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Practical Nursing Strategies for Connecting with Dementia Patients

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jeastridge jeastridge, BSN, RN (Trusted Brand)

Specializes in Faith Community Nurse (FCN).

Is working with dementia patients challenging for you?

It can be a challenge to connect with our patients that suffer from dementia. This article suggests some approaches related to the 5 senses to build bridges of communication.

Practical Nursing Strategies for Connecting with Dementia Patients

Freda

As I entered the room at the nursing home, Freda looked up at me with the foggy eyes of dementia, trying to place me and looking for my name tag. I repeated my name, speaking in a steady, calm, friendly voice, trying to make a connection with this dear elderly lady who was not feeling well and so confused. We talked a few minutes as I did a visual assessment and sat down in the folding chair by the bed. As her Faith Community Nurse, I checked on Freda with some regularity, watching for changes, trying to encourage her, the staff, and the family. Sometimes I suggest small interventions that might help make Freda’s life more enjoyable.

How do we continue to connect with our patients that have dementia? What are some ways we can show kindness and build a bridge of communication when the usual pathways fail?

How to Bring Sunshine to Dementia Patients

Below are some practical ideas. You will likely have many more, but maybe this list will get you  started thinking about the little ways to bring some sunshine to your patients. Some of these will be completely impossible but there may be one or two that spark your enthusiasm. I hope you will share others in the comments.

When dementia clouds the mind and confusion sets in, we must work harder to appeal to the various senses: vision, hearing, touch, taste, smell.  We also work to find ways to connect to the spirit. The tangles of Alzheimers and the brain shrinkage of vascular dementia both erase connections and leave those that suffer adrift in a sea of loose associations, waiting for bridges to form, so they can dock and enjoy moments of clarity and memory.

Some of the docks available to us as nurses include anything that appeals to the five senses.

Smell 

Have you ever smelled something that just took you back to a moment in time? This happened to me recently: As I walked down the long hall of the retirement community, on my way to visit a member of our congregation, I inhaled deeply and was suddenly fully present at my own grandmother’s assisted living, thirty years in the past. What was it? Maybe it was the elusive combination of Jergen’s hand lotion and laundry detergent. Although I couldn’t pin it down, I enjoyed the feeling of being back with my grandmother and my heart held a sweet ache of longing for a few minutes as I remembered and missed my grandmother again. What takes you back? More importantly, what might take your patient back and help them make a meaningful connection? Is it Rosewater spray or Lavender sachet? A particular type of soap? Hot tea with cubes of sugar or brewing coffee? Be on the lookout for smells that are practical to bring to patients. In my daily walk, I often pass a lavender bush. I always let my hand touch the plant as I pass by and then walk on with my hand covering my face, enjoying a scent that takes me back to age 7 when I had a birthday party and several children brought Lavender perfume as a gift. A sprig of rosemary, mint or some other aromatic or essential oil, can bring enjoyment and connection to your patient.

Sight 

What is it that can help those with dementia bring back enjoyable memories from the past?

Technology makes motion-activated picture screens practical and helps us bypass the clunky photo albums.

Nature offers up a regular array of free stuff: leaves changing color, acorns, wildflowers, bird feeders, pumpkins, fruit, etc. Recently, with the cooperation of grandchildren, I was able to raise several Monarch caterpillars into butterflies. The process does take some assistance, but is fascinating every step of the way!

Spiritual reminders of their faith. Depending on their faith tradition, a variety of symbols might be used to occupy some of the wall space around them, serving as gentle reminders of what continues to be a comfort to them.

Sound 

How about playing a song from when your patient was 14? Going back in time is now easy with the help of Youtube and other apps that serve up an infinite variety of music from bygone eras. Did the person with dementia play an instrument? Were they into old-time country or big band? Sometimes we have more information about our patients than at other times, but even with just their age, we can make some good guesses about what might bring them some connection to the past.

Taste

This is a fun one! If your patient is still able to eat and enjoy food there are many possibilities. But even if they are no longer able to chew or fully participate in eating, there are some ways to make connections through food. It just takes a taste to evoke the memories!

1. A cold Coke in a little bottle with a paper striped straw bobbing up and down

2. Corn bread with honey

3. Candy sticks or traditional style candy—Cracker Barrel keeps a good assortment!

4. Hot bread with butter.

5. Candy apple

6. Pound cake

7. Apple butter

8. Chow-chow

9. A lovely wine.

10. What else? What does this list make you think of?

Touch 

This one requires care, thought and responsiveness in the moment. People with dementia can easily fluctuate, within the same encounter, to being pleased with a touch to becoming agitated. Just as they may know the visitor initially and a few minutes later look puzzled and ask who they are, so touch can alternate between being pleasant to irritating within a short span of time. It is up to the nurse and caregiver to be discerning about how to best approach a patient with memory loss.

Spiritual connection 

While sensory connection may be easier in some ways, spiritual connection is also a necessary focus of attention. Familiarity can be helpful. If the person is from the Christian tradition, old songs, liturgical prayers (The Lord’s Prayer, for example), can all bring back memories and sometimes participation. Prayers, meditation, scriptures from their faith tradition, can all work together to help bring peace to a troubled mind.

As nurses, we have many opportunities to administer care to persons with dementia or some type of cognitive deterioration. As professionals, we continue to look for inspiration and new ideas about how we can do this better. I hope you will share below thoughts that may inspire others.

Joy is a Faith Community Nurse that has worked in a variety of nursing areas for the past 37 years. She enjoys writing, reading a good book, taking long walks and spending time with her family.

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14 Comment(s)

tnbutterfly - Mary, BSN, RN

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Thanks for posting these wonderful and thoughtful ways on how to connect with our dementia patients or loved ones.  These are so simple yet so meaningful.

 

jeastridge, BSN, RN

Specializes in Faith Community Nurse (FCN).

It was fun to think along these lines. I look forward to hearing others' ideas for connection! Thank you for your comment. Joy

LittleOldLadyWho, ADN, BSN, LPN, RN

Has 25 years experience.

This post made me see, smell, hear, and feel the things you so aptly described. Reminds me of the two patients who shared a room. One whose bed was away from the window, the new patient was near the window. The new patient daily described the beautiful view thru the window and this softened the grouch. They lived that way for a while before the "new" patient died. The formerly grouchy pt then was shown the view. A brick wall.  If a caregiver applies this, the patient will be well-served. 

jeastridge, BSN, RN

Specializes in Faith Community Nurse (FCN).

13 minutes ago, LittleOldLadyWho said:

This post made me see, smell, hear, and feel the things you so aptly described. Reminds me of the two patients who shared a room. One whose bed was away from the window, the new patient was near the window. The new patient daily described the beautiful view thru the window and this softened the grouch. They lived that way for a while before the "new" patient died. The formerly grouchy pt then was shown the view. A brick wall.  If a caregiver applies this, the patient will be well-served. 

Great story!! Thank you for sharing. Joy

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

When I was in nursing school back in the mid-‘90s, the prevailing wisdom was that we were supposed to reorient dementia patients to the current time, location, and reality. Even then I thought that was wrong—who wants to be told their husband or wife is dead and that they are in a nursing home?

So instead of breaking their hearts, I entered THEIR reality. If the patient believed it was 1952 and she was cooking dinner and waiting for her mate to arrive home from work, what was the harm? I was also usually able to prevent them from wandering by giving them something useful to do, like folding towels or their own laundry. You just have to get creative; it works much of the time and is always worth trying. And if you think there’s no time for this, well, making an investment in them early on may just save you a lot of time later, instead of dealing with their issues only after they’ve had their meltdown and are upset and agitated. 
 

The other thing is, I believe people with dementia are humans first, and that somewhere down deep there is a part of them that is appalled at what is happening to them. Almost no one chooses to urinate and defecate on themselves, or drool, or be unable even to feed themselves. So we need to be mindful of their dignity at all times and treat them with kindness and respect, even when they’re cussing us out or being combative. 
 

Thank you for this post, OP. Treatment of people with dementia has certainly improved since I was a student nurse. 😊

jeastridge, BSN, RN

Specializes in Faith Community Nurse (FCN).

1 minute ago, VivaLasViejas said:

When I was in nursing school back in the mid-‘90s, the prevailing wisdom was that we were supposed to reorient dementia patients to the current time, location, and reality. Even then I thought that was wrong—who wants to be told their husband or wife is dead and that they are in a nursing home?

So instead of breaking their hearts, I entered THEIR reality. If the patient believed it was 1952 and she was cooking dinner and waiting for her mate to arrive home from work, what was the harm? I was also usually able to prevent them from wandering by giving them something useful to do, like folding towels or their own laundry. You just have to get creative; it works much of the time and is always worth trying. And if you think there’s no time for this, well, making an investment in them early on may just save you a lot of time later, instead of dealing with their issues only after they’ve had their meltdown and are upset and agitated. 
 

The other thing is, I believe people with dementia are humans first, and that somewhere down deep there is a part of them that is appalled at what is happening to them. Almost no one chooses to urinate and defecate on themselves, or drool, or be unable even to feed themselves. So we need to be mindful of their dignity at all times and treat them with kindness and respect, even when they’re cussing us out or being combative. 
 

Thank you for this post, OP. Treatment of people with dementia has certainly improved since I was a student nurse. 😊

What a beautiful post! Thank you for sharing your experiences and your thoughts. Your patients are blessed to have you caring for them. Yes! Dignity is so important. Joy

DallasRN

Specializes in ICU/ER/Med-Surg/Case Management/Manageme.

On 10/13/2020 at 6:47 PM, VivaLasViejas said:

The other thing is, I believe people with dementia are humans first, and that somewhere down deep there is a part of them that is appalled at what is happening to them. Almost no one chooses to urinate and defecate on themselves, or drool, or be unable even to feed themselves. So we need to be mindful of their dignity at all times and treat them with kindness and respect, even when they’re cussing us out or being combative. 

My hope is if - or when - I sink into the world of dementia, I have a nurse like you, VivaLasViejas.  Being treated with dignity and respect is paramount to me.  I just turned 71 about 2 weeks ago but I'm still able (and fortunate) to work in a part-time job with seniors.  Most are essentially active and reasonably healthy save for the "old age" complaints we all have.  Without exception, every client believes being treated with dignity and respect is as important as receiving top-quality healthcare.

If I may add just a bit to Joy's article, please...for all the younger nurses reading, please consider the fact that not all people with dementia are in nursing homes or hospital beds.  You may encounter the person at the grocery store, church, while out walking who is experiencing the early stages of dementia.  They may be slow to respond, shaky on their feet, can't immediately recall meeting you yesterday, unable to find their words.  In your hurried world, try to find a little patience and a little time.  Also, delete the words honey, sweetie, mama, etc. from your vocabulary when addressing anyone older than you.

jeastridge, BSN, RN

Specializes in Faith Community Nurse (FCN).

1 minute ago, DallasRN said:

My hope is if - or when - I sink into the world of dementia, I have a nurse like you, VivaLasViejas.  Being treated with dignity and respect is paramount to me.  I just turned 71 about 2 weeks ago but I'm still able (and fortunate) to work in a part-time job with seniors.  Most are essentially active and reasonably healthy save for the "old age" complaints we all have.  Without exception, every client believes being treated with dignity and respect is as important as receiving top-quality healthcare.

If I may add just a bit to Joy's article, please...for all the younger nurses reading, please consider the fact that not all people with dementia are in nursing homes or hospital beds.  You may encounter the person at the grocery store, church, while out walking who is experiencing the early stages of dementia.  They may be slow to respond, shaky on their feet, can't immediately recall meeting you yesterday, unable to find their words.  In your hurried world, try to find a little patience and a little time.  Also, delete the words honey, sweetie, mama, etc. from your vocabulary when addressing anyone older than you.

Thank you, Dallas, RN, for adding such an important comment to our discussion. Yes, the terms of address are so important. People need to feel seen and heard--and not just in the literal sense but on a higher plane than that. Showing patience and grace toward our elders is necessary for their dignity but it also informs our own humanity. Somehow we become more human when we acknowledge others' humanity and dignity. Joy

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

On 10/12/2020 at 1:25 PM, jeastridge said:
Spiritual connection 

While sensory connection may be easier in some ways, spiritual connection is also a necessary focus of attention. Familiarity can be helpful. If the person is from the Christian tradition, old songs, liturgical prayers (The Lord’s Prayer, for example), can all bring back memories and sometimes participation. Prayers, meditation, scriptures from their faith tradition, can all work together to help bring peace to a troubled mind.

As nurses, we have many opportunities to administer care to persons with dementia or some type of cognitive deterioration. As professionals, we continue to look for inspiration and new ideas about how we can do this better. I hope you will share below thoughts that may inspire others.

I love this article, it brought tears to my eyes. What better service than to give of ourselves to connect. Thank you for sharing. 

jeastridge, BSN, RN

Specializes in Faith Community Nurse (FCN).

7 hours ago, Nurse Beth said:

I love this article, it brought tears to my eyes. What better service than to give of ourselves to connect. Thank you for sharing. 

Thank you, Beth. It did my heart good to think along these lines, too. Connecting, even if small ways, is such an integral part of being human, isn't it? Joy

GracefullyGritty, LPN

Specializes in wound care/rehabilitative care. Has 4 years experience.

This was such a beautiful reminder of the small ways to connect with patients. Thank you very much for this !

jeastridge, BSN, RN

Specializes in Faith Community Nurse (FCN).

2 minutes ago, GracefullyGritty said:

This was such a beautiful reminder of the small ways to connect with patients. Thank you very much for this !

I'm glad it resonates with you! I hope it serves as an encouragement. Joy

Julie

Specializes in Sm Bus Management, Operations, Planning, HR. Has 38 years experience.

I recently had a close family member diagnosed with early onset dementia.  These tips will be helpful as time goes on.  Thank you!

jeastridge, BSN, RN

Specializes in Faith Community Nurse (FCN).

53 minutes ago, Julie said:

I recently had a close family member diagnosed with early onset dementia.  These tips will be helpful as time goes on.  Thank you!

Blessings on you throughout this journey. Joy