Pleasantly Confused

StNeotser, ASN, RN · May 2, 2009

I use it too. Means they're a safety risk, self care deficit and all that but not a harm to other patients or staff but in shorter language. However, thinking about it, it's probably not pleasant for the patient to be confused and that's why the description maybe inappropriate?

Hey thanks for posting this, I've never thought about it before.

catshowlady · May 2, 2009

I use it too, to refer to pts who are confused, but are easily redirected and not combative, angry, or agitated.

I have never heard that it was inappropriate, not even during NS. I would also be interested to hear what others have to say.

debRN0417 · May 2, 2009

Thanks for the replies. I was told that it is more appropriate to say pleasant AND confused- but to me pleasantly confused means just that- they are pleasant, relatively happy, calm, not anxious, probably have no idea who or where they are, but are happy and content....

other oipnions or maybe a journal reference if anyone knows of any????

RNfromMN, BSN, RN · May 2, 2009

I loooovvvvvee "pleasantly confused." I use it all the time - I'm a new nurse, I haven't really ever thought of the "appropriateness" of the term. I feel when I describe someone as "pleasantly confused" -to a family member or otherwise- I'm saying that no, they're not with it, but they're okay with it, it's not upsetting to them.

Jailhouse nurse · May 2, 2009

Have used "pleasant, confused (x2 or 3 if LOC varies), appears comfortable", or just "pleasant,

confused, no apparent distress".

Good question, O.P.

expltcrn · May 2, 2009

it's quite deeply ingrained in physician lingo as well. if you research the records of the elderly who end up in the nursing homes, it is a term frequently used. there are those patients who are confused, and remain pleasant (as in not yelling at you, not getting angry) even when redirected or reoriented. even when you attempt to reorient them and they realize to a certain extent that they have forgotten something, or have awareness that they don't quite have it together, they have the ability to laugh it off, or even laugh at themselves and even apologize for being forgetful.

then the not pleasantly confused range from those who are agitated and acting out, to those who are pleasant at first, but once you attempt to reorient them or ask questions to gauge their orientation, either attack you verbally for attempting to "correct them" or daring to contest their view. i personally have never thought it through, nor know of a formal reference, but i have through the years seen its manifestation!

JNF RN · May 2, 2009

When I was a CNA in a nursing facility I took care of a man and his wife. After giving AM care and dressing them I would wheel them out to the lobby as she loved to watch the traffic, passersby, etc. Every day, like clockwork, she told me how much she liked this "hotel" and I was her favorite "bell boy". She would go on about other hotels where the service was not as good as it was here.

This is what I call pleasantly confused. In her world she was being pampered in a hotel rather than spending her last days in a nursing home. I can only imagine what went on in her inner world as she looked out that picture window with her husband of 50+ years at her side. If you have to have dementia, this is the kind to have. I would go ahead and use "pleasantly confused".

caliotter3 · May 2, 2009

Well, this is the first time I have heard of this phrase. I don't see anything wrong with it if it describes the situation well.

CapeCodMermaid, RN · May 2, 2009

I hate the term..find in old fashioned and demeaning.

I had a doc write LOL in his progress note one day. I asked him if he was laughing out loud about something and he said, "No, it means little old lady". When I asked him if he would want that in a permanent medical record if it ever went to court he said Yikes...you're right and changed it to an appropriate term.

debRN0417 · May 4, 2009

Thank you for your responses. I don't feel that the term is degrading, however, I guess it could be if the resident or family thinks so.

Nascar nurse, ASN, RN · May 5, 2009

I spent 10+ years as MDS coordinator with a lot of my time spent inservicing on documentation. While I don't see anything wrong with the term, I don't think it is very descriptive either.

Just using the word confused.. what does that mean? I lost my car keys for 2 hours today (I put them in a different desk drawer than normal and forgot em). I was confused. Compare that to the sweet little lady today that thought her daughter was actually her mother. She was confused too. We were both very pleasant about it (alright I was getting a tad irritated with myself). But my point is these conditions are not the same. Rather than use generic words it is always better to give actual examples. Describe what you actually see/observe that makes you think the resident is confused and then describe their reaction to redirection, etc. Let the reader determine she's pleasantly confused based on the picture you painted.

Ok, taking my MDS hat back off - thought I threw that thing away.