pacify or orientate? Alzheimers...

Specialties Geriatric

Published

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?

Any advice/ suggestion?

Specializes in Geri, Home Health, OB GYN.
You are wrong. It is not unethical to go along with an alzheimer's patient. To continually try to reorient them will only upset them and frustrate the staff. There is, and one would think it goes without saying, a huge difference between a kid telling his mom a lie to get away with some bad behavior, and a caregiver going along with a dementia resident. I suggest you read some of the aforementioned books on dementia. You can not improve the short term memory of a dementia patient.

I couldn't agree more, well said.:yelclap:

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Not trying to flame or start a mean discusion, but I'm very curious to your background and experince with the alz dementia patients? Have you spent time in a nursing home or in a community setting?

Dealing with a confused or pt with short term delerium is very different. A previous poster mentioned that there are different forms of dementia...SDAT, vascular...etc Yes these all need to be considered.

Please enlighten us on your experiences (not school instruction). Maybe the rest of us are missing something.

Again...not trying to flame, but I'm always willing to learn something new.

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Jess, while the word orientate does bother me as does using the word "arouse" when "rouse" is preferable, please keep in mind that maybe you don't know it all...

from merriam webster dictionary online -

Main Entry: ori-en-tate

Pronunciation: 'or-E-&n-"tAt, -"en-

Function: verb

Inflected Form(s): -tat-ed; -tat-ing

intransitive verb : to face or turn to the east

transitive verb : ORIENT

Please take a step back from your opinion and listen to what many of these nurses are saying. I am also glad that you had a great psychology professor when you were in school. Perhaps you have forgotten that Alzheimer's is not a psychological condition but rather an organic brain disorder which involves neuron deterioration?

I will refrain from making any sarcastic comments here to respect your post. It was a good effort, but when you are going to quote a dictionary, remember to read the definition first. Orientate IS a word, yes, but it means 'to face or turn to the east.' The way the OP used it was 'orientated' to a situation, and that is incorrect. Orient refers to 'the orient' which historically was used to refer to the east, as in eastern asian countries. Again, I mean no disrespect by reminding you of this.

Anyways... lets try to get back to the main topic shall we?

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Specializes in LTC, home health, critical care, pulmonary nursing.

Tell my 88 year old resident who constantly looks for her mother that her mother died in 1964. Then watch her grieve all over again. Watch her cry hysterically and refuse to eat and say she wants to kill herself. Hey, why not "reorient" her on a daily basis, as she forgets the conversation every day. THAT is unethical.

(and someone at work got the bright idea to do this for four days before she figured out maybe that wasn't the greatest idea.)

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Not trying to flame or start a mean discusion, but I'm very curious to your background and experince with the alz dementia patients? Have you spent time in a nursing home or in a community setting?

Dealing with a confused or pt with short term delerium is very different. A previous poster mentioned that there are different forms of dementia...SDAT, vascular...etc Yes these all need to be considered.

Please enlighten us on your experiences (not school instruction). Maybe the rest of us are missing something.

Again...not trying to flame, but I'm always willing to learn something new.

Experience isn't everything. I just know how to use my resources and happen to find this topic interesting. My resources include include a 4 year college degree, great psych nurses, and friends with masters degrees in psychology.

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Specializes in LTC and Critical/Acute Care/Homehealth.

To Jesskanurse: May we please have some background. It would be very helpful to know where you are coming from. Also, in dealing with alzheimer's patients/residents, I always have to keep in mind that there IS the book way and then there is reality. I have seen nurses really upset an already upset p/r by telling them the truth to the point of medication. Not a good thing.

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Specializes in Utilization Management.
Experience isn't everything. I just know how to use my resources and happen to find this topic interesting. My resources include include a 4 year college degree, great psych nurses, and friends with masters degrees in psychology.

Experience certainly is not everything. Therefore, since you find this topic so interesting, I challenge you to try volunteering on an Alzheimer's unit and putting these textbook theories into practice.

If these theories work, we're all willing to learn how to use them to best help our patients. :nurse:

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Specializes in LTC, home health, critical care, pulmonary nursing.
Experience isn't everything. I just know how to use my resources and happen to find this topic interesting. My resources include include a 4 year college degree, great psych nurses, and friends with masters degrees in psychology.

I think it is wonderful that you are so educated at such a young age. However, dealing with this kind of resident is something that school can't teach you. I know at least my school can't.

I have worked with many psych nurses who had lots of education, but no experience working with dementia patients, and they learned very quickly how to "pacify."

My mother has a masters in psychology. She does not know how to care for dementia patients. There is a difference between knowing about the disease and caring for the person with it.

When my DON was a floor nurse, her viewpoint was very similar to yours. She was trying to tell a resident that this was the nurse's station, not a bus counter, she could not buy a ticket to South Dakota. That nurse had to report off to the DON and go get a tetorifice shot because the resident bit her.

You sound like a very learned person. Please be open minded as well.

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Not to get off topic again, but orientate can also mean to orient. Orient is more common, but orientate is not inappropriate.

http://66.161.12.81/search?q=orientate

A lot of your posts seem to have a bit of mean-spirit to them. I'm not really sure what that is about.

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I'm not sure why I'm so facinated by this thread?

Oh...maybe because I was in your shoes 10+ years ago. Fresh out of my BSN program at age 20(also with great instructors, great nursing program in large university setting in which I was exposed to the best hospitals,etc) I took a job in a long term care facility. (years ago...there wasn't much of a nursing shortage and I told myself....I hate psych...lol). Boy was I wrong in thinking that there would be no "psych" pts to take care of and that everyone was doing things all wrong. Well, LTC has come a long way since then.

Education vs experience.....hmmm? I'm gonna go with both. You live and learn everyday. I applaud you for coming to these forums to gain further knowledge and a better understanding of the demented pts. Really I do. Please keep and open mind to what is being posted and use your education in gaining valuable experiences in your nursing career. If you are really interested in this subject, many ltc facilities would love to have a pt or prn nurse...think about it.

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Specializes in LTC,Hospice/palliative care,acute care.
Experience isn't everything. I just know how to use my resources and happen to find this topic interesting. My resources include include a 4 year college degree, great psych nurses, and friends with masters degrees in psychology.
Practical experience IS a large part of learning how to communicate with these pts.Walk onto a secure dementia unit with all of your degrees and this mindset and first you'll likely get bitten,scratched or clocked in the head and next-you'll be asked to leave the unit for some specialized training because you'll have the whole place in an uproar...As I have stated plenty of psych nurses are not experienced in caring for dementia pts-nor does a master's in psychology make you a better communicator with these pts.These are not like your patients in ICU-you can't manage their care by titrating their drips-Dementia is not logical..You may find this topic interesting but you are demonstrating a closed mind.You seem to want to "stir the pot" instead of learn from those of us with many years of experience in dementia care............IMHO experience when people in this type of discussion start to rely on picking apart someone's grammatical errors it's because they don't have anything else to back up their opinion....For the OP-check out the links I've provided-also go to your library for books like "The 36 hour Day" and Relax...Your residents can read your tone of voice and body language.Also you'll set the tone for the unit-read about environmental controls.Learn how helpful soft music,calm quiet tones and aroma therapy can be....You can help the cna's carry out their duties and you can also help family and friends have meaningful visits by facilitating communication..Encourage them to be WITH their loved one-not to argue with them.Also you will find that more and more loved ones of Alzheimer's disease and related dementias are educating themselves.Chances are good that if you try "re-orientation" with a little old lady in front of their family you'll likely be reported for verbal abuse....
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"Therapeutic lying" is absolutely inappropriate. It is unethical and in my opinion, it implies pure laziness on the Nurse's part. Telling the patient what you think 'they want to hear' does nothing for them therapeutically.

now i'm curious.

if you had a pt who recently suffered a painful, anguishing death and their spouse asked you if their loved one suffered as s/he died, your answer would be?

you have received consistent responses from sev'l, experienced nurses.

may i suggest you have much to learn.

and it's the type of education that cannot be found in a textbook or by virtue of earning a degree.

now, if you would be so kind in answering my question about your pt that died a horrible death....

leslie

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