Looking for intervention ideas

[Leighange]

I am presently working with a gentlemen in LTC who has recently lost his wife and also has recently lost his priviledges to smoke due to lighting up in his room after many warnings. He is definitely depressed but speaks very little and is in a w/c due to stroke so struggles with communication. He does have a picture communication book for staff to utilize and he has laminated pocket pictures of his wife as well as a pillow case with a picture of her on it. He is very lonely but does not want to attend or engage in any activities nor will he go outside because he cannot smoke. He has music in his room that he will listen to at times. He rings constantly for staff and wants to be in bed most of the time. He will start with an older adults counsellor soon but do you have any other intervention ideas? Thank you

[blaundee]

Depression makes a person withdraw from social interaction, and the isolation deepens the depression... however, forced socialization is very draining if you have depression, so it's a catch 22.

My advice is to be extra sweet and friendly to him, suggest playing his music if it isn't playing (music is healing), and gossip with him a little bit about what's going on in the rest of the home and the world- it'll help him to feel human again.

[blaundee]

If something in his room or pics makes you think of something, tell him. Tell him what it looks like outside, how your lunch break was, that so&so is wearing ugly scrubs, complain about price of gas, etc...

Find out what he used to do for work, or what his or his wife's hobbies were, and ramble about that if you can.

[Here.I.Stand, BSN, RN]

Is it a possibility that rather than losing his smoking privileges, he simply loses access to the cigarettes? Like the pack stays locked in the med cart, and each one signed out like the nurses do for narcotics? That would eliminate the fire hazard without punishing him. I realize that smoking isn't healthy, but it would get him outside. Plus he's dealing with the loss of his wife, loss of independence, even the loss of fluent speech...why impose yet another loss?

Something to discuss w/ the nurses.

[Leighange]

You are right. Depression does cause a person to withdraw from socialization. I have been doing just that, being friendly, offering the items of pocket pictures and pillow case of his wife's picture to help ease his pain and give him some sort of comfort. My issue is, that in my role I am not to be considered a "friendly visitor". I am to work with the behaviours that are present and be a "detective" to try and figure out why he is doing the things he is doing and come up with an intervention and then mentor the staff. I realize that the reason he is ringing +++ and wanting to be in bed is because he is depressed, lonely and probably afraid of being alone. The expectations of my role are to come up with ideas to support him and stop the excessive ringing. I offer him to go outside and to attend activities but it's only an option. I do encourage the music, puzzles, books/magazines, tv, made pocket pictures and ordered the pillow case. He will receive counselling soon but I am at a loss for more ideas. :0( There is only so much a person can do for someone grieving and depressed. He does have a brother that visits often.

[Leighange]

It's very difficult when it comes to conversation as I am the only one talking, he had a stroke and says yes and no mostly along with the random curse word. Lol But yes I do ramble on some. :0) ty

[Leighange]

Yes this was trialed and he would smoke half a cigarette and bring the other half indoors. It was too hard for staff to keep track of the cigarettes and lighters he was not handing in and bringing to his room. He was given e-cigs but does not use them.

[blaundee]

It's very difficult when it comes to conversation as I am the only one talking, he had a stroke and says yes and no mostly along with the random curse word. Lol But yes I do ramble on some. :0) ty

My grandpa was like that... could barely speak, and would often say the opposite of what he meant (yes when he meant no, vice versa). He could say Pretty day, I'll be damned (his way of acknowledging what you had said), yes (which usually meant no), No, "kay" (which usually meant yes) and "Kay kay kay" which meant oh hell no.

[blaundee]

I finally learned to ask him yes and no questions, and carry on the conversation that way. If you need to repeat a question for him, ALWAYS use the sane phrasing you previously used (I learned that when working with dementia patients). A lot of people will change the phrasing... they'll say "Are you hungry? " and the patient will say "what?" So they ask "Do you want something to eat?" Etc. Always keep the phrasing the SAME, because they patient's brain is processing that phrase, and changing it thwarts the process.

[blaundee]

Can he have a candy bar instead of cigarettes? I know that neither are healthy, but some patient's will accept the substitute...

[blaundee]

Can your facility offer a sit in aide, someone who'll just hang out with him? Perhaps a volunteer, or a pastor, social worker, intern?

I can only imagine the pain of losing your spouse... I'm sure it's crushing. I imagine he's in a place where he doesn't want to be alone and doesn't want company at the very same time. They say that most spouses die within 6 months of each other, I think it's because the grief is too heavy.

[Leighange]

Our LTCH would definitely benefit from more volunteers, so many have tried to recruit more but have been unsuccessful. The hardest part is sitting with him and trying to make conversation as it can feel very uncomfortable... after so many questions you don't know what else to ask.