pacify or orientate? Alzheimers... - page 13
So I have worked my third day as a LVN in a LTC facility. Orientated for one day then turned loose...on the alzheimers lock down unit. 21 residents. A little scary, but I am fairly comfortable, so... Read More
Sep 8, '06Quote from Nascar nurseI agree completely. I worked alzheimer units for three years on night turn, and we had a lot of sundowners. To tell an alzheimers patient the truth, contradicting what they are saying, is basically calling them liars. Their reality and your reality conflict. Besides most of them, imo, tend to revert back to happier times in their lives, ie, childhood, young mothers, first married, etc. Why would you want to try, which is unsuccessful 99% of the time, to take that person out of such a happy time, back to the reality of being in a nursing home?No experience working with dementia/alzheimers patients huh? Been doing this over 20 years. The staff the insist on reality orientation gets cussed, hit, bit, spit at, etc and the resident can become agitated beyond belief. The staff the goes w/ the therapuetic lying ends up with calm happy residents. Lazy?? Takes alot more energy to be running around a building pretending to milk cows then just say "There are no cows out there" and walk away.
Sep 8, '06Stan Tomandl has just written a book about Alzheimers called
Alzheimers " a surprise party". its a very sensitive book written by a psychologist and counsellor who worked and related to his own father as he lived in the altered state of consciousness which we know as alzheimers.
I recommend it for its humanity and supportive suggestions
Sep 8, '06ALLRIGHT, who came up with the lying thing????? Whatever happened to CREATIVE REALITY? This is what I do out our facility.....it sounds much nicer, and how can you orientate someone who is living back 20, 30, 40 yrs or more, do you want to have a severe confrontation? agitatation? combativeness? GET REAL and use CREATIVE REALITY!
Sep 8, '06Hey, have been following this thread. Now decided to "add" to the discussion. I work geripsych. There are so many "theories" that we learn in Nursing School, and then we have to actually apply the stuff practically in our daily work. We are trained to gear our work/teaching at the developement level/educational level of our patients. An AD pt is developmentally not in the same level as a pt without it. Our dementia pts run the full range of developmental/educational levels. Many people back 50-80 years ago were not able to finish even the 8th grade before having to go out and work. We also can not forget that they ARE adults with adult experiences, some of which they still remeber parts of.
I think back to when my dad was growing up in MN. My dad only went to the 8th grade. The family lived in a "cold water flat" with a shared bathroom and no shower/bathtub. My Grandma had to get out washtubs and fill with water heated on the wood burning stove to bath the kids and they only did this on Saturday night, so as to be clean for Mass on Sunday. There were 9 kids in the family, and only 5 beds, in 3 bedrooms. My Grandfather was not a steady worker, and there was not always enough food to go around.
On the other hand, my Mom's family was very well educated. My Mom's dad had a college degree in Math and worked at Honeywell. He even had a job throughout the Depression. They lived on a farm and had plenty of food. My Mom had 4 siblings, each had their own bed.
Why am I bringing this up? I always try to remember that we can not just take a theory and make it work with our pts. I can imagine if my Dad was alive and had dementia and we were trying to make him bath because that is the right thing to do. Gotta keep the pt clean, and it is what we were taught to do in school. We would have a HUGE fight on our hands. His family only washed up daily and took one bath a week. He would be the one hoarding food in his room because he'd eaten "enough" and would be remembering to save back something for later just in case, and not to waste it. He might also be that naughty guy crawling into bed with another resident, because he never had the luxury of having his own bed, and is confused.
We have to use our theories and experience to formulate the care of our pts. For example...that old guy crawling into bed with another pt may not be an old "horn dog". It is a lot more therapuetic for a staff memeber to say "Oh, Mr Green, I am so glad to see you. Lets go down this way and get something to eat before you go to bed" than saying something like "What are you doing in here. I have told you over and over again that this is not your room and you have your own bed. It is not okay for you to keep bothering this patient. Now get out of here"
I hope you can follow where I am going with this.
One more thing.....we need to remember the developmental stages when dealing with "young" nurses. This is not a slam to anyone. We just have to keep in mind not to alienate the "youngsters". They have lots of enthusiastic ideas and we can learn from them too.
BUT....could they not just learn to repect their elders!!
OK sorry I could not resist that!!
Sep 8, '06I think the word you mean is *orient*. Patients with Alzheimers Disease are not oriented to begin with so you're not going to orient them. What you can do is redirect them. As others have mentioned in previous posts there are good books out there that are worth reading. Not sure if I can mention the title of a simple one to read but it has to do with a 36 hour day.
Sep 8, '06It doesn't seem nice or fair to lie to anyone, especially a demented elderly person- we have been taught all our lives not to lie. But think of it as a "little white lie". Remember the goal is a happy peaceful patient. They can't accept our reality; all they have is theirs. So you, having the capacity to step into their reality, must do so. Don't forget redirection- "Oh, Mrs. X, your dog is fine. She's under the bed where she always sleeps. Would you like a snack?" (do a favorite activity, help me with something, etc.). I had a very active wanderer who would go into other resident's rooms, upsetting them, agitated etc. She went behind the nurses' station one day and totally disorganized all my paperwork. I had a brainstorm and gave her an over bed table and some non-HIPAA, nonessential papers and she sat quietly and shuffled them around with intense concentration. She was a schoolteacher! Why didn't I think of it sooner? Many ladies love to fold and fiddle around with clothing and pieces of fabric- years of laundry and sewing, I guess.
Sep 8, '06Quote from Nascar nurseI agree with you Nascar - It is not called "pacifing", it's called making what little time they have left on this earth as pleasant as possible - when an Alzheimer's pt's get to this point, they tend to have just a couple of years remaining - why not make them comfortable and happy?No experience working with dementia/alzheimers patients huh? Been doing this over 20 years. The staff the insist on reality orientation gets cussed, hit, bit, spit at, etc and the resident can become agitated beyond belief. The staff the goes w/ the therapuetic lying ends up with calm happy residents. Lazy?? Takes alot more energy to be running around a building pretending to milk cows then just say "There are no cows out there" and walk away.
Alzheimer's is not reversible and trying to re-orient them to "reality" does nothing to slow it down, either. When you "go along" with what ever the pt is experiencing at that time - it is NOT lying - you are validating their reality - in their mind, it's true!!!
thanks for all of you who work so hard in helping these wonderful people experience sweet memories in their last days.
Sep 8, '06Quote from onechattynursewell said. isn't that why we became nurses? because we are compassionate and we should show that in the care that we give to our patients/residents. isn't that the real meaning of ethics?[font="comic sans ms"]reminding a dementia patient that her husband is dead several times a day and watching her horror and shock (because to her this is the first time she has heard it) is not only wrong, it is mean, cruel and inhumane.
we had a husband and wife that shared a room they had been married for over 60 years. the first few times she asked about him she was reminded that he had passed away. if you could have seen the absolute horror in this womans face each time she was told this you would realize what everyone is trying to tell you. she was never going to get through the grieving process because she could not remember long enough to get through the denial and shock let alone the rest of the steps. from that point on i instructed my staff to not tell her again that her husband had died. in their younger years her husband was an avid fisherman. from then on we reminded her that he was "up north on a fishing trip" never again did she have to grieve for him.
treating a patient/resident with respect is about more that being truthful. it is about treating them in a kind, compassionate, humane manner.
Sep 8, '06Quote from earle58Beautifully said!!!i'm talked out so i will summarize w/this:
nobody can rubberstamp any one therapy as an absolute solution.
i think we all agree that unless someone is in the early stages of alzheimers, reality orientation is futile and even cruel.
i have researched all of the behavioral interventions used.
therapeutic lying is indeed widely used and accepted.
i cannot speak for anyone else, but i utilize therapeutic lying as a last resort.
validation therapy does not work, even most times.
it is a viable and realistic intervention but certainly not even nearly, always effective.
a nurses' interventions should be as unique as are the needs and personality of ea resident.
what works for one, will not necessarily work for the next.
i know what my goals are with every single patient i care for.
and i feel good about myself.
i can sleep at noc, knowing i gave my personal best.
as long as i treat ea pt with integrity and respect, knowing that i want to and need to abate any type of suffering, then i've done my job.
whether we are nsg students or experienced nurses, this is a profession where learning is perpetual.
the science of nursing is concrete but filled w/new and changing data that commands us to keep up.
but it's the art of nsg that presents the real challenges, for there are no absolutes.
when dealing with the ilk of human nature, we try and apply what we were taught.
most often, this is not sufficient.
we know that we must treat ea and every pt with benificence and dignity, but no one really ever taught us how.
that's where the artform comes in.
our own personal contribution that defines what works and what doesn't.
as long as my intent remains in parallel with the grace of God, i will continue to do as i do.
as long as i combine my knowledge base w/literally, my hearts' desire, then my pts and i will both be fine.
Sep 8, '06At our facility we use a combination of techniques to deal with our residents. If they ask where they are we tell them. If they think they are at ****** then that is where they are. There is no point in messing with the few memories that they have left. Imagine you have a new baby and go to sleep on night and then you wake up to some stranger telling you to get dressed and that your infant son was not in the room next door and that you are infact an old lady then they show you pictures of some old lady that you don't recoginize. Why would you want to distress them more than they already are?
Sep 8, '06I have "therapeutic" lied to pts for years. I have assured little old ladies that I locked the front door and put the cat out so they can sleep. I have told farmers that the cows were milked. My best one was when I "delivered" a baby - from an 85 year old lady. She screamed she was in labour all night - reality orientation didn't do squat. Finally at 0200,(with no one on the unit sleeping) I delivered that baby. Took it to the nursery. My pt was alseep before I left the room to take the baby to the nursery.
And Jessanurse, short term memory lost due to demetia cannot be rebuilt. Its not like a brain injury in a young person. Brain tissue is gone - there is no rebuilding. Alzheimer's cannot be cured (at least, not at this point in time) it can be slowed but it cannot be cured. And finally - its not cruel. Cruel is telling someone that they are never going home and that they will spend the rest of their lifes living in the nursing home with strangers.
Sep 8, '06maybe i'm wrong, but i don't think jesskanurse was focused on reality orientation.
rather, she was clearly against therapeutic lying and thought that other interventions be utilized, i.e., validation.
but whatever, it's evident that we will do what it takes to bring peace and closure to our pts....until the next pt, next time.