pacify or orientate? Alzheimers...

[Lfransis]

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?

[grandee3]

My first nursing job was on a LTC Alz. unit. It was very sad at times.

I had a patient come to the dest saying "I'm here to buy a new car." And another man who was trying to hook up with one of the ladies, came to the desk and wanted to rent a motel room. A few days later he was shipped out to a psych unit because he was found on top of the woman in her room.

(they both still had their clothes on). His wife was soooooo wonderful, when she was told why he was transferred she said, in a calm, low voice "He never acted like that before, I wish I could have my husband back.) The woman was only 59 years old and was one of the saddest case of Alz that I have ever seen.

What really made my heart sink was the residence that never got a visit, call or card from relatives. I guess some people deal with it in different ways. I guess they cant stand to see their family member in that state.

[Katnip, RN]

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.

If you bother to get to know your residents you do know what will harm them.

By the same example you use here, how do you know that what she needs is to relive pain over and over again? How do you know that she hasn't already gone through the grieving process but your "orienting" her takes her back to a very painful stage.

I agree that you cannot just rely on theory and what other people who do not have experience in the field say.

My geriatrics instructor told us the same thing you are seeing here. In the very early stages of Alzheimer's or similar dementia it's ok to do some orienting. But at some point they reach a stage where they no longer live in this reality and agitating them just to make yourself feel better is wrong.

[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.

[Katnip, RN]

If I have Alzheimer's and someone told me over and over that, no my son Andrew isn't coming because he died a long time ago, that would be so cruel.

I cannot imagine anyone wanting to do such a thing. THAT would be unethical.

At the end of my life, let me have the peace of having my loved ones with me, even if it's only in my imagination.

[leslie :-D]

If I have Alzheimer's and someone told me over and over that, no my son Andrew isn't coming because he died a long time ago, that would be so cruel.

I cannot imagine anyone wanting to do such a thing. THAT would be unethical.

At the end of my life, let me have the peace of having my loved ones with me, even if it's only in my imagination.

what's so sweet, is when these (and most others) pts are dying, they really do 'see' those who have already died.

working in hospice for so many yrs, combined with books i have read by other hospice nurses, it's a very common phenomenon- and always so very comforting.

leslie

[Katnip, RN]

I hope so, Leslie, I hope so.

[txspadequeenRN, BSN, RN]

I am coming back into this thread after taking a cooling off period. Please explain to me what experience you have with these type of patients. Because it really sounds like none.

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.

[txspadequeenRN, BSN, RN]

I love the movie but it disturbs me that they went about portraying alzheimers/ dementia in that manner.

Has anyone ever seen "The Notebook?"

[Quailfeathers]

I've worked with Alzheimer/dementia pt in a LTC facility and in private duty. There's a wonderful book The 32-Hour Day that has alot of helpful information on pt care/orientation. I agree that in most cases bring an alzheimer's pt into reality only makes the pt aggitated and more confused. I love the cow example; wonderful intervention. You may want to find some creative way of handling the daily confusion BEFORE it happens. Sometime just telling the pt ahead of time "your daughter is at work so I'll let you know when it's a good time to call" will calm your pt down and bypass the behavior all together. Just remember that an intervention that works today may not work tomorrow.

Working with this particular disease takes getting used to, lots of patience, creativity, and understanding of the disease process/behavior. How these patients are handled makes a big difference in their world.

[Natkat, BSN, MSN, RN]

The following is taken right out of the Fundamentals of Nursing Textbook by Potter and Perry.

"Validation Therapy. Validation therapy is an alternative approach to communication with a confused older adult. Where reality orientation insists that the confused older adult agree with our statements of time, place and person, validation therapy accepts the description of time and place as stated by the confused older adult. Older adults with dementia are less likely to benefit and more likely to become agitated by the caregiver's insistence on the "correct" time, place and person.

In validation therapy, statements and behaviors of the confused older adult are not challenged or disputed. The statements and behaviors are believed to represent an inner need or feeling. The appropriate nursing intervention is to recognize and address the inner need or feeling. Validation does not involve reinforcing the confused older adult's misperceptions, but reflects a sensitivity to hidden meanings in statements and behaviors. By listening with sensitivity and validating what is expressed, the nurse conveys respect, reassurance, and understanding. Validating or respecting confused older adults' feelings in the time and place that is real to them is more important than insisting on the literally correct time and place."

So it seems nursing is coming around to understanding that it is the result that is most beneficial to the patient and not the process. I am relieved to know this.

[sbic56, BSN, RN]

Jesskanurse is very new at all this. I think we need to cut her some slack. Time & experience will be her teacher!

[rn/writer, RN]

Jesskanurse is very new at all this. I think we need to cut her some slack. Time & experience will be her teacher!

I agree. She isn't evil, just inexperienced. Let's shift the focus from scolding her back to finding ways to help this fragile population. I've taken many good ideas away from this thread. Hope I never have to use them (or have them used on me!), but it's nice to know they--and the many caring nurses who use them--are out there.