So I have worked my third day as a LVN in a LTC facility. Orientated for one day then turned loose...on the alzheimers lock down unit. 21 residents.
A little scary, but I am fairly comfortable, so far. (should I be?)
Mrs. X is driving me crazy. For my three days she has asked to call her daughter to come get her.She is going home, looking for her car, easily agitated,etc.
The aides pacify her: "Mrs. X your daughter is at work, you can call her when she gets home from work" " your going home after lunch" This goes on all day.
I am new with Alzheimers behavior. I am new at being a nurse.
I don't feel good about telling her she can call her daughter to get her
"after she gets off work" , or that she is going home.
Is this not implanting the idea even futher, possibly even creating a cycle?
I work in a med/surg ward in a rural hospital and we almost always have at least one geriatric/ALC pt on our cencus. They come through the ER because they have fallen, caregiver has burnout, etc. What ever the reason, they can no longer live at home and are waiting for placement.
The unit is definitely not an environment conducive to utilizing the various philosophies of care I was taught.
I personally have found the best way is to 'join' them in their reality. If they are agitated and "waiting for mom" -- I would never try to reorient them by telling them that their mom is dead.. I might however ask if they would like a clean gown or sweater while they wait. I would also use any other creative distraction technique. Even therapeutic lying.
But--with open stairwells and exits, restraining them by using a gerichair has become necessary. Sometimes just parking the chair at the nursing station, reclining it and covering the agitated pt with a heated blanket is all they need.
With four or more other pts on my assignment it's not for lack of desire, but for lack of time that such a restraint becomes necessary.
Specializes in Gerontology, Med surg, Home Health.
4 other patients!!! Try taking care of 40 on 3-11 as one licensed person with 4 aides and being mandated to use 'as few restraints as possible". Goes to show no matter where we work, we are challenged to provide the best care we can.
Less than a year experience on ICU and you are an expert in dementia care??? Part of being a good nurse is being open to learning from others' experience and getting off your high horse occasionally to see that people who have been dealing with dementia patients longer than you have been alive just possibly may know a thing or two more than you.
Before I became a nurse I did counseling on an inpatient geropsych unit, worked with HCFA on a grant with non-institutionalized Alzheimer patients, worked as resident care director in a LTC facility, and was on the board with the Alzheimer's Association, leading workshops for families with a new diagnosis and also led a monthly support group. So here is a news flash...what you read in a book last year and heard a lecture on one time does not make you an expert!!! Experience is the teacher here. You can benefit from the experience of others or you can wreak havoc in the minds and hearts of the most vulnerable of patients....whatever feels 'right' to you.
4 other patients!!! Try taking care of 40 on 3-11 as one licensed person with 4 aides and being mandated to use 'as few restraints as possible". Goes to show no matter where we work, we are challenged to provide the best care we can.
I hear you...been there, and do that too... Well--on occasion when I work 1100- 2200 PRN at a LTC facility. Then- I have 39 residents with 3 or 4 Care Aides. It is a tough job.
I was referring to my regular nursing job on a M/S ward where the focus of care is on the acutely ill and is totally not equipped for the demented, but not sick senior. AND have four+ other acutely ill pts.
I'll use whatever technique necessary to soothe an agitated senior.
In addition to our place having many exits to the outdoors, we are at the top of a hill and any road a confused senior may take goes dowwwn.
Once again, I need to remind everyone that continued negativity toward Jesskanurse will not be tolerated. State your opinion without referring to her in any way. Members who hold an unpopular opinion need to be prepared to hear plenty of dissenting reactions, BUT they do not need to be ridiculed, scolded, shamed, or spoken of in any other way that makes the discussion personal.
Members who do not comply with this request may find their posts edited or removed and they may be given warning points as well. This has been an informative and interesting thread. Rather than close it down, I will deal with anyone who does not heed the above request on an individual basis.
Thank you, everyone, for your stories, experiences, advice, and responses. Reading this thread really has given me a broader perceptive on Alzheimer’s. I commend any nurse with the patience and creativity to care for these wonderful people.
I am, however, no longer working LTC. I started on a Med/ Surge floor last week and feel like I am getting a better foundation in nursing (as a new LVN).
Alzheimer’s/ Dementia is to be found here as well and I have really utilized all advise offered. Thanks again.
I just wanted to say how impressed I am with the compassion (and creativity) of so many that have posted in this thread. It makes me feel proud to be entering the field of nursing, and humbles me. When I am a practicing nurse I hope I have a tenth of the skill, patience, and compassion of those posting.
4 other patients!!! Try taking care of 40 on 3-11 as one licensed person with 4 aides and being mandated to use 'as few restraints as possible". Goes to show no matter where we work, we are challenged to provide the best care we can.
yeah - in our facility there is a nearly NO restraint policy - we DO have one in the over a yr i have worked there and it was jumping through hoop after hoop to get it ( seat belt ) and thank god for it - the facility before i worked there near 3 yrs - never once did we get to use a restraint - one tie called cops to9 come restrain and transport to psych - instead of restraints we now have low beds ( nearly a mattress on floor ) mats by beds - alarms that go off all the time cause they dont work when they are supposed to - sigh - i dont wish to restrain like we used to in the "good ole days" where any confused patient had some form of restraint from vests to laptop tables- but sheesh - wed have so much fewer falls if we could use a few - and without going through a month of hoops to get it ( woman that has belt fell i think it was over 20 times in that month took us to get seat-belt - no falls since - thanks to god for no fractures while we waited for legal to get the belt. )
Wow!! What a thread. It's like reading responses from all the different coworkers I've worked with meaning - we all have different ideas, opinions, and approaches. Many sound all to familiar. I absolutely love working with dementia. The disease and its progression is so interesting. I go to work to make these moms, dads, grandmas, aunts, brothers happy in their world. They are people. They used to have productive exciting lives. If they believe they are still in 'that life' then all the better. I don't go there to just give pills. On my last shift at my new job I went to a residents room to give her her 0800 meds and saw an old pic on her table of a young beautiful women in a white nursing uniform and cap. I didn't know anything about this lady yet and showed her the pic and asked who it was. Her response was "oh how cute. Isn't she cute?" and she had a big grin. She did not know it was her. She was one of us a long time ago. How sad. We are not 'lying' to these residents. And like so many others have said you have to decide who you can re-orientate as there are different stages of dementia. At my new job, the LPN I have worked with just makes me cringe. She's worked there for 4 yrs. Her response to the lady who kept getting up from the table at brkfst (still 1 hr before it was to be served) was to YELL: "go sit down. stop getting up. brkfst is coming, now sit and stay there until you've eaten!" I wanted to slap her! This resident is not a 3 yr old. She does not remember 2 mins prior. Why not let her walk around and when the brkfst is acutally waiting for her on table then sit her??? Hello!!! geesh I think someone needs some retraining or find a different job!
Story: There was a wonderful resident who could not 'function' in her daily routine because she was always 'looking for her baby' she refused to stay at the table. Wandering, constantaly looking everywhere. She began to lose weight and more agitated. She became very difficult to redirect. Where she could normally follow simple commands, she now could not because she was so focused on finding her baby that nothing else mattered to her. One day someone came up with the idea - give her a baby - We had a quick care conference with staff and family and discussed the pros and cons and possible consequences. We all agreed to try. The family bought a baby doll. We couldn't believe the difference. It was a complete 360. Although there were times we had to 'babysit' the baby so she could eat her meal or have her bath, she gained weight, stayed in bed and slept, knowing her baby was safe with her. Positive outcome. That's all. No harm done. She was happy and healthy. Happy ending :)
With a pt who doesn't have dementia you can and do have to bring them back to reality when they get off track. About 9 years ago my boyfriend at the time and I were living in Vegas and boyfriend's mom's ex-husband's stepfather(George) who was in his 70's mother(Molly) was 94 was living in a LTC facility and she was still very sharp and with it. One day Nick (boyfriend) and I were at George and Sandy's(his wife) house and the phone rang and Sandy answered it. It was Molly who had called up(she had their phone number memorized and used the phone by herself) and she was all upset because she thought the George had visited her earlier that day and didn't say goodbye when he left(he hadn't visited her that day yet.) Being that she was with it most of the time Sandy was able to tell her that George had not visited her that day and whenever he visited her when he left he ALWAYS would tell her goodbye before he went and that George was coming to visit her later that day. Molly understood and was very happy that George didn't leave without saying goodbye to her and she could also look forward to seeing him later that day. Lying to her would have been wrong as she was of sound mind, but if she wasn't, say if she had dementia, then 'lying' to her and having George apologize for leaving without saying goodbye(even though he did no such thing) would have been the best course. We all, George, Sandy, Nick, his little sister Chrissy(16), his mom and I all went to visit her that night. She was a wonderful lady and as I said she was still sharp as a tack even at her age. We loved listening to her talk about what her life was like when she was younger and we loved seeing pictures of her when she was a young woman. She was a beautiful woman and she still was, older and wiser, but still a wonderful pretty woman. I was very sad when she passed away a few months after this.
Now that approach worked because she did not have dementia and was able to be brought back to this reality. If you had tried that with my grandma with Alzheimer's in the same situation she most likely would have tried to attack you or otherwise become violent becuase her reality was not ours.
Different residents require different approaches. It all depends on what their mental state is. Non demented patients can be brought back to our reality without much problem but demented patients can't and if you try chances are you are going to end up with a violent resident who is at risk to injure themselves or others.
speti4
20 Posts
I work in a med/surg ward in a rural hospital and we almost always have at least one geriatric/ALC pt on our cencus. They come through the ER because they have fallen, caregiver has burnout, etc. What ever the reason, they can no longer live at home and are waiting for placement.
The unit is definitely not an environment conducive to utilizing the various philosophies of care I was taught.
I personally have found the best way is to 'join' them in their reality. If they are agitated and "waiting for mom" -- I would never try to reorient them by telling them that their mom is dead..
I might however ask if they would like a clean gown or sweater while they wait. I would also use any other creative distraction technique. Even therapeutic lying.
But--with open stairwells and exits, restraining them by using a gerichair has become necessary. Sometimes just parking the chair at the nursing station, reclining it and covering the agitated pt with a heated blanket is all they need.
With four or more other pts on my assignment it's not for lack of desire, but for lack of time that such a restraint becomes necessary.