Older generation vs the Younger Generation! RANT!!!

[Amyjosonata]

So, I have somewhat of a quandry with the nurses in my Grandmother's LTC. I am JUST a nursing student and I don't want to seem like I am trying to start something but I think that there are some problems. Does it ever seem to anyone else that sometimes there is a lack of understanding of a Patient, or Client relationship/ nurse, CNA relationship as opposed to a Friend or Grandmother/ nurse, CNA relationship. My grandmother is suffering from dementia and in my opinion side effects of pain meds and she is doing some name calling, and recently attempted to hit one of the nurses before they took her to her shower. My problem with this is that if a person is suffering from dementia and thinks that her only safe place is her little room, and someone tries to take her to shower without warning, that she is going to react that way. I think she needs some kind of warning or needs to be told an hour or two before. The CNA that takes care of my grandma used to be pretty careful at taking good care of her. Now recently since the dementia started she is taking my grandmothers comments personally. I think people need to understand in LTC that I know that you can get attached to these people but that they are your PATIENTS and your CLIENTS NOT YOUR FRIENDS!!!!!!!!!!!!!!!!!!!!! NOT YOUR GRANDPARENTS!! These are not people that it is NOT appropriate to expect a two way friendship. People in LTC go downhill. You take care of them and respect them not expect them to be your wise old grandparents. It is a JOB that needs to be done well. I also think that these people need to understand that these post WWII generation people come from a different time and understanding and culture. There is a different level of respect than is needed in our generation's more casual culture. Certain things may offend them that don't offend us. What do you think? Am I crazy?

[Amyjosonata]

She may forget, but the point is, is to not assume that she doesn't have the capability to understand. To give her a chance at least. My suggestion was to have them write on her markerboard ONE HOUR TILL BATH and then write 30 MINUTES UNTIL BATH . I mean i know everyone is busy but it really wouldn't be that much bother. It would be less bother than to fight with her for 20 minutes. Quicker to try. Sorry about your grandfather. It is a saddening process. When my grandfather had alzeheimers he would say it was like walking into a fog. I hope you get to spend some quality time with him.

[mandana]

Amy, I agree with you. I'm just a student too, so maybe I'm lacking some 'real world' experience here, but my grandmother is in a LTC facility with dementia too.

The comment to your mother about "daugther not wanting her to eat" is horrible. I am not sure that it's illegal, but it's definitely unethical and frightening. I also dislike the scare tactics you mention. I think you may want to see if there's another facility that might meet your needs.

The relationship between patients and staff is not a two way street - it's about fulfilling the patient needs. If that can be done in a friendly and compassionate manner, wonderful - it should be. But if the patient is hostile (especially with dementia) they should still be treated with respect. Of course, I do not mean that people should tolerate ABUSIVE behavior from patients, but we must understand that people with dementia often act out. It's not hard to understand why. I can only imagine how terrifying it would be to not recognize people that walked into your room, especially when they are frequently coming in. Or how terrifying it would be to be have those people "drag" you off to do something you don't want to do at a time when you don't want to do it. (no flames please, I understand the other side too - you have a limited time to shower all your patients, and it's Granny's turn)

I like your idea about 30 minutes to bath time, but the concept of time is often lost in dementia. This can probably start quite effectively 10 minutes before it's time with a 5 minute notice too. I'm also sure there are ways to make the process easier. The person showering her could spend a few minutes talking to her, orienting her, and establishing a relationship - which really needs to be done on every encounter in some cases with dementia.

OK - I'm thinking I've said enough. Bottom line, I agree with you.

Amanda

[UM Review RN, ASN, RN]

So get this, mom went in to see her the other day and a nurse who didn't know it was my mother said "yeah, she is a sweet old lady too bad her daughter doesn't want her to eat, she is trying to put her on a diet" Doesn't that violate some type of confidentiality law?

They have also used intimidation tactics with my grandma, like if she is being stubborn (we are italian and this happens alot) they will say to her "You just want until your daughter gets here then you will be in trouble'' Then when my mom goes in again grandma is scared and crying because she feels abandoned and that mom doesn't want to see her anymore. I just think it is really abusive.

Wrong facility for her, IMO.

[Antikigirl, ASN, RN]

Marie was so on!!!!!! I also use special shower bags given by family members so that we can talk about how kind thier family is to give such wonderful items, and get them prepaired for showering!

Telling a pt that they will shower, even 5-15 minutes before will more than likely be forgotten with patients suffering from dementia. Our facility did the shower bags, had a special pre-shower outfit (like a snap mumu or robe for the gents) to place on them before hand, had showers scheduled on certain days and times for each pt and a shower aid so the routine was the same, and constant queing in preparation. That worked 80% of the time...but some days your patient has a good one, and others not so good...so things could get ugly dependant despite our best plans.

I also agree that the patients/client are that, they are not your friends or relatives. This is a job, and think of it that way. Doesn't mean you can't appreciate and be friendly with a client, in fact that is part of the job as well...but getting so attached is not professional...and will cloud judgement when it is needed most...not a good thing since they rely on CNA/LPN/RN and so on for being there thinking like a medic when that time arrives!

Plus...no matter how much you actually make at your facility...those clients pay A TON for your service (whether that is reflected in your wage or not), be there for them in a professional yet friendly mannor! They aren't paying for a 'friend' or 'relative', they are paying for assistance for daily living and medical assistance...always remember that....

It is hard to do that mind set...but I came to that conclusion early on, and was well liked by staff and clients...so it does work well :). And I wasn't tortured each and every night by thoughts of my clients after my shifts! That was very helpful for me!

[vloho]

A quite approach, a soothing tone, and a smile, a gentle touch ,hugs are all the approaches I always used.Some people just don't like to take showers or baths. Always be ready to step back.

[weyschad]

Move your grandmother now. I worked in long term care for many years. Our facility would not have tolerated those comments to family and patient. The showere reminders are nice if they come close to shower time with visual reminders. My aunt showers with her daughter. Called it mother and daughter shower. My aunt was tickled pink and could wait to get to the shower room. Find a place that calls to let you know the wonderful positive things as well as the bad days. I used to call family to say that patient seems to rcognize people today, she would love your company. My dad and my aunt are so bad that to get that call is so wonderful. Can actual talk and not hear who are you. So look around. I would recomment a long term care facility that specilizes in Dementia. Look beneath the pretty wrapper and pay surprise visits. Our facility did not discourage visits early or late.

Small town though and we knew every one by first name