pacify or orientate? Alzheimers... - page 18

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

  1. by   Lfransis
    Thank you, everyone, for your stories, experiences, advice, and responses. Reading this thread really has given me a broader perceptive on Alzheimer’s. I commend any nurse with the patience and creativity to care for these wonderful people.

    I am, however, no longer working LTC. I started on a Med/ Surge floor last week and feel like I am getting a better foundation in nursing (as a new LVN).
    Alzheimer’s/ Dementia is to be found here as well and I have really utilized all advise offered. Thanks again.
  2. by   Halinja
    I just wanted to say how impressed I am with the compassion (and creativity) of so many that have posted in this thread. It makes me feel proud to be entering the field of nursing, and humbles me. When I am a practicing nurse I hope I have a tenth of the skill, patience, and compassion of those posting.
  3. by   CHATSDALE
    when dale graduated she knew everything that could possibly be known
    experience is a GREAT teacher and humbler
    however let us also keep our minds open to new ideas . this is the way that knowledge speads to those who are willing to learn

    you don't have to swallow everything you hear, just listen and evaluate

    thank everyone for the input that has been on this thread...i love you alll
  4. by   twotrees2
    Quote from CapeCodMermaid
    4 other patients!!! Try taking care of 40 on 3-11 as one licensed person with 4 aides and being mandated to use 'as few restraints as possible". Goes to show no matter where we work, we are challenged to provide the best care we can.
    yeah - in our facility there is a nearly NO restraint policy - we DO have one in the over a yr i have worked there and it was jumping through hoop after hoop to get it ( seat belt ) and thank god for it - the facility before i worked there near 3 yrs - never once did we get to use a restraint - one tie called cops to9 come restrain and transport to psych - instead of restraints we now have low beds ( nearly a mattress on floor ) mats by beds - alarms that go off all the time cause they dont work when they are supposed to - sigh - i dont wish to restrain like we used to in the "good ole days" where any confused patient had some form of restraint from vests to laptop tables- but sheesh - wed have so much fewer falls if we could use a few - and without going through a month of hoops to get it ( woman that has belt fell i think it was over 20 times in that month took us to get seat-belt - no falls since - thanks to god for no fractures while we waited for legal to get the belt. )
  5. by   Lovin' my job!
    Wow!! What a thread. It's like reading responses from all the different coworkers I've worked with meaning - we all have different ideas, opinions, and approaches. Many sound all to familiar. I absolutely love working with dementia. The disease and its progression is so interesting. I go to work to make these moms, dads, grandmas, aunts, brothers happy in their world. They are people. They used to have productive exciting lives. If they believe they are still in 'that life' then all the better. I don't go there to just give pills. On my last shift at my new job I went to a residents room to give her her 0800 meds and saw an old pic on her table of a young beautiful women in a white nursing uniform and cap. I didn't know anything about this lady yet and showed her the pic and asked who it was. Her response was "oh how cute. Isn't she cute?" and she had a big grin. She did not know it was her. She was one of us a long time ago. How sad. We are not 'lying' to these residents. And like so many others have said you have to decide who you can re-orientate as there are different stages of dementia. At my new job, the LPN I have worked with just makes me cringe. She's worked there for 4 yrs. Her response to the lady who kept getting up from the table at brkfst (still 1 hr before it was to be served) was to YELL: "go sit down. stop getting up. brkfst is coming, now sit and stay there until you've eaten!" I wanted to slap her! This resident is not a 3 yr old. She does not remember 2 mins prior. Why not let her walk around and when the brkfst is acutally waiting for her on table then sit her??? Hello!!! geesh I think someone needs some retraining or find a different job!
  6. by   Lovin' my job!
    Story: There was a wonderful resident who could not 'function' in her daily routine because she was always 'looking for her baby' she refused to stay at the table. Wandering, constantaly looking everywhere. She began to lose weight and more agitated. She became very difficult to redirect. Where she could normally follow simple commands, she now could not because she was so focused on finding her baby that nothing else mattered to her. One day someone came up with the idea - give her a baby - We had a quick care conference with staff and family and discussed the pros and cons and possible consequences. We all agreed to try. The family bought a baby doll. We couldn't believe the difference. It was a complete 360. Although there were times we had to 'babysit' the baby so she could eat her meal or have her bath, she gained weight, stayed in bed and slept, knowing her baby was safe with her. Positive outcome. That's all. No harm done. She was happy and healthy. Happy ending
  7. by   Alixandra
    With a pt who doesn't have dementia you can and do have to bring them back to reality when they get off track. About 9 years ago my boyfriend at the time and I were living in Vegas and boyfriend's mom's ex-husband's stepfather(George) who was in his 70's mother(Molly) was 94 was living in a LTC facility and she was still very sharp and with it. One day Nick (boyfriend) and I were at George and Sandy's(his wife) house and the phone rang and Sandy answered it. It was Molly who had called up(she had their phone number memorized and used the phone by herself) and she was all upset because she thought the George had visited her earlier that day and didn't say goodbye when he left(he hadn't visited her that day yet.) Being that she was with it most of the time Sandy was able to tell her that George had not visited her that day and whenever he visited her when he left he ALWAYS would tell her goodbye before he went and that George was coming to visit her later that day. Molly understood and was very happy that George didn't leave without saying goodbye to her and she could also look forward to seeing him later that day. Lying to her would have been wrong as she was of sound mind, but if she wasn't, say if she had dementia, then 'lying' to her and having George apologize for leaving without saying goodbye(even though he did no such thing) would have been the best course. We all, George, Sandy, Nick, his little sister Chrissy(16), his mom and I all went to visit her that night. She was a wonderful lady and as I said she was still sharp as a tack even at her age. We loved listening to her talk about what her life was like when she was younger and we loved seeing pictures of her when she was a young woman. She was a beautiful woman and she still was, older and wiser, but still a wonderful pretty woman. I was very sad when she passed away a few months after this.
    Now that approach worked because she did not have dementia and was able to be brought back to this reality. If you had tried that with my grandma with Alzheimer's in the same situation she most likely would have tried to attack you or otherwise become violent becuase her reality was not ours.
    Different residents require different approaches. It all depends on what their mental state is. Non demented patients can be brought back to our reality without much problem but demented patients can't and if you try chances are you are going to end up with a violent resident who is at risk to injure themselves or others.

    Last edit by Alixandra on Oct 10, '06
  8. by   lvs2nrs3535
    I am so sorry Jesskanurse, but you seem so young, and so full of your opinions of "right and wrong"! It is really terrible that the world is so full of GRAY areas, there is no right and wrong when you are dealing with patients who have no concept of reality, they are living in the past, the very short present, (i.e., could I have ice cream now?). Please please please reconsider your hard stance on this. Would you really want to cause more pain to someone whose brain is breaking down? If you think about it that way, seriously, they have a breakdown on their function in their brains, it does NOT work the way yours or my mine does, and it is a physical breakdown, not a choice of theirs. We cant force reality on these persons. Whatever we want to call it, 'therapeutic lying', ect., ect., the bottom line is to DO NO HARM. When my patient who is so very confused, wants her mommy, (who has been dead for over 20 years,), I am NOT going to push my 'reality' on her. I might be right, I know I am, but in her word, it is just giong to cause her pain.
    I dunno.
    I hope you can listen to much older, seasoned nurses than you. (I am not one of those, but have read every post on this line, and you have so much information to listen to.)
    I wish you peace, love and happiness, and the same to your patients.
    Quote from quibron
    wow! how wonderful to know so many of you are extremely aware of how to help a dementia patient with what you term 'therapeutic lying'. I am an RN and wish you were all working with me. However, definitely not you Jesskanurse. How would you like to be given bad or frightening news about your life 10times to 200 times every 24 hours, or even once...? well that is how these people react to reality orient (whatever makes you happy here). How about 'dont be silly, your over 80, your mums dead, so's your dad" as an answer to "I've got to get home, mum will be worried sick, she doesn't know where I am". being asked 50 or more times a day.....the grief may only last a few moments or minutes, but it is there and recognisable....go back to selling books or something but PLEASE keep away from nursing until you learn how to be a nurse as you will meet these sweet, wonderful and sometimes quite dangerous people in every aspect of nursing and I certainly would not like your ideas anywhere near someone I love or look after.
    And good on you Lfransis, keep asking questions and don't give up, you will feel like you are walking on a cloud when you leave work once you get to know and understand all these different wonderful people we call dementia's. And we do have cows around our facility, so don't even have to pretend, actually a very pacifying pastime for them to watch the cows.
  9. by   ktwlpn
    I'm happy to see that this thread did not get closed.It's a good learning tool.It also illustrates how closed minded some of us can be.I work with several nurses both new and experienced staff who insist on doing certain things in their certain way.It's the pt/resident that suffers for it and sadly our administration does not want to hear about it..(retiring soon-thank the Lord) I hope I NEVER stop learning and growing.
  10. by   jnette
    Quote from ktwlpn
    I'm happy to see that this thread did not get closed.It's a good learning tool.It also illustrates how closed minded some of us can be.I work with several nurses both new and experienced staff who insist on doing certain things in their certain way.It's the pt/resident that suffers for it and sadly our administration does not want to hear about it..(retiring soon-thank the Lord) I hope I NEVER stop learning and growing.

    I agree ktwlpn. I have learned a lot here already, and I am going to need ALL the wonderful advice and learning I can get as my poor mom is now fullblown Alzheimer's. From mild to moderate dementia and still functioning well and living/driving on her own over the past two years, to a sudden major deline and deterioration...the kind described above. "My Papa is waiting for me" (her Papa died before I was ever born), ... "I need to call my boss, he'll think badly of me if I don't call and let him know I'm not coming in today" (her job in pre-war Vienna)...etc., etc.

    Sis Pati and her partner Roo are now caring for her in thier home in Tucson until Spring, when I will take my turn and keep her with me here through the summer mos. I just returned from Tucson to see for myself the tragic decline. And it is more than the heart can bear.

    So yes, let us please keep this thread alive... I know I shall be coming here often for information, advice, suggestions, support.

    Thank you.
  11. by   CaLLaCoDe
    Superb thread, I learned a plenty ;-)
  12. by   fultzymom
    Quote from Jesskanurse
    Yes, It may be unethical in YOUR OPINION to tell her that... but any ethics board would tell you that you are wrong. As for your last sentence: How do you know what will damage your resident and what wont?? You dont. You are just using your own feelings and displacing them on the patient. You think it will damage her. Who are you to decide this? THAT is why it is unethical. What if there is a stage of the grieving process that she hasn't gotten through just because nurses are uncomfortable seeing her in anguish? I think that is what is happening. You cant have peachy happy patients all the time. Sometimes that anguish is therapeutic for them.
    I had a patient whose husband died, she went to the funeral and the meal after it. Right when she got back to the facility she asked where her husband was. One person told her that he died and she had just came from his funeral and it was like she learned about his death for the very FIRST time. That same staff member continued to tell her this every time that she asked about him. Every time she asked, she relived his death as if it were the first time she was hearing about it. So, how many times per day should we put this resident through this mental anguish in your opinion? That is just cruel to tell her over and over that he was gone when we had just gotten her calmed down from the time that she asked before but did not remember.
  13. by   linzz
    This is a great learning thread. I am glad it is has not been deleted. I truly do believe that working with dementia/alzheimer clients is truly an art. Again thanks to all who have shared their extensive experience.