pacify or orientate? Alzheimers...

CoffeeRTC, BSN, RN · Sep 1, 2006

"....Sometimes we need to cross our i's and dot our t's....

Exactly!!

Nurse_Pauline · Sep 2, 2006

I have a 27 yr history with dementia residents, both as a cna and a LPN. Currently Im involved in a 60 bed long term care dementia unit,and managing that is quite a challange. My father in law also had Alzheimers Disease when he passed, so I have had a bit of experience. Personally, I think it can be almost cruel to try to reorient these types of residents. Some traumas are tough enough to live thru once, never mind multiple times. When im older i want to be the pleasantly confused little lady wandering happily thru the halls. And I hope to god no one tries to reorient me. No matter what books or teachers say, whatever keeps my residents comfortable is what I will do.

Multicollinearity, BSN, RN · Sep 2, 2006

Personally, I think it can be almost cruel to try to reorient these types of residents. Some traumas are tough enough to live thru once, never mind multiple times. When im older i want to be the pleasantly confused little lady wandering happily thru the halls. And I hope to god no one tries to reorient me. No matter what books or teachers say, whatever keeps my residents comfortable is what I will do.

Same here.

fleur-de-lis, BSN, RN · Sep 2, 2006

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.

Those resources seem like opinions to me, where is the research that backs up your position? I did a very quick search of guidelines.gov and found this quote from the American Psychiatric Association (APA).

"Cognition-oriented treatments, such as reality orientation, cognitive retraining, and skills training, are focused on specific cognitive deficits, are unlikely to be beneficial, and have been associated with frustration in some patients" (From http://www.guidelines.gov/summary/summary.aspx?doc_id=1428)

Here is another quote: "Avoid arguing or attempts at reasoning with the resident; such attempts tend to escalate agitation" From http://www.guidelines.gov/summary/summary.aspx?doc_id=6221

The writers of these guidelines have more degrees than you and your friends combined. I would refer to resources such as these before arguing so strongly for your position. Just my 2 cents.

greenfiremajick · Sep 2, 2006

Those resources seem like opinions to me, where is the research that backs up your position? I did a very quick search of guidelines.gov and found this quote from the American Psychiatric Association (APA).
"Cognition-oriented treatments, such as reality orientation, cognitive retraining, and skills training, are focused on specific cognitive deficits, are unlikely to be beneficial, and have been associated with frustration in some patients" (From http://www.guidelines.gov/summary/summary.aspx?doc_id=1428)
Here is another quote: "Avoid arguing or attempts at reasoning with the resident; such attempts tend to escalate agitation" From http://www.guidelines.gov/summary/summary.aspx?doc_id=6221
The writers of these guidelines have more degrees than you and your friends combined. I would refer to resources such as these before arguing so strongly for your position. Just my 2 cents.

:yeahthat:

what she said...thx for doing the real research on this fleur!!

onlyanrn · Sep 2, 2006

Why would you even consider lying to a patient? It seems very cruel to me! Think about the poor patient, desparetly wanting to see her mother and jsut being out off and pacified by staff. What a horror! The kind thing to do, is to explain to the patient that she is quite old and that her mother died years ago. Hold her hand and give her postivie feedback when she grieves, but don't ever lie.

For uou jesskanurse, orientate is in fact a word and it is proper use of the term. Orient is just as proper. Also, dearheart, the word nurse isn't always caplialized, I see you do that quite often. And it is anyway, not anyways!

rn/writer, RN · Sep 2, 2006

Please, let's set the grammar and usage issues to the side. This thread is challenging enough without getting derailed by semantics.

onlyanrn, what is your background/experience with dementia patients?

joyflnoyz, LPN · Sep 2, 2006

Why would you even consider lying to a patient? It seems very cruel to me! Think about the poor patient, desparetly wanting to see her mother and jsut being out off and pacified by staff. What a horror! The kind thing to do, is to explain to the patient that she is quite old and that her mother died years ago. Hold her hand and give her postivie feedback when she grieves, but don't ever lie.
onlyann, what is your experience with dementia patients?
As for "lying" FIRST DO NO HARM
For the 85 year old dementia patient looking for her father every night- *HER* reality says he is alive. IF I tell her "daddy died years ago" That causes her incredible distress and pain (harm) It is the first time she has heard that news.
(and what about the fact that she will probably not believe me, because she spoke to him not 30 minutes ago??) I have taken "cakes out of the oven"; checked on the babies, told a patient "I haven't seen your father, but when I do, I'll tell him where you are"
To tell someone her parent is dead, when she truely believes he is alive is just plain cruel.

nursejohio, ASN, RN · Sep 2, 2006

As for "lying" FIRST DO NO HARM
For the 85 year old dementia patient looking for her father every night- *HER* reality says he is alive. IF I tell her "daddy died years ago" That causes her incredible distress and pain (harm) It is the first time she has heard that news. (and what about the fact that she will probably not believe me, because she spoke to him not 30 minutes ago??) I have taken "cakes out of the oven"; checked on the babies, told a patient "I haven't seen your father, but when I do, I'll tell him where you are"
To tell someone her parent is dead, when she truely believes he is alive is just plain cruel.

:yeahthat:

I spent 3 years in LTC as an aide. Early in the process patients can be reoriented, often hundreds of times a day. When they've progressed to looking for their father (who died 40 years ago) no amount of "reality" is going to change their minds. I challenge everyone of the *lying is cruel* crowd to spend some quality time on a dementia unit. See how many times you can watch your patient crumble in grief because you just told her for the 15th time that her husband died long ago. Doesn't matter that he died before she was this far in the organic brain disease, she doesn't remember that! Each and every time you tell her, she's hearing it for the very first time. No matter how hard you try, she's not coming back to our world. How dare you invade hers and break her heart over and over again!!! :angryfire

tryingtomakeit, RN · Sep 2, 2006

I worked on a dementia unit as a CNA for several years before returning to nursing school. Try having as your most vocal patient a woman who ran an illicit brothel for several years during the 50's ...

Nurse_Pauline · Sep 2, 2006

"Try having as your most vocal patient a woman who ran an illicit brothel for several years during the 50's "... Oh would that be a riot! I bet she was great the stories she could tell!! And I still firmly believe that if lying makes my resident feel better, so be it! And yes, if im the resident I want to be lied to. No problem. Better to pacify without restraints, drugs or a section 12 call with a little "white lie". This is a terrific thread, very interesting to everyone involved. Hopefully, some posters have learned a bit. I know i do, still on a daily basis.

lovingtheunloved, ASN, RN · Sep 2, 2006

I worked on a dementia unit as a CNA for several years before returning to nursing school. Try having as your most vocal patient a woman who ran an illicit brothel for several years during the 50's ...

Oh, I bet you could write a book about her...:beer: