moving and handling difficulties working with dementia clients

[ellamazur]

Hi, I need your help. I am working with severe dementia clients in the nursing homes. On occasions I am have problems to use correct moving and handling with these patients. I'll give you one example and if could suggest how to deal with it. We have one lady who can be very uncompliant with moving and handling equipment, she is able partially weight bear. We were using standing aid hoist to move her. Sometimes she will not allow anyone with the sling near to her - biting, kicking, punching and etc. Only one thing she would comply is a "drag lift" when you holding her under arms she holds on you and managing slightly weight bear just enough for transfer. She thinks she is 20 years old and nothing wrong with her mobility, she is in the army and of course she doesn't need any equipments. She unable to understand what you are saying to her at the times. I did ask moving and handling trainer how would we deal with her, but he couldn't give me an answer, he suggested that she shouldn't be moved at all from the bed if she is uncompliant. But she trying to get out of bed if left to long and ending up on the floor. Some days she is compliant, so we can get her up, but later on the day she will be kicking off. We tried to leave her an come back later, but it doesn't work. She could be sitting ion the same chair for several days, swimming in her urine. What we can do without breaking moving and handling rules. Please share your ideas.

Thanks

[vwde]

I am currently working in a psych unit with a specialization in geriatric/dementia patients. You are right, they can be very difficult to deal with. But, we have amazing docs and nurses who can pick up on the slightest issues with these patients. In fact, we often get patients from long term care with acute mental status changes or increased aggression, like you're describing. Once we get them, they go through the entire medical head to toe. Often, they have a UTI, which can be the root of the problem. Also, we've found underlying pain. If neither of those are there, the docs often switch up their drugs and that works. I would recommend that someone sees her and evaluates her. I'm sure many people would say, "that's just her!", and leave it be, but it's not safe for the patient or the staff that she's that non-compliant and aggressive. I feel your pain. I hope it works out.

[ktwlpn, LPN]

Try minimizing the noise and activity when trying to put her into the equipment you are going to use.Have one staff member speak quietly to her and talk her through it while the others are moving the sling and lift into position and NOT talking,banging or slinging stuff around.You can also try having her hold a stuffed animal or baby if she enjoys them-she may comply with a hoyer if she has a job to do such as keeping the baby or pet "safe".Or-you are all "in the army" and working together and you have a new piece of equipment you need to train the staff on and you need her help..

Nothing wrong with leaving her bed for safety and getting her up later.Is she more compliant later in the day? Try prn tylenol prior to moving her.Those lifts look like they can be un-comfortable.

Rule out a UTI and maybe get a psych consult.Sometimes nothing works and they need an antipsych med to help them accept care and be safe.Good luck