Re-directing tips needed for Alzheimer's/behavior pts

[bluegeegoo2]

What tricks of the trade do you have for re-directing Alzheimer's or behavior pts? There are 2 in particular on my unit that drive me up the wall! One is so very fixated on "going home" that it seems no amount of attempts at redirecting will work. For instance, last night the 2 were hell-on-wheels. I had 2 skin issues, a fall, and a med pass to take care of. After 11.5 hrs of hearing, "who can help me move my stuff?", and "I want to go home" and watching her pace up and down the halls, go in others peoples' rooms, "pack" some of her stuff and drag it to the nurses' station from 1 res, then the other who wails like a banshee at any attempt at redirection had me pulling my hair out by the time I (mercifully) left. We offered snacks, drinks, turned on the t.v., radio, gave them pain meds, anti-anxiety meds, and sat with them in their rooms and NOTHING WORKED. I am sooooo very frustrated I could scream!!! And, naturally, both are up ad-lib. The lady who was trying to move all night sat RIGHT IN FRONT OF ME FOR HOURS going on about wanting to leave, call the police, etc. She, however, was not violent or any other behavior to warrant a chemical restraint. Any tips on keeping my sanity during such occasions would be GREATLY appreciated!:plsebeg:

[deleern]

Interventions. (I am a unit manager for a Alzheimer's unit) I keep a note book in the nurses station. if some thing works we write it down....

One fellow in the afternoon around 3pm he wants to "bum a smoke" I give him 2 tootsie rolls he eats one and puts one in his pocket. He Pats his pocket now and then to check and see if it still there.

At 2PM we draw the shades. put Lawrence Welk on the Big screen TV we have Lavender oil we Put on a handkerchief and place in wheel chair or tuck into a shirt pocket. and we serve "drinks" Juice, Water and Coffee. (Dehydration)

We monitor Pain and discomfort very carefully. Sometimes they just need to go to the bathroom.

Medication is the last resort... we keep track if we are using PRN's

[jlynn2303]

Thanks all! I am a new grad who will be starting in LTC on Monday. Nervous. I graduated in November, NCLEX in Jan and am afraid I've forgotten everything already. The place I will be starting has a behavioral wing, an Alzheimer's wing, a fast track rehab wing, an acute wing (everything but trach's and vents) and then standard assisted living, etc. I will be floating, which makes me nervous. I am also afraid that I will forget all of my medsurg stuff! I kept hearing that any experience is good experience, take ltc right out of school, and then another new grad told me that she was told that once you did ltc a hospital wouldn't look at you!? Ultimately, I want to do hospice, so I think it will be ok, but I find it frustrating. One nurse recruiter at a local, smaller hospital (150 beds) said she gets 300 RN applications a week. So, a steady job with benefits sounds good right now - and those pesky loans will be rearing their heads soon. Since we did mostly hospital clinicals - what advice would you give a new grad going into ltc? Things to watch for, do, be aware of, etc? Thanks!

[supervisorhatchet]

Your (family member) comes on (day of the week), this is (day of the week).

We have a room for you. It is number _____. Let me show you. We even have turn down service (pull the covers back). ______(family member), brought you _________(favorite item...food, article of clothing, etc) so that you would feel more comfortable.

Yes, I will be here in the morning. (They don't know who you are, but you are a familiar face)

take 2 minutes and sit down with him or her. That 2 minutes to have a drink of soda on the front porch (just like the old days), or providing an activity really DOES pay off.

Make sure all of their needs are met.

Safe. Fed. Clean & dry.

remember that just because you saw them walk into the dining room doesnt mean that they ate, offer finger foods esp favorite foods

a wet or soiled brief is enough to make anyone want to escape!

I have seen a normally pleasantly confused resident become violent, exit seeking, very sad/emotional when constipated or with UTI (and unable to pee)....when assessing voids per CNA reports....ask how much!

take a time out! sometimes you just have to.

[nurse_autumn]

We had a gentleman who was a music teacher - he would get to talking about how he needed to leave and get to this conference or that class. We told him his car was in the shop, and start asking him questions about a favorite composer, or how his class was going, etc. He'd sit at the the nurse station all night and talk our ears off, sing to us...I miss him! :)

We have a lady now that will ask where her Mom and Dad are and say how she needs to go home, and we tell her the weather is bad outside and we all have to stay in for the night. Usually does the trick.

It can be really frustrating, but trial and error will usually sort out what works for a particular resident. Try asking the family (if they are around) about favorite food and drinks. Sometimes they get restless when they are thirsty, and face it - most older folks are dehydrated anyway. Or feel out and ask the resident about what movies or music they like when they are in a good mood - might give you something to talk about when those situations crop up.

[gatoraims RN]

Not sure if this is the same thing. I am a new nurse at a LTC. Our residents are mostly psych pts. The average age is 50. I mostly work in the elopement unit. It is locked and you cannot enter or exit without a code. Many of our residents "want to go home" or beg the staff to take them home. They will even pack bags and sit at the nurses station and follow your every step.

On a good day we have at least 3 incidents (fall, resident to resident. resident to staff, or a bruise/ skin tear that has no know origin) each incident can take an hour to do all the paper work and assessments/treatments.

Halloween the residents as a whole seemed to be out of their "normal" behavior. The vast majority of them were acting up, hitting, stealing, yelling, running, banging, you name it and they did it. We even had two that pushed the meal staff out of the way and high tailed it out of our unit. We were right there and able to get them back in but still it was crazy.

So one of the nurses brought in cupcakes and icing and little candies (a few sugar sub). We got all the residents who wanted to decorate cupcakes in our activities room. Never have we been out of space for them. All but 3 of the 54 residents packed into that room. They were busy for over an hour. Our unit has never been so peaceful.

Long story short but it was a fun activity that was not with-in the usual activities. I know it might not work for everyone but it really helped us have a great day and for the first time we were able to pass meds with-in the "state" regulated time frame.

[teeniebert, LPN]

Do you have any suggestions for more appropriate shows they could watch? I wonder if keeping a liabrary of DVD's would help the ones that don't sleep at night very well. We have one resident in particular who watches tv a lot. We've also had a recent increase in new tv's over the last little while. The residents don't really know how to use them. Or would music be more appropriate at night time? :)

A family brought in some DVDs and a portable player for their mother. Her favorite one to watch was Golden Girls, and other residents would hear the theme music from her room and get interested, so we asked the family if we could put Golden Girls on in the lounge. It became a regular after-supper thing for a while which helped decrease the mad rush to get everyone in bed right after the meal.

[JustAdmitToObs]

What about those residents who constantly scream "help me"? Sometime accompanied by more screaming about peeing in pants. How done one deal....

[TardisMom]

Sometimes you just have to keep them safe and tune it out. I find that many times they can be redirected but sometimes no matter how hard you try you just get them more agitated by trying to play along. Always remember that it is not personal and they can't help it. It helps to keep you patient and sane when the screaming goes on for hours.

[EmpathyInAction]

Some patients have days where they just can't be redirected, sadly.

You can always try going with the flow and telling her that her stuff is already packed or that someone is doing it for her.

Also, I find that if you can distract some just long enough to get off the topic they are stuck on, then you can start asking questions about the past and things they remember well, they will sit calmly and talk about that for a while.

[midazoslam]

I apologise if this comes off as harsh, but I hate the term "redirection". Why? Because it provides no quantifiable or meaningful information about what was tried or even what it means. To some, redirection may just be taking the resident away from an area, to others redirection may mean sitting with them and talking to them to minimise their distress. It's a subjective and very vague term; please consider being more specific when talking and documenting your interventions.

Before even trying to find solutions to a behaviour, it must first be understood. Why is it happening? What does it mean to the person? Was there a trigger? Is it an acute change or has it been slowly developing? Asking these questions can help to formulate your interventions and subsequent nursing care plan.

With dementia, you've really got to step into their world. Their understanding, perception, and recognition of reality can be so different but there is no use in challenging their reality. Accept it and use it to your advantage.

For wandering, there could be a host of reasons. To name a few, assess for things like pain, boredom, social isolation, psychotic symptoms, delirium, basic biological needs (hunger, thirst, thermoregulation, elimination), or side effects from antipsychotic medications (extrapyrmidal side effects such as restlessness and impaired gait).

Like with most BPSDs, there are no recommended first line medications. Simply put, the risk outweighs the benefit, and most BPSDs can be managed effectively with non-pharmacological interventions and creative thinking. For wandering, considef the following (of course tailor it to the individual - what works for Sue may not work for Jan):

-Aromatherapy and hand/shoulder massages

-Addressing emotional,and psychosocial needs (include them in activities that they may enjoy, not just the standard bingo or word puzzles)

-An exercise program to help burn off energy

-Review of medications

-Full delirium screen, including B12, thyroid fn, FBE, LFT, U&Es etc

-Implementation of a multisensory diet (check out sensory modulation and Snozelon rooms in dementia)

-Provide meaningful tasks for the person to do (i.e wipe down a table, fold towels, do gardening)

-Using subjective barriers on places you don't want the resident to go. Subjective barriers include 2D images of bookshelves which can mask a door, or using bright/contrasting colours to encourage use of a particular door/item/area etc.

I love non-pharma management of dementia. I hope my rant helped.

Midaz 😄

[ktwlpn, LPN]

I apologise if this comes off as harsh, but I hate the term "redirection". Why? Because it provides no quantifiable or meaningful information about what was tried or even what it means. To some, redirection may just be taking the resident away from an area, to others redirection may mean sitting with them and talking to them to minimise their distress. It's a subjective and very vague term; please consider being more specific when talking and documenting your interventions.

Before even trying to find solutions to a behaviour, it must first be understood. Why is it happening? What does it mean to the person? Was there a trigger? Is it an acute change or has it been slowly developing? Asking these questions can help to formulate your interventions and subsequent nursing care plan.

With dementia, you've really got to step into their world. Their understanding, perception, and recognition of reality can be so different but there is no use in challenging their reality. Accept it and use it to your advantage.

For wandering, there could be a host of reasons. To name a few, assess for things like pain, boredom, social isolation, psychotic symptoms, delirium, basic biological needs (hunger, thirst, thermoregulation, elimination), or side effects from antipsychotic medications (extrapyrmidal side effects such as restlessness and impaired gait).

Like with most BPSDs, there are no recommended first line medications. Simply put, the risk outweighs the benefit, and most BPSDs can be managed effectively with non-pharmacological interventions and creative thinking. For wandering, considef the following (of course tailor it to the individual - what works for Sue may not work for Jan):

-Aromatherapy and hand/shoulder massages

-Addressing emotional,and psychosocial needs (include them in activities that they may enjoy, not just the standard bingo or word puzzles)

-An exercise program to help burn off energy

-Review of medications

-Full delirium screen, including B12, thyroid fn, FBE, LFT, U&Es etc

-Implementation of a multisensory diet (check out sensory modulation and Snozelon rooms in dementia)

-Provide meaningful tasks for the person to do (i.e wipe down a table, fold towels, do gardening)

-Using subjective barriers on places you don't want the resident to go. Subjective barriers include 2D images of bookshelves which can mask a door, or using bright/contrasting colours to encourage use of a particular door/item/area etc.

I love non-pharma management of dementia. I hope my rant helped.

Midaz ������

I think most of this was covered throughout the thread."Redirection" is an accepted term,this is where the care plan comes in,the aides use them.Our aides now have static assignments and they get to know each resident very well.The nurses and aides on the unit work very hard to individualize each resident's care plan.Another tool we use if a resident appears to be having more frequent escalations is a behavior tracking program for several days.This will capture triggers.

[Natasha A., CNA, LVN]

I just starting working at a LTC and was recommended to learn validation therapy