pacify or orientate? Alzheimers...

Specialties Geriatric

Published

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?

Specializes in Corrections, neurology, dialysis.
"Therapeutic lying" is absolutely inappropriate. It is unethical and in my opinion, it implies pure laziness on the Nurse's part. Telling the patient what you think 'they want to hear' does nothing for them therapeutically. >snip

P.S. The correct term is 'orient,' NOT 'orientate.'

Oh, thank you for saying that. It was bugging me to see that. It has only been recently that "orientate" has been "allowed" to be used and I don't think it's right to dumb-down language instead of insisting on using it properly. I will never accept "irregardless" as a word either.

As for therapeutic lying, I stop just sort of that by giving a non-commital answer. We have a patient who always tells us she forgot to clock in. I always tell her "it's alright, everything has been taken care of." It's true, everything with regard to her care has been taken care of. I didn't say anything about the clocking in part, but reassurred her that there is nothing to worry about and let her interpret that however she wants. It usually keeps her happy.

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.

i don't think she has any experience.

if she does, God pity her frightened, disoriented pts.

Specializes in Gerontology, Med surg, Home Health.

Oh,wait....I just read back. Jesskanurse says she has psych nurse friends and a friend with a Masters in psych...hmmm...my father was a radiologist. Does that give me the knowledge I need to read CT scans???

P.S. The correct term is 'orient,' NOT 'orientate.'

acutally both words are correct!!

Specializes in Too many to list.
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

Right on target as usual, leslie.

I work in dementia units almost nightly as an agency nurse.

It is heartbreaking to hear a woman in her eighties insisting that her children are home alone, and she must go to them. She is sobbing and trying to get us to understand. She can not believe that this is not really happening. If trying to orient her is making her more agitated, clearly this is not an appropriate intervention. Trying to orient her causes her even more emotional pain. It is more respectful and helpful to be in that moment in her reality, and go from there.

Years, and years of taking care of these patients in many different units has convinced me that our job is not to try to force our reality on them. It truly, can not be done. It does not help. It makes their situation worse, and this is not OK. I am there to care for them, not harm them, that is my job. When it becomes clear, and this does not take long, that the patient can not be oriented, you have to move on to the next intervention. You take your cue from their behavior.

Experience is the best teacher. If you haven't done this type of work, researching the work of those who have is useful, that and actually getting out there, and working in one these units with staff who do this work every day.

Nursing and caring for real human beings, requires us to make judgement calls that are not what we learned in school unless of course, one has been lucky enough to be exposed to an instructor who has had actual experience with the type of dementia we are talking about here.

Specializes in LTC, home health, critical care, pulmonary nursing.

I fear that Jesskanurse will be one who just has to learn the hard way. I'm the same age as she is. I wish I knew everything too.

Oh,wait....I just read back. Jesskanurse says she has psych nurse friends and a friend with a Masters in psych...hmmm...my father was a radiologist. Does that give me the knowledge I need to read CT scans???

my only hope is that jesska is confused, and that she thinks this therapeutic lying is taking place in the pts' early stages of their dementia.

btw jesska, any experienced nurse will tell you that a pt almost always experiences their grieving in the early stages.

it's in the early stages that you can apply reality orientation, and that you can tell them they have a progressive dementia.

yes, they have the right to know.

especially when their agitation and depression actually serve as masks for fear.

they know 'something's' wrong and they deserve answers.

so please keep in mind, that much of the grief work has already been done by the pt.

and to work through grief in late stage dementia?

are you serious in thinking of this as realistic?

if you had a pt w/late stage alzheimers, who is distressed and combative, what are you going to do?

first you're going to rule out pain, hunger, thirst, being wet or soiled.

if behavior still persists, frequent 1:1, quiet place, reassurance.

a nsg asst that has been looking after him, reports he misses his (dead) mother.

a nurse (w/whom the patient feels safe) will assess and try to explore.

pts' mother was supposed to come and pt is frantic, still waiting, worried sick.

now, what's the next step, since all interventions so far, have failed?

granted, the agitated pt may calm down for 30 sec, and then he'll go on his frantic search again for his mother.

are you the nurse going to look directly at your pt with warmth, concern and quietly tell him his mother is at church: and she will see him tomorrow? and perhaps you will have him follow you on your med pass for a bit, until you're satisfied that pt is feeling better?

maybe a prn if there is residual restlessness?

even if you did give a scheduled or prn med, it may take effect but it still does not mean he's not thinking about his mother.

what is the harm in putting your pts' mind at rest?

nsg in a ltc environment is unlike any type of nsg.

these residents often look at the staff as their own family.

and much of nsg has also taken a protective wing of their residents.

it is a mutually caring and trusting relationship.

you need to learn that whatever you have learned in nsg school is only a foundation.

it is your experiences in the real world that make one a true professional.

i truly hope wherever you work, you enter with an open mind.

these old nurses will teach you a thing or two.

your nsg assistants will also teach you more than you could ever hope for.

use your colleagues and your staff as invaluable resources.

keep your eyes and ears open; and sometimes, your mouth closed.

i don't know what else to tell you.

you've heard it from many experienced and competent nurses here on the bb.

and still.....

be well.

leslie

Specializes in private duty/home health, med/surg.

What should we do as Nurses? We need to allow the patient as much ability to function independently of staff as possible to be considered therapeutic. If you have a patient that is constantly asking you the same question and you continue to feed into their delusion, you are not assisting them in being more functionally independent. You in fact are allowing them to depend on you, because they may not remember asking the question already, but they will remember that you have helped them in the past.

Dementia cannot be treated as a blanket disruption in memory. It depends on the cause- to in every case pacify the patient and not attempt to reorient is not being attuned to the fact that not all patients with dementia have it because of the same cause. Also, dementia affects different parts of the brain depending on the cause. To blanket pacify is laziness because it's not keeping in mind any of these factors.

If therapeutic communication did not work, I highly doubt we would be taught it in Nursing school.

This thread is talking about people who have progressive deterioration due to physical changes in the brain. These people are not going to become "more functionally independent" no matter what interventions staff employs.

Please read & re-read earle58's post with the goal of understanding why so many people who have worked closely with this population for so many years have decided that "therapeutic lying" is an appropriate technique to use.

Specializes in NA - 100 years ago.

I love this thread. One, for the great information regarding dementia and two, for the wonderfully explicit example of bullheadedness. Brain anomalies are so fascinating to me! :wink2:

Specializes in LTC,Hospice/palliative care,acute care.
I love this thread. One, for the great information regarding dementia and two, for the wonderfully explicit example of bullheadedness. Brain anomalies are so fascinating to me! :wink2:
LMFAO!
Specializes in LTC, Hospice, Case Management.
I love this thread. One, for the great information regarding dementia and two, for the wonderfully explicit example of bullheadedness. Brain anomalies are so fascinating to me! :wink2:

NOW THAT IS THE FUNNIEST THING I HAVE EVER EVER EVER READ ON THIS FORUM. You are brilliant. Is anyone else thinking "troll"?

:roll :roll :roll :roll :roll

Specializes in Utilization Management.
NOW THAT IS THE FUNNIEST THING I HAVE EVER EVER EVER READ ON THIS FORUM. You are brilliant. Is anyone else thinking "troll"?

:roll :roll :roll :roll :roll

I hate to say this, but I've known quite a few people like this IRL, so I'm guessing no troll. But if troll she be, what kind of person indulges in this kind of behavior?

Form your own opinion. I have mine.

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