Never Argue With Dementia (and Other Nuggets of Nursing Wisdom) - page 5

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   TrishaDL
    I loved this article. I worked in LTC for a while and actually enjoyed when I was asked to float to the memory care unit. I have also had the opportunity to experience a few of these too. Lol we would wait inside for our "Roberts " because we know he would be awful upset if he came to get you and you were outside in the cold. Lol but we left word with such and such friend /family member and he knows exactly where to get you. In the meantime would you like to have a cup of tea/cocoa with me! It was
    so rewarding to see tha you helped someone where ever their mindset was to avoid
    irritation and you got to hear a few good stories. I also had the opportunity to do a
    Little private care with an elderly woman. She was 100y rs old!
    Everyday that I would go to her house I was a new Friend, or I was the nice
    nieghbor who came to visit. She just couldnt believe that there were still people
    that were so caring! I would get to hear the same stories several times a day
    sometimes she would remember a little more detail! I wouldnt trade those
    opportunities for the world!
    Last edit by TrishaDL on Jun 28, '12 : Reason: errors
  2. by   VictoriaGayle
    Love love LOVE this article!
    I think its sometimes cruel to "reorient".
    Why on earth would you tell a little old woman sitting happily in the hallway, waiting for her husband, that he is dead?
    Either she's going to argue with you, or she is going to remember and cry for hours!
    Let her stay there. Work your reason for needing her to go somewere or do something into her reality. It's easier and she is happier that way.
  3. by   KrystelMychelle
    Thank you for posting this. Ive recently graduated and THIS is the kind of things that I like to read from a forum. You are honest and funny too! Now I know a little more about what to expect in the work place and how I can manage a patient like Ethel. Thank you very much, I enjoyed it!
  4. by   VivaLasViejas
    I'm so glad you stopped by here. You sound like the kind of nurse all elderly, demented people need. Welcome to ALLNURSES.COM and to the wild, woolly, and wonderful world of nursing!!
  5. by   artsmom
    I love the trips dementia patients could take you on. I took care of one woman who thought she was the DON of the LTC she lived at. If she got a hold of the phone, she would tell the caller who she was, the DON. She also sent home a brand new CNA because he hadn't gotten his CXR done for TB screening, not knowing any better, he started to leave. She was hilarious. Whenever she was "in trouble" she would tell me to call her by her alias name, Maryanne Trebanowski, so no one would know it was her.
  6. by   al586
    Quote from ixuzus
    Absolutely spot on. When I was working as an aide I found that I got far more cooperation when I wasn't challenging their perception of reality.

    There was one aide I worked with (eighteen, maybe nineteen years old?) who insisted on trying to reorient everyone and was forever leaving residents in tears. One evening I tried reorienting her. I kept insisting that it was really 2064 and she was an old lady and should act her age. The RN we were working with, who hadn't shown any hint of a sense of humour previously, joined in and confirmed that was indeed 2064 and added that we were in a lunar base as 'no decent person has lived on earth since the late twenty-forties'. I don't know if she got the point we were trying to make but she did start to get fairly angry after a couple of hours of this story. In hindsight it probably was a bit juvenile but I was getting so fed up with her upsetting people who were off in their own little reality, happy, and not hurting anything.
    Juvenile?!? I think it was genius! I just may use that tactic someday!
  7. by   ixuzus
    Quote from al586
    Juvenile?!? I think it was genius! I just may use that tactic someday!
    If you do decide to try the tactic then I recommend replacing the calendar in the nurses' station. It makes an excellent prop. All of the major office programs will allow you to create a calendar for any year quickly and easily. Just make sure that you pick a year where the days of the week fall on the same dates as the current year or there may be more confused people than you anticipated. For extra points throw in a holiday or two nobody has heard of and add an image of a futuristic car. Google images is your friend.

    When you see the shadow of doubt cross their face and they just for a second contemplate the possibility that you may be telling the truth or go sneaking off to independently verify the date you know you have won. Whether they actually learn anything is yet another question.
  8. by   JZ_RN
    I have worked with patients that needed to "get to work"... so I politely told them, oh, no you just woke up early, they're still closed. I'll get you up when it's time to go. They never remember. Your family (who either are dead or never come or some other craziness) are supposed to be here? If they are dead I usually will just say, well, I haven't seen anyone come in yet, I'll bring them down if I see someone, or, if they are alive but just not coming, I'll say, Oh, the highway is all backed up! I don't know when they'll be able to get here. You're going to a barbeque today! Well, I'll go look for some food to pack and take with you! One man wanted to look for his steak from 2 years ago. He was adamant, very angry and upset his nurse wouldn't let him go. wheeled him to the kitchen, emptied the contents of the fridge onto the table and said, nope, no steak, sorry. That calmed him down. I left a note on his menu though, so guess what he had for dinner the next night?

    If their reality is safer for them or more pleasant than mine, why not let them live in it. They hardly remember things you say, and I try not to outright lie if I don't need to (there's one man whose wife just died, he goes in and out of reality, more in than out), I always say, Oh, I'm so sorry, remember the funeral we had 2 weeks ago? I know it must be so hard, but she was such a good woman." Or if you have a family that will get involved, the family sometimes comes to explain that so and so is dead, but they provide much comfort just being there. Pictures help. I sometimes will go along with the more innocent situations. The washer is overflowing and leaking everywhere! OH NO... let me go look for some towels, you stay put so you don't slip on the suds, I have shoes on and you don't! Sure, I'll get your (pillow) handbag so you can look for some lipstick. I've got the baby upstairs so that it's quiet for her, everything is okay though. I've even assured patients their food wasn't poisoned by eating a small bite. See, it's safe for me! One lady thought the floor cleaner was bombs in "the war!" I put up her bedside buddy pillow and then put pillows all around her (high fall risk, especially when agitated) and said "there, you're protected now, I'll go and stop them, I'll get you when it's safe, stay here" to which she replied, "Okay, be careful, those b******s are tricky! Sure, I'll call your work and tell them you'll be off today because you fell, no problem. Your son is the president? Well, can he get me a raise? I'll ask him next time I see him! Sure, I saw the doctor's "non-existent" son. His wife and baby are doing well, heard he got a promotion!

    The fun times outweigh the sad usually. I loved the patients in LTC. Too bad I couldn't stay in that dreadful work environment. =/
  9. by   DanaNP
    I worked in an LTC facility where 80 and 90 year old patients routinely wanted to get married (to other patients) in spite of the fact that their wife or husband of 50 year was a regular visitor.

    I can't wait to get old! It'll be so much fun (unless those darn nurses try to crimp my style!)
  10. by   Penelope_Pitstop
    Quote from DanaNP
    I worked in an LTC facility where 80 and 90 year old patients routinely wanted to get married (to other patients) in spite of the fact that their wife or husband of 50 year was a regular visitor.

    I can't wait to get old! It'll be so much fun (unless those darn nurses try to crimp my style!)
    We often joke about what kind of older person we'll be. One nurse, we've decided, will be helping other patients, one will be stripping, another telling stories nonstop, etc.

    I think I'll be like my dear departed paternal grandmother. She was an escape artist. She jumped fences and ran away a few times in her 70s....that's when we decided she needed perhaps a more structured environment than my aunt's house.
  11. by   Clementia
    Working my ortho floor, I once had a (demented) patient who was very worried about us nurses and aides. He was convinced there was a murderer roaming the halls, looking for us. I calmed him down by telling him we had called the police and they were on their way, and that all of us had safe places to hide. I thought it was sweet of him to be worried about us!
  12. by   Vinniesguy
    The arguement over this kind of approach has been going on for years! Naomi Feil started validation therapy in 1963 and since then others have talked about it being a total approach to dementia rather than a therapeutic session (though I see how it would work in both situations). I researched it for an assignment in my masters degree and it sounds great - the odd time I've tried it out it had a good result - but because no-one can come up with any reliable empirical evidence they can't advocate the teaching of it (well that was the latest article I could find anyway). It all comes down to the boffins in their labs - if they say it's okay then it's allowed. Doesn't matter that there are hundreds of us out there saying it works - that's anecdotal and not scientific (and therefore unreliable).
    I'd rather sit in a bunker for 10 minutes with an army officer and wait until those damn gerries have passed than spend half an hour pulling a screaming old man out from under his bed - wouldn't you?
  13. by   MedChica
    This was helpful.

    We have a little lady or two who goes in and out like that.
    I get to her for dinner.
    "Oh, no - honey. I'm waiting for my husband. He's supposed to pick me up any --"
    So I said something like, "Well - we can meet him at the train station. Let me take you to the train station so you can wait for him to pick you up and we can get a bite to eat there too. So, you won't be hungry. It's way easier to instead of having him come alllll the way around to come get you?"

    She thought it over and said, "Ok..."

    I'll have another resident who will 'out of the blue' just get scared when she's in her room and start screaming for her husband. "Charles! I'm cold. Where's Charles...? Charles! Charles! Help! Heeeeeelllllpppp! Charles!"

    I sometimes don't know WHAT to tell these residents when they go off like that. What can I say, "He'll be right back"? What if she expects it and goes looking for him? I've seen residents look for loved ones. Day after day. It's sad. They get dressed up and wait by the windows or go outside in the courtyard (purse in hand) refusing to eat their meals because their daughter/husband/mother is coming to 'pick them up'

    It's not the case with my little lady. She's about 88 and her husband's been deceased for years.
    So, I just try to redirect her. Get her mind off the matter.
    "Charles...where's charles...?"
    "What's going on, Ms _______"
    "I'm cold. I'm so cold. Take me over yonder. I need Charles."
    "Whose Charles, mama?"
    "Say what?"
    "Who is MR. Charles, Ms _____"
    "My husband."
    I feign surprise. "You're married? I never knew that!"
    She looks up, "Yes..."
    "Oh, how long have you been married?"
    She thinks. "Fifty...two years, I reckon..."
    "I hope to be married that long. My parents have only been married 34 years. So, you've got them beat, huh."
    "I sure do...!"
    Then I have to sit and talk with her b/c she doesn't want to be alone. "Don't leave. You sit right here. Sit down."
    ...and she'll grab your hand and pat it.

    Like that. All in all, I've really been getting a load of practice on my therapeutic communication skills since working with psych pts.
    We have to. We're a no-restraint facility. No 4 Pts. No seclusion. Might have a little Ativan to calm them but it's 0.5 mg.
    So, we have to 'use our words'... a lot. This will sound bad, but 'time outs' help.... too.
    Sometimes, rowdy or riled pts just have to collect their thoughts and simmer down.

    Anyway, as I understand it? You feed into it, I guess, if they're suffering dementia alzheimers...for peace of mind. Because the truth causes pain.
    ...but if they're having schizophrenic delusions,i.e., seeing snakes and beasts, etc...?
    You should try to orient them to reality. To help them understand 'real from not'.
    I tried this after I did my mental health clinial/course in NS.

    "I know that you see the snakes - but I don't see them."
    It worked.
    He stopped saying it for the moment.