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?
Specializes in Med-Surg, LTC, Rehabiliation Nursing.
I am so sorry Jesskanurse, but you seem so young, and so full of your opinions of "right and wrong"! It is really terrible that the world is so full of GRAY areas, there is no right and wrong when you are dealing with patients who have no concept of reality, they are living in the past, the very short present, (i.e., could I have ice cream now?). Please please please reconsider your hard stance on this. Would you really want to cause more pain to someone whose brain is breaking down? If you think about it that way, seriously, they have a breakdown on their function in their brains, it does NOT work the way yours or my mine does, and it is a physical breakdown, not a choice of theirs. We cant force reality on these persons. Whatever we want to call it, 'therapeutic lying', ect., ect., the bottom line is to DO NO HARM. When my patient who is so very confused, wants her mommy, (who has been dead for over 20 years,), I am NOT going to push my 'reality' on her. I might be right, I know I am, but in her word, it is just giong to cause her pain.
I dunno.
I hope you can listen to much older, seasoned nurses than you. (I am not one of those, but have read every post on this line, and you have so much information to listen to.)
I wish you peace, love and happiness, and the same to your patients.
wow! how wonderful to know so many of you are extremely aware of how to help a dementia patient with what you term 'therapeutic lying'. I am an RN and wish you were all working with me. However, definitely not you Jesskanurse. How would you like to be given bad or frightening news about your life 10times to 200 times every 24 hours, or even once...? well that is how these people react to reality orient (whatever makes you happy here). How about 'dont be silly, your over 80, your mums dead, so's your dad" as an answer to "I've got to get home, mum will be worried sick, she doesn't know where I am". being asked 50 or more times a day.....the grief may only last a few moments or minutes, but it is there and recognisable....go back to selling books or something but PLEASE keep away from nursing until you learn how to be a nurse as you will meet these sweet, wonderful and sometimes quite dangerous people in every aspect of nursing and I certainly would not like your ideas anywhere near someone I love or look after.
And good on you Lfransis, keep asking questions and don't give up, you will feel like you are walking on a cloud when you leave work once you get to know and understand all these different wonderful people we call dementia's. And we do have cows around our facility, so don't even have to pretend, actually a very pacifying pastime for them to watch the cows.
Specializes in LTC,Hospice/palliative care,acute care.
I'm happy to see that this thread did not get closed.It's a good learning tool.It also illustrates how closed minded some of us can be.I work with several nurses both new and experienced staff who insist on doing certain things in their certain way.It's the pt/resident that suffers for it and sadly our administration does not want to hear about it..(retiring soon-thank the Lord) I hope I NEVER stop learning and growing.
I'm happy to see that this thread did not get closed.It's a good learning tool.It also illustrates how closed minded some of us can be.I work with several nurses both new and experienced staff who insist on doing certain things in their certain way.It's the pt/resident that suffers for it and sadly our administration does not want to hear about it..(retiring soon-thank the Lord) I hope I NEVER stop learning and growing.
:yeahthat:
I agree ktwlpn. I have learned a lot here already, and I am going to need ALL the wonderful advice and learning I can get as my poor mom is now fullblown Alzheimer's. From mild to moderate dementia and still functioning well and living/driving on her own over the past two years, to a sudden major deline and deterioration...the kind described above. "My Papa is waiting for me" (her Papa died before I was ever born), ... "I need to call my boss, he'll think badly of me if I don't call and let him know I'm not coming in today" (her job in pre-war Vienna)...etc., etc.
Sis Pati and her partner Roo are now caring for her in thier home in Tucson until Spring, when I will take my turn and keep her with me here through the summer mos. I just returned from Tucson to see for myself the tragic decline. And it is more than the heart can bear.
So yes, let us please keep this thread alive... I know I shall be coming here often for information, advice, suggestions, support.
Yes, It may be unethical in YOUR OPINION to tell her that... but any ethics board would tell you that you are wrong. As for your last sentence: How do you know what will damage your resident and what wont?? You dont. You are just using your own feelings and displacing them on the patient. You think it will damage her. Who are you to decide this? THAT is why it is unethical. What if there is a stage of the grieving process that she hasn't gotten through just because nurses are uncomfortable seeing her in anguish? I think that is what is happening. You cant have peachy happy patients all the time. Sometimes that anguish is therapeutic for them.
I had a patient whose husband died, she went to the funeral and the meal after it. Right when she got back to the facility she asked where her husband was. One person told her that he died and she had just came from his funeral and it was like she learned about his death for the very FIRST time. That same staff member continued to tell her this every time that she asked about him. Every time she asked, she relived his death as if it were the first time she was hearing about it. So, how many times per day should we put this resident through this mental anguish in your opinion? That is just cruel to tell her over and over that he was gone when we had just gotten her calmed down from the time that she asked before but did not remember.
This is a great learning thread. I am glad it is has not been deleted. I truly do believe that working with dementia/alzheimer clients is truly an art. Again thanks to all who have shared their extensive experience.
If therapeutic communication did not work, I highly doubt we would be taught it in Nursing school.
I know this is an old post and an old thread and the dead beaten horse is decomposing:deadhorse, but this caught my eye.
There is a lot of things we're not taught in nursing school. I think there's even an entire thread dedicated to things we were never taught in nursing school.
Yes, It may be unethical in YOUR OPINION to tell her that... but any ethics board would tell you that you are wrong. As for your last sentence: How do you know what will damage your resident and what wont?? You dont. You are just using your own feelings and displacing them on the patient. You think it will damage her. Who are you to decide this? THAT is why it is unethical. What if there is a stage of the grieving process that she hasn't gotten through just because nurses are uncomfortable seeing her in anguish? I think that is what is happening. You cant have peachy happy patients all the time. Sometimes that anguish is therapeutic for them.
Is that therapeutic anguish so good for them when they experience it 20 times a day or more?
Go right ahead... I'm very interested to see what you say in regard to me being 'wrong on so many levels.'
I want to know how you try to justify lying to your patients.
Jesska - I see that you are 24, so let's say that maybe you haven't had a lot of major life experience yet.
At 24, maybe you are supposed to be upset at what you perceive to be 'lying' to the patients, but just stop and think about it for awhile.
What if some LOL is looking for her husband, and he's been dead for 20 years. In her mind he's still alive - and when you insist on reorienting her to the fact that he's dead, she will again suffer the grief that she suffered when he died.
If you take care of me when I'm like that - and I get closer every day - please let me live in whatever pleasant fantasy my mind has placed me! :)
When my mother's sister had cancer, she developed brain mets, and became confused - and thought she was back in the time when her children were young. I told my Mom not to be so unhappy - that it was a much happier time of my aunt's life.
Please keep the focus of the topic on how best to work with dementia patients. It's fine to quote someone else's post, but because this thread became so intense, please address your comments to the membership in general and not to a specific poster.
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lvs2nrs3535
130 Posts
I am so sorry Jesskanurse, but you seem so young, and so full of your opinions of "right and wrong"! It is really terrible that the world is so full of GRAY areas, there is no right and wrong when you are dealing with patients who have no concept of reality, they are living in the past, the very short present, (i.e., could I have ice cream now?). Please please please reconsider your hard stance on this. Would you really want to cause more pain to someone whose brain is breaking down? If you think about it that way, seriously, they have a breakdown on their function in their brains, it does NOT work the way yours or my mine does, and it is a physical breakdown, not a choice of theirs. We cant force reality on these persons. Whatever we want to call it, 'therapeutic lying', ect., ect., the bottom line is to DO NO HARM. When my patient who is so very confused, wants her mommy, (who has been dead for over 20 years,), I am NOT going to push my 'reality' on her. I might be right, I know I am, but in her word, it is just giong to cause her pain.
I dunno.
I hope you can listen to much older, seasoned nurses than you. (I am not one of those, but have read every post on this line, and you have so much information to listen to.)
I wish you peace, love and happiness, and the same to your patients.