tips for dealing with dementia

Specialties Geriatric

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I work on a secure unit with a great staff-problem is the evening and some of the night shift.Many nurses in this facility are "old school" and think that there is a pill out there to control these resident's behaviors...I believe that keeping them safe and hydrated ,maintaining opitimal level of functioning as long as possible and protecting their dignity while supporting their loved ones is just about all we can do....What difference does it make if one refuses to get in bed at 9 pm in a night gown? Will she die from it? So what is she wants to crawl on the floor and "scrub"? I get down there alongside her till she tires out...Scream at bath time?-skip it til tomorrow...I realize that sun-downing is a problem(why do you think I work 7 to 3?-my momma didn't raise no fools!) I know that there are steps the staff can take to alleviate it-and most don't want to hear it-they want a quick fix-a pill...Which we all know often leads to further problems...We have a new admit that was great for the first 2 days and started getting a bit agitated the evening before last---I was told by evening shift-"We'll call YOU later and you can come in when she starts" Believe me-they are well staffed-3 nurses to 39 with 3 or 4 aides---Someone could have come from behind the desk to do a little hand-holding...Anyone know of any web sites with some good info? I need some teaching tools...I think it wil be accepted better then if I attempt a verbal inservice with this bunch...a few of them think they know it all....Of course one still thinks that reality orientation is where it's at...When she hears "Mom! Where are you?" She is apt to say-"Your mother has been dead for 50 years" I think that is cruel.....I usually go with "Taking down the wash-let's get a cold drink and sit down for a minute" Usually works for me......How can I convince some of the others?

ktwlpn

l found this an interesting thread - just a question did you have a chance to check out the dementia site in Australia l suggested and what did you think - how would it compare with your own online information that may be available

I too would be interested in any sites you or others might recommend - have searched and found some interesting sites - however always like to learn more

Tookie

Specializes in LTC,Hospice/palliative care,acute care.

Thanks for the link,Tookie-the site was helpful.I am also looking for info specifically for dementia units regarding behavior interventions and activity ideas.......have you any links?

No no links as such will try if my own dementia/tiredness lets me rememer to ask my DON - she may be able to suggest something there

We have 2 dementia specific house at our nursing home of 50 (High care)and 1 at our hostel of 40 (low care) - l think we do it well

There is a lot of stuff around - l will have a think about thatv and come back - look up Hammondville australia - dont know the web site but if you type that in that might help - they do a lot of work in the demenita area within Australia.- I would do a search for you but am on my way out to Christmas in July now - its winter over here - and my lift is at the door.

skl0923 :

You and I must work in the same facility. I am definitely looking for a new job tomorrow. Would say more but.......

Have you looked into Validation Therapy? The site is http://www.vfvalidation.org/whatis.html.

Another brief article is:

http://www.update-software.com/abstracts%200101/ab001394.htm

I am loving the people I meet at the classes and it makes this sh*%8y job more gratifying, not to mention what it will look like on my resume of a better place where I want to get hired. Country Meadows seems to do a great job of keeping their employees satisfied. They are paying the fee for their staff to attend this class. I would go there if they were closer, but I am determined to find a place where it is valued and I can practice VT , experience safer staffing ratios, and spend more time with the residents. Good Luck!

Hello to my colleagues in Geriatric care out there... this is such a great thread and am so glad to be able to participate. I am a Nurse Case Manager on a 26 bed acute care GeriPsychiatric Unit in the midwest. We happen to have a great group of team members (Key element Team!!!). Care delivery to memory impaired individuals, who often present with a variety of co-morbidities common to the aging population is a challenging but very rewarding field. I believe that all persons are worthy of human dignity, respect and compassion. Can you imagine what it would be like to hear the news of someone's death (mother, husband, etc, as described above) as new information every time!

How horrible that would be. I find that judicious use of low dose antipsychotics and low doses of mood stabilizers povide better relief of restless wandering and late afternoon agitated behaviors. I agree that entering that person's reality is the way to interact with these persons, for it is often impossible for them to be in ours. I recently joined the NGNA, and they have a great journal that comes with your dues, and super meetings. Also, APNA's convention in Dallas in going to have an entire Gero track for those involved in this specialized care delivery model.

Thanks for letting me share.

Morghan

Wow, First, I'm glad I found this board. Second, I have to add my two cents worth. I HATE it when staff doesn't allow demented res to act the way they need to act, to be who they need to be because they don't remember who they are or what they are supposed to be doing. THEY ARE NOT BEING NAUGHTY:( . (I know you agree with me on this) Last night I had a lady, who simply couldn't sleep. She was up and down all night. They wanted me to "give her a pill or something". I have nights where I can't sleep and am up and down. She was hurting not one. I invitied her to come down to the desk and sit with us while we did paper work. It worked fine. We had another man who didn't want to go to bed at 10 pm:eek: I had the audicity to tell him it is okay. You can stay up. "NO NO" they said, we have to wash his WHEELCHAIR." Duh! You can wash it after he goes to bed....LATER! He sat up, watched Jay Leno and then was ready to go to bed. GRRRRRRRRRrr These people are people too. Okay, I'm done venting. Thanks for listening. :roll

Any one look at Validation Therapy? I am very upset in my facility. I hear-we don't have time-give her an ativan. Most times all you need to do is come back later or spend some time with the resident. Sometimes their is no connection to reality and the resident doesn't even make eye contact, Validation Techniques give dignity and establish trust. My co-workers think I'm nuts. I feel so bad for the elderly in nursing homes. The whole system stinks. The CNA's are burnt out and they are the ones who provide the most direct care and for the longest periods. They don't want to hear the resident doesn't want to get up or go to the BR when it goes against their routine. Our facility hasn't has an inservice in working with dementia residents since I've been there.

You know, I know exactly what you 2 are talking about! There just is not enough of an understanding out there of how to work with those with dementia. Lord knows I try to teach others that the actions of the confused are not behaviour that warrants discipline. Some times I feel like I'm talking to a brick wall. There is too much of a controlling attitude out there. These are not children, they do not need to be kept "in line". Even people that I know have attended the same inservices as I have, don't seem to get it (or at least choose not to use it).

That truly sucks Carrie. Unfortunately, it's the way the system is done until the state is getting ready to come in and do the annual inspection...suddenly there is a whirlwind of inservices and staff meetings...of course, you are signing and signing and signing all those lovely UNDATED roll sheets. Terrible. These Alzheimer's/Dementia/OBS patients are such a special category. I had one who developed the dementia like symptoms after a stroke. He had visual and auditory hallucinations. My favorite was when he would ask to get his boat which was moored, of course, just off the starboard corner of the nurses station. So, to distract, we would go for a walk, holding hands, around the nurses station and he would point out all sorts of things to me and tell me about his boat. The worst was when he would ask me or one of the other staff members to take him away in the car. He would tell us his car was parked right outside and let's go let's go, please please!! That was hard so we would try different things...the car's in the shop, we aren't leaving right now but let's go do this.........etc etc. He loved oreo cookies.

Staff inservices and training is so important. In my humble opinion, the admin staff and management have either forgotten how it's done or have never actually done nursing and either way, they are not good choices for the job. I agree with the previous posts, look up some stuff on the internet and if you have an employee message board at work, tack up a copy for people to see and read while they are eating lunch or whatever. You'd be suprised how many people it reaches.

Ah nursing.........

We should treat these residents the way we have spoken of because it is the right thing to do. All people deserve dignity and they have needs of usefulness, the need for love, etc.

Nice thread! Glad to hear some sense out there. Let's all get together and start our own loving facility.

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