pacify or orientate? Alzheimers...

MedSurgeMess · Sep 13, 2006

Experience isn't everything. I just know how to use my resources and happen to find this topic interesting. My resources include include a 4 year college degree, great psych nurses, and friends with masters degrees in psychology.

Oddly enough, one of my best friends has her masters degree, is a Clinical Nurse Specialist, specializing in Gerontology and related issues. She firmly disagrees with you....She has 24 yrs experience--8 yrs of those in Psych, and she really thinks that maybe you ought to look beyond the psych resources.

jharris71RN · Sep 14, 2006

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 far. (should I be?)
Mrs. X is driving me crazy. For my three days she has asked to call her daughter to come get her.She is going home, looking for her car, easily agitated,etc.
The aides pacify her: "Mrs. X your daughter is at work, you can call her when she gets home from work" " your going home after lunch" This goes on all day.
I am new with Alzheimers behavior. I am new at being a nurse.
I don't feel good about telling her she can call her daughter to get her
"after she gets off work" , or that she is going home.
Is this not implanting the idea even futher, possibly even creating a cycle?
Any advice/ suggestion?

I'd be pretty nervous. 15 years as a LPN and now an RN I can relate. I had near the same experience with 2 years under my belt, first LTC job. I walked in the first day and was told the lady that was to orient me had called off so I was placed with a LPN department head of some sort that popped back and forth to the unit and her office leaving me pretty much responsible for the 25 to 30 residents. I would laugh on my way out the door without a proper orientation especially on an alzhiemers unit since they aren't often able to assist in properly identifying them (5 rights...) and a hot news story here recently is a trial for manslaughter against a LPN of 30+ years and a new grad. as they were administering meds and the LPN "popped" the meds out and the GPN gave them.... she gave them to the room-mate they failed to report the error... now the District Attorney is charging each with the man slaughter chare... If they are so desperate or have such little value for the employee and #1 their residents safety that they give a unit to a nurse regarless of experience the day after employemnt.... I doubt they defend you in malpractice or other legal problems.... WATCH OUt

joliesmomizaRN · Sep 14, 2006

All I can add here is that as a nurse, Jesskanurse, has a long hard road ahead in learning the difference between textbook knowledge and the real world. I pray, for the sake of all the patients with alzheimers/dementia, that she never comes in contact with them because I believe it would be unethical not to mention cruel to deliberately torture them with information that will only cause them grief over and over again. Sometimes common sense is the best experience you can have as a nurse.

Leolion · Sep 14, 2006

I agree that reorientation isn't always the way to go it depends on the situation where I work we have a resident who is always looking for his car and if you tell him that its safe in the garage he is happy but if you say you don't have a car he is very upset

Critical LPN · Sep 15, 2006

All I can add here is that as a nurse, Jesskanurse, has a long hard road ahead in learning the difference between textbook knowledge and the real world. I pray, for the sake of all the patients with alzheimers/dementia, that she never comes in contact with them because I believe it would be unethical not to mention cruel to deliberately torture them with information that will only cause them grief over and over again. Sometimes common sense is the best experience you can have as a nurse.

:yeahthat:...........While yes it is the accepted ( and believe me, document, document..) and proper thing to do to try (operative word), to orient the confused patient, one must remember that someone who has the clinical diag. of Alz. or other psych diag. that does not let them process reality at the moment cannot be reoriented to that moment. It is a horrible thing to feel you are lying to the patient and also the fear that co-workers or pt. relatives will hear you trying to agree with or make up a story to keep the patient happy.

Do I hold steadfast with my teaching and constantly try to orient the pt. regardless of how it makes her act or feel just to protect my license? Must I be like those in the ivory towers of upper levels of schooling and :mortarboard: management who while are valuble resources and filled with book and controlled (while in nursing school and advanced practice education) situations, that have forgotten what it is really like working on the floors when you are responsible for umpteen patients, each more disoriented then the next? Also the pt. to nurse ratios are worsning everyday , making it impossible for the caring and resposibleness to take time for orienting constantly. :idea: Or do I go out on that limb called critical thinking skills (does not just mean critical care nrsg. thoughts and trx., but also the ability to take a challange and think out a process to to the best end result possible.) Also called good old "common sense" back before I ever became a nurse.

Might try making up a list of the patient's life dreams, family dynamics, life before the mental deterioration: what was their former job in life(this I find can be really educative for you as the nurse,as remember......the past is ususally the most clear and really accurate time they know and sometimes very interesting to you also when you find out they had a really intersting life or a historical event maker. :cool: ), were they in the military? Did they do work that helped the military?(like women at the USO's, collecting items like hose, metals etc,. for the war effort?), what is their favorite type of music and ask the family to bring in a few tapes and a recorder, where in the world did they live and let them tell you of the adventures they have had over the years(and if you think the story sounds embellished and fictictional, remember sometimes, truth and reality is stranger than anything that could be made up .

Always assess(yes ...thats right, assess the moment you are dealing with in the now). How is the patient's rationality, what is your normal raport with the paient? Are you rushed and not going to have time to deal with the possible lengthly aftermath to your question/answer, response when dealing with the pt.? All needs to be considered and if you feel that the patient can (at that moment>>>>>),possibly absorb some truth to whatever the situation, then by all means try to orient. If not, then you learn to pick non truths well leaving them broad and plausible without really lying to the patient. The story earlier in this thread of the nurse and "milking the cows" was a good way to passify the pt. but since she really was lying to the patient, a goody-two-shoes co-worker or family member might overhear and then report her, putting her in a legal bind. I have found that taking the broad sense approach (in this case, making sure the cows were milked) works well without being specific, thus less possible ammunition in a court to be used against you. Perhaps stating that a fellow named John,Mike, Fred or whatever is milking the cows and all is fine, if the patient needs reassurance it is done. After all, surely there is a farmer somewhere in the country that has the name you choose to make up that is doing just that

(milking the cows), thus not really a lie but using the broad scope of your imagination that will work with the patients (in the now). You did not state it was the cows she was referring to, but that cows were being milked, thus no true lie to patient could be used against you.

Most patients can be redirected if at the very moment you do whatever it is to passify them, you give them a task or a job to do for you. Sometimes just giving them some papers and have them reorganize them for you or fold some linens all over again. It is well documented in many books and journals that many Alz. patients had type A or obsessive work drive personalities and thus the need for a constant to keep them as grounded as possible and increases their feeling of worth and importance. It is difficult however, to broad lie when it is a specific person they want or want to talk to that is not available . Then sometimes you can get them to tell you a little about this person and what they did together or what common interests they had that can stretch to you shring a common interet or event , therefore, changing the subject in a direction toward you or the patient and off the original person they were trying to get ahold of. Also can lead to someone else that in their social circle that you just might be able to get ahold of . :blushkiss

lvs2nrs3535 · Sep 15, 2006

:yeahthat:...........While yes it is the accepted ( and believe me, document, document..) and proper thing to do to try (operative word), to orient the confused patient, one must remember that someone who has the clinical diag. of Alz. or other psych diag. that does not let them process reality at the moment cannot be reoriented to that moment. It is a horrible thing to feel you are lying to the patient and also the fear that co-workers or pt. relatives will hear you trying to agree with or make up a story to keep the patient happy.
Do I hold steadfast with my teaching and constantly try to orient the pt. regardless of how it makes her act or feel just to protect my license? Must I be like those in the ivory towers of upper levels of schooling and :mortarboard: management who while are valuble resources and filled with book and controlled (while in nursing school and advanced practice education) situations, that have forgotten what it is really like working on the floors when you are responsible for umpteen patients, each more disoriented then the next? Also the pt. to nurse ratios are worsning everyday , making it impossible for the caring and resposibleness to take time for orienting constantly. Or do I go out on that limb called critical thinking skills (does not just mean critical care nrsg. thoughts and trx., but also the ability to take a challange and think out a process to to the best end result possible.) Also called good old "common sense" back before I ever became a nurse.
Might try making up a list of the patient's life dreams, family dynamics, life before the mental deterioration: what was their former job in life(this I find can be really educative for you as the nurse,as remember......the past is ususally the most clear and really accurate time they know and sometimes very interesting to you also when you find out they had a really intersting life or a historical event maker. ), were they in the military? Did they do work that helped the military?(like women at the USO's, collecting items like hose, metals etc,. for the war effort?), what is their favorite type of music and ask the family to bring in a few tapes and a recorder, where in the world did they live and let them tell you of the adventures they have had over the years(and if you think the story sounds embellished and fictictional, remember sometimes, truth and reality is stranger than anything that could be made up .
Always assess(yes ...thats right, assess the moment you are dealing with in the now). How is the patient's rationality, what is your normal raport with the paient? Are you rushed and not going to have time to deal with the possible lengthly aftermath to your question/answer, response when dealing with the pt.? All needs to be considered and if you feel that the patient can (at that moment>>>>>),possibly absorb some truth to whatever the situation, then by all means try to orient. If not, then you learn to pick non truths well leaving them broad and plausible without really lying to the patient. The story earlier in this thread of the nurse and "milking the cows" was a good way to passify the pt. but since she really was lying to the patient, a goody-two-shoes co-worker or family member might overhear and then report her, putting her in a legal bind. I have found that taking the broad sense approach (in this case, making sure the cows were milked) works well without being specific, thus less possible ammunition in a court to be used against you. Perhaps stating that a fellow named John,Mike, Fred or whatever is milking the cows and all is fine, if the patient needs reassurance it is done. After all, surely there is a farmer somewhere in the country that has the name you choose to make up that is doing just that
(milking the cows), thus not really a lie but using the broad scope of your imagination that will work with the patients (in the now). You did not state it was the cows she was referring to, but that cows were being milked, thus no true lie to patient could be used against you.
Most patients can be redirected if at the very moment you do whatever it is to passify them, you give them a task or a job to do for you. Sometimes just giving them some papers and have them reorganize them for you or fold some linens all over again. It is well documented in many books and journals that many Alz. patients had type A or obsessive work drive personalities and thus the need for a constant to keep them as grounded as possible and increases their feeling of worth and importance. It is difficult however, to broad lie when it is a specific person they want or want to talk to that is not available . Then sometimes you can get them to tell you a little about this person and what they did together or what common interests they had that can stretch to you shring a common interet or event , therefore, changing the subject in a direction toward you or the patient and off the original person they were trying to get ahold of. Also can lead to someone else that in their social circle that you just might be able to get ahold of . :blushkiss

Question....

Can you really be sued for pacifying a patient who has no memory of day to day living? Is this truly a worry?

Yikes.

leslie :-D · Sep 15, 2006

i tend to doubt that a family member or coworker hearing you lie to an upset, alzheimers' pt, has any legal grounds at all.

first of all, experts are always changing their theories and proposed interventions. it is not a science.

the research i did, revealed therapeutic lying is widely accepted.

but what is more important, is the intent.

when anyones' intent is to relieve suffering (no matter what form it takes, or how it manifests itself), then you are indeed upholding your oath "to do no harm".

i will repeat, i am not rubberstamping this particular intervention to all alz patients.

rather, it is implemented specific to the pts' presentation, the stage of the dementia, the level of disorientation/agitation/fear. there are many consideration when applying it.

but any judge (if it even made it to court, which i highly doubt) would agree with the goal of removing stressors and bringing peace to the patient.

i would bet my nsg license on it.

leslie

lilypad2424 · Sep 15, 2006

Has anyone ever seen "The Notebook?"

lilypad2424 · Sep 15, 2006

Thank you. Well done, etc.

Nascar nurse, ASN, RN · Sep 15, 2006

but any judge (if it even made it to court, which i highly doubt) would agree with the goal of removing stressors and bringing peace to the patient.i would bet my nsg license on it.leslie

Me too. And if they didn't... is it really an enviornment I want to be a part of anyway? Nope not me, just not gonna tell a sweet little ole lady that her husband died 30 years again over and over. Cruel and heartless.

P_RN, ADN, RN · Sep 15, 2006

We keep a "Notebook" at Mama's. I also had written a short story about how my parents met. She reads it many times a day. And each time she says "This is my life story."

MedSurgeMess · Sep 15, 2006

Has anyone ever seen "The Notebook?"

Loved it...bawled my eyes out...best love story ever...going to go watch it now :bluecry1: