoriented.
    The distress and pain that this reorientation elicited was heartbreaking.
    The occupational therapist, who played the film for us, said to me, "I knew you would appreciate this!"
    I sure did.

    Every time you tell a dementia patient their mother is dead is like telling them for the first hot-dang time!
    Yes, let's just rip that wound right back open afresh!

    I have to shut up now.
    Just the thought of all this makes me greatly agitated!
    Last edit by Hygiene Queen on Jun 23, '12 : Reason: I was too agitated to spell correctly.
  5. by   sapphire18
    Beautiful article, as always, Viva. As a new grad on orientation 3 years ago, I was attempting to ask a patient about *her* reality instead of reorienting her to ours, and I was scolded by my preceptor. It never made sense to me, the way we are "supposed" to do it, as they will never believe us anyways!! I suppose that 60 years down the line, I will be insisting that I need to go give room 10 their meds or suction room 12...I hope that whoever is taking care of me will "let" me!
  6. by   Hygiene Queen
    I've packed bags and sat in train stations.
    I've doled out payroll.
    I've taken dictation.
    I've gone shopping.
    I've checked the stove.
    I've travelled to 1952 and back.
    Man, we do a lot with our dementia patients!
  7. by   VivaLasViejas
    In my way-back days, there was a 100-year-old lady in the LTC where I worked who had been a night-shift LTC nurse herself. The poor thing had outlived two husbands, all five of her children, and even a couple of grandchildren. But she'd worked nights for 50 years, so she went on rounds with me, making her "nurses' notes" on a clipboard and advising me on when I should go find the doctor. I'll never forget the night she greeted me with a big hug and a kiss on the cheek, excitement in her eyes, and a packed suitcase: "My daughter's coming for me! She's picking me up after I get off duty and taking me home with her, isn't that wonderful?" She passed away three nights later.
  8. by   CompleteUnknown
    Quote from Hygiene Queen
    I've packed bags and sat in train stations.
    I've doled out payroll.
    I've taken dictation.
    I've gone shopping.
    I've checked the stove.
    I've travelled to 1952 and back.
    Man, we do a lot with our dementia patients!
    I seem to spend a lot of time checking train timetables, planning trips, finding out why husbands are late home from work, making sure the baby is okay, reassuring people they don't have to worry about the cost of staying another night because the room is 'on the house' tonight, and agreeing that it's very irritating the way these meals are served at unsuitable times but suggesting we probably should all have something to eat while the food is there.
  9. by   Hygiene Queen
    Quote from CompleteUnknown
    I seem to spend a lot of time checking ...why husbands are late home from work...
    That is the worst!

    I did have one patient who got excited when we told her that her husband, Joe, was coming to visit.
    She would giggle and get in a dither and insist she had to "put her face on" for Joe.
    We would help her put some lipstick on and reassure her that she looked pretty.
    It was so cute!
    But Joe was her second husband and she would sometimes forget that.
    So, she would have periods where she would travel back to when she was married the first time (to a man who had cheated on her).
    She would fret and, literally, wring her hands over how she thought he was cheating on her.
    Reassurances otherwise did not work. This was a real experience and she was time-warped right back into it... not even remembering Joe.
    The pain she was experiencing was heart-breaking and there was nothing we could do, but she did get a lot of hugs.
  10. by   Five&Two Will Do
    When I was first a CNA, I worked with Maxim Healthcare. I was sent to a place that had locked Alzheimers unit and of course that is where the "agency guy" was always assigned. I loved to watch the old CNA's work with the demented patients. I learned right away that there is no reasoning or logic or redirection for someone with advanced dementia. You just gotta role with it. The saddest thing though was a little old lady from Norway. Every night while the bulk of the patients began to pack up their stuff to go home cause it's getting dark, she would cower in her bed and call out over and over on the call light making sure that we had locked the doors and were keeping a look out. She had lived during the time of WWII and was terrified that the Germans were coming. That was certainly one of the most heart breaking things to date that I have experienced all of these years later.
  11. by   Hoosier69
    Luv your writing style!
  12. by   Hoosier69
    My late grandmother suffered from dementia and later, Alzheimer's Disease. She passed away last June at the tender age of 97....
  13. by   Pepper The Cat
    I had an 85 year old woman convinced she was in labour now night. She streamed, she yelled. Finally, at 2 in the am, I "delivered" the baby, showed him to her and then took him to the nursery. She slept the rest of the night!