How do you deal with dementia residents?

[godlycreations]

When I started my journey to becoming a nurse, I had so many ideas of what kind of nurse that I wanted to be. As my journey progressed through school, I also starting dreading getting into certain areas of nursing due to the stigmas surrounding them. I had big dreams of becoming a critical care nurse on a cardiac unit, specializing in wound care and such. The area I dreaded the most was working in a LTC facility, and more specifically, taking care of people with dementia.

After getting my RN license and applying for jobs, I was on the fast track to getting my dream job! I had applied to several positions at the local hospital with my brand new license, and started getting interviews right away. I became excited when I was being offered jobs on three different units at the same time. Two of the positions were to be a nurse in two different med/surg units, and the most thrilling offer was to be trained as a step-up nurse in the cardiac unit. After shadowing and being offered all three of these, I chose to follow my dreams and take the job as the step-up nurse because it was a chance of a lifetime for a new RN. The position itself required at least one year of experience as a med/surg nurse before even applying, and that was waved for me, and I was on my way. That job fell through at the last minute due to an unforeseen medical issue that prevented me from starting for at least three months, and the job was given to someone else during my wait.

With my dream job gone and being stuck waiting for three months for the issue to be resolved, I was stuck with very little options. I found myself going from my dream job to my dread job instantly. I was offered a position as a nurse in a LTC facility to replace a nurse in the dementia unit of all places. I accepted the position thinking that I can give them a year, then go on to pursue my dream job after that.

I have heard many times that taking care of people with dementia was the worst because of their lack of cognition, forgetting what is going on, and many other things of that nature. I was not sure if I was really up to dealing with those kind of issues. It was hard enough trying to figure out what I was doing as a new nurse, without having the additional stress of trying to give care to people who did not know that they were in a nursing home, or even needed the care I was to provide for them. How was I going to convince these people that I was someone that they could trust? How was I going to get this person to take their medicine when they believed that they did not need medicine? These questions and more flooded my mind on my way to work the first day.

My first day was a major wake up call for me, not sure of anything, I took report on the people that I would be taking care of, and was given an introduction to who they were. The first person I approached looked at me and became very excited to see me. Her eyes lit up and she opened her arms for a hug, with a smile that went from ear to ear. I was thrown for a loop when she said to me "Where have you been? I have been waiting here for hours to see you!" My first thoughts were, "How does she know who I am, and why was she waiting for me?" I reacted instinctively and leaned over to hug her. At that point, the only thing that I was sure of, was that she thought I was someone else. That was confirmed by her later on when she started calling me by a name that was not my own.

That day, I learned that I need to be whoever that person thinks that I am. I learned that I need to be living in their moments and just go with the flow. Over the past year, I have been a husband, a brother, an uncle, a father, and even the man the woman was seeing behind her husband's back. The one thing that has remained constant is that no matter who I am that day, I am a person that these people trust, and they will do whatever I need them to do to take care of them.

Many times, I find that it is as simple as helping them overcome some type of worry that they have. For instance, one day one of my residents was upset because she could not find her car keys. This really had set her off in a tail spin and she would not calm down for anyone. It was reported to me from the previous shift that she was like that for hours, and she was refusing everything. When I went up to her, she started yelling at me to help her find her keys, and so I gave her a big smile and told her that the keys are in the car. She wanted to know why they were in the car, and so I explained to her that the mechanic was fixing her brakes for her. You could see the relief flood over her, and her tone softened and with a smile, she tells me "those darn brakes have been making so much noise this past week, and I forgot to tell you. How did you know they needed fixed?" I smiled and said that I heard them when she pulled into the drive yesterday, and I wanted to surprise her by having them fixed up so she was safe.

I found that most behaviors that a nurse has to deal with in dementia residents has a root cause to a worry of one form or another. They are worried about getting home in time, finding something lost, missing a loved one, and many other such worries. And most of the time, you, the nurse are in the position to relieve that worry by diving into their world, finding out what it is, and then removing the worry.

Evidence Based Practice tells us that the environment plays an important roll in people. This goes double for people with dementia. I turn their normal evening dinner into a dinner party where they are all the guests of honor. I provide them with music and dancing, sometimes singing and games. If you are struggling with behaviors in a dementia unit, look around and see if this is a place that you would want to come. Is it fun and exciting, or is it boring and institutional? Is it a place you can relax and enjoy the company of others, or a place where people are on edge because they do not know what to do?

The biggest surprise of all to me, is that the job I dreaded the most, has become the one place I want to be more than ever! I do not get to work down on the dementia unit as often as I would like, but every time I am scheduled to go down there, I get overjoyed and excited to take another exciting journey into the lives of the people that I get to take care of down there.

I do find it frustrating when I see evidence that nurses would rather go straight to the PRN medications for correcting behaviors instead of dealing with the problem. I know this occurs frequently when nurse aids come up to me and tell me that I need to give so-and-so something to calm them down, because they are starting to get upset. I also see it when trends show up in the PRN's that have been given to the people. In the past year, I have only had to use PRN's a few times in order to calm a person down. Most of the time, behaviors can be corrected by simply spending a few extra minutes with someone to find out what is bothering them, then making a change.

If you are working with dementia residents, take a look at how often you are giving the PRN's to control behaviors. And if you see that it is frequent, take a look at how you interacting with that person, and see if there is something else that you can do to change their environment. I challenge you to get into their memories and become that person that they need most of all. The next time you have a resident trying to get out the door so that she can go home to take care of her kids, instead of going for the PRN, go to her and figure out a place where her kids might be that she feels safe about them being. "They are spending the night at grandma's house so that you can relax and have an evening for yourself. Come have a cup of coffee and lets talk."

If you are struggling with a behavior, leave it in a comment so that me and others who deal well with dementia can give you some new ideas to try. We are here to help, and would love to help you brighten the day of the person that you care for.

In your service,

Kevin

[nt2002]

This is a lovely post and wonderfully written. Thanks! When I started reading and came to the part about you having to take your "dreaded" job I thought this was going to be a negative rant about LTC-- boy was I wrong (and happy to be!).

[psychgeribuff]

♥♥♥♥♥♥-love this post, I believe we are on the same wave length Kevin. I think you would be the perfect Nurse for a geri-psych unit!!!!

[Thimbalina]

aw. That was heart warming. :) Thanks.

[amoLucia]

Your approach to our pts is something that I like to call "therapeutic fibbing". Bag all that 'reality orientation' foolishness!!! Just relieve all the psychic stressors.

I'd rather have that peaceful cup of coffee with my LOLs 'while their grandkids are napping'.

I'd bet you make great coffee, too!

[litbitblack, ASN, RN]

I too work in long term care at a dementia care facility that is divided into suites designed to meet the needs of the residents based on what stage of the disease they are in. You would be surprised how just changing the environment can help a behavior. When a person is struggling to keep up with their peers and don't understand what the issue is the behaviors come. I am on the highest functioning unit and its more of assisted living so when my residents start declining and their behaviors start affecting the other residents then it becomes a dignity issue as the declining resident will get talked about or fights get started ect. The other side of the coin is the family. The family has to deal with all the things that come with dementia. Placing their loved ones in a facility because they can no longer keep them safe at home. Watching them decline and forget things and knowing it will not get better. The nurse is also there for the family and I feel the staff taking care of these residents are doing so to provide the family when they visit time to be a spouse, daughter, son, grandchild ect and not have to focus on the disease but enjoying time with their loved one while they can...We try everything else prior to a prn for behaviors. Sometimes their routine medications are not at therapeutic levels or they may have progressed enough in the disease where some of the medication that was working is actually causing behaviors....There is a lot a room for nursing in dementia and its not all about giving medications. I really enjoy the place I work for the most part...

[nursielou72]

I thought the same thing!

[nursielou72]

This is a lovely post and wonderfully written. Thanks! When I started reading and came to the part about you having to take your "dreaded" job I thought this was going to be a negative rant about LTC-- boy was I wrong (and happy to be!).

I thought the same thing!