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?

[romie]

A few months back a resident of mine would pace the unit anxiously asking everyone to help her find her sister Rosa. Then some well meaning staff and her family reminded her that her sister died. For weeks after that, this resident would pace the unit anxiously asking everyone to help her find her dead sister. "have you seen her? She died and I have to find her coffin." sob sob, cry cry. Reality Orientation at its best.

I really like this thread and the diversity of opinions and experiences. Even experts and the literature on the topic is pretty well divided on issues of reality orientation vs. therapuetic lying vs. validation therapy.

Sometimes beating around the bush and only stating facts can help. "Have you seen my mother?" asks resident. "No, I haven't seen your mother" replied staff. It is not a lie ( I haven't seen the residents mother, though I assume she may have died years ago), and I don't perpetuate the delusion.

" I have to go home and make dinner" says anxious resident. "Why don't you stay here and have dinner with us?" replies staff.

I find that any sort of verbal redirection works best when paired with an actual change of environment and redirection to a new activity.

[Nascar nurse, ASN, RN]

Sometimes beating around the bush and only stating facts can help. "Have you seen my mother?" asks resident. "No, I haven't seen your mother" replied staff. It is not a lie ( I haven't seen the residents mother, though I assume she may have died years ago), and I don't perpetuate the delusion.

" I have to go home and make dinner" says anxious resident. "Why don't you stay here and have dinner with us?" replies staff.

I find that any sort of verbal redirection works best when paired with an actual change of environment and redirection to a new activity.

I absolutely agree with these approaches too. Again, it's all about finding what works well for each individual and realizing that what works one moment, may not work the next. I take great offense at someone who has never actually done the job (only read about it in a book) to come off as the expert. I would never ever claim to be more knowledgeable about the care of an ICU patient than an actual ICU nurse w/ years of experience - just because I read about it in a book.

Those of you so against therapeutic lying.. ever told someone their new hairdo looked great when it looked horrid?, ever told your signif. other "No honey you don't look fat in that outfit?, etc. Don't you get it.. sometimes it's about sparing other peoples feelings, demented or not. It's not about being cruel and not about being lazy.

Ok, I will try to be done now.. this thread is far to frustrating

[casi, ASN, RN]

When a dementia resident is searching for their children, the first thing I do is find out how old they are (adult, child, teenager) I’ve made the mistake of getting the wrong age which adds to agitation (“My son is too young to be married!”). Then I try to get them talking about their children to see if it distracts them a little. Sometimes reminiscing about their 5 year old son helps quite a bit. If that doesn’t work I’ll try, “Their in bed”. I assume that if it’s 3am their son or daughter is in bed, so it’s a truth. When that doesn’t work I’ll jump into the therapeutic lying.

One thing I’ve found is if what they want is simple enough like making dinner, I’ll give them a loaf of bread and peanut butter to make sandwiches. Simple activity that keeps a resident calm and engaged.

When you try to orientate a dementia resident it only adds to their anxiety and agitation. Next thing you know you’ll have to medicate and that becomes unsafe. When you have a resident who’s still rather agitated because you won’t let them go home and rather sedated from whatever you had to give them to try and calm them down, you are asking for a fall.

Sometimes lying is the best way to keep your resident safe and happy.

One of the first things I was taught concerning dementia residents is enter their world, don’t try to make them come to yours. That will never happen.

[P_RN, ADN, RN]

One of the first things I was taught concerning dementia residents is enter their world, don’t try to make them come to yours. That will never happen.

Casi that is perfect.

[leslie :-D]

One of the first things I was taught concerning dementia residents is enter their world, don't try to make them come to yours.

there you go.

enter their world.

if i chose not to "lie" and told them their mom died 50 yrs ago, who's actually doing the lying?

according to my pts' perception, I AM!

afterall, their mom isn't dead!

it is my job to DO NO HARM.

so in my interventions, should i opt to keep my pt safe, w/o fear, w/o distress, w/o agitation, then yes, i shall lie.

and better still, my pt believes me.

trust, security, comfort, beneficence.

furthermore, all the truth-telling in the world not only serves to harm my pts' well-being, but it will do nothing to ameliorate their cognitive function.

when you first meet your pt, it's perfectly appropriate to tell the truth; reality testing...it's a needed assessment tool.

but once it is determined the severity of their dementia, then you revise your plan of care to reflect your pts needs and abilities.

therapeutic lying should never be your first intervention.

but the bottom line speaks for itself.

you do whatever it takes to make your patient feel safe.

and such are the actions of a sensitive and experienced nurse.

leslie

[lovingtheunloved, ASN, RN]

there you go.

enter their world.

I much prefer to enter their world. It's usually a whole heck of a lot more interesting than mine.

[txspadequeenRN, BSN, RN]

Well your not using your resources very well. Experience is a major plus when dealing with dementia/alzheimers patients. You can read about it and consult about it all day long but until you play the game you shouldnt knock what works. I have been a alzheimers nurse in a locked facility for years and Im here to tell you that you do what works. If mama is coming this afternoon ...guess what she is. Because there is no way Im going to tell her she is not coming only to have to a very agitated and distressed resident. There is no sense in that, it is unethical in my opinion to place your patients in this state. When all you have to do is agree with what they are saying or just acknowledge what they are talking about. I will redirect to time, place and self but im sorry if you dont agree , I will never orientate to the truth if it will damage my resident in the end.

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.

[Jesskanurse]

Well your not using your resources very well. Experience is a major plus when dealing with dementia/alzheimers patients. You can read about it and consult about it all day long but until you play the game you shouldnt knock what works. I have been a alzheimers nurse in a locked facility for years and Im here to tell you that you do what works. If mama is coming this afternoon ...guess what she is. Because there is no way Im going to tell her she is not coming only to have to a very agitated and distressed resident. There is no sense in that, it is unethical in my opinion to place your patients in this state. When all you have to do is agree with what they are saying or just acknowledge what they are talking about. I will redirect to time, place and self but im sorry if you dont agree , I will never orientate to the truth if it will damage my resident in the end.

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.

[UM Review RN, ASN, RN]

Sometimes that anguish is therapeutic for them.

:trout:

[ktwlpn, LPN]

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.

:deadhorse A nurse can only learn and grown when willing to do so and maturity is key.I will say again that we are talking about pts in LTC-THEY ARE IN THE LATER STAGES OF ALZHEIMER'S AND OTHER DEMENTIAS.........What don't you get about that? Believe me-after working with these patients for a few years you DO learn what works and what doesn't....Have you checked out any of the links posted in the thread? Done any additional research on your own? When you grown up you'll see that there is more to the world then your black and white...

[leslie :-D]

some of her statements are deeply concerning.

i have nothing more to add.

leslie

[CapeCodMermaid, RN]

I would like to know how much Jesskanurse has in working on a dementia unit. I'd never hire her to work in my building.