reorientation in dementia

[marjoriemac, LPN]

:wink2: Just a wee note to say how disgusted I was recently to hear a nurse in my facility tell a resident her husband 'flying in heaven'. The lady in question was not terribly confused but probably for her own comfort liked to convince herself that everynight her husband came to see her. We tended to go along with her and she got very animated telling us what her husband and her got up to! When this poor excuse for a nurse butt in, the lady was very upset and cried for ages. Why do people do this? I know from personal experience with my gran too, it can be very degrading and confusing to persistently correct which is why I am quite happy for her to think I am her brother or the cleaning lady or whatever. If their delusions bring them pleasure we should strive to become a part of their altered reality. Living in confused bliss vs living in confusing and degrading reality? It is amazing how many of my oldies think I was around in 1950!!!

[Cindy_A]

I remember when I was in LPN school, they told us to reorient the person. Then when I went to RN school, the idea had changed to just go along with them. That nurse sounds like she needs to be reoriented!

[mandana]

Newest information (which any of us who have dealt with this personally already knew) indicates that there is no point in reorienting and that going along with the flow is better for the patient. I know that you could find some published data on this if you'd like to present that to your coworker. Evidence based practice tends to convince people a little more than arguing! Sometimes.

Good luck.

Amanda

[rn/writer, RN]

There is an extensive thread on this very subject that was still active as of a couple weeks ago. Here is the link:

https://allnurses.com/forums/f22/pacify-orientate-alzheimers-176053.html?highlight=pacify

[lovingtheunloved, ASN, RN]

There is an extensive thread on this very subject that was still active as of a couple weeks ago. Here is the link:

https://allnurses.com/forums/f22/pacify-orientate-alzheimers-176053.html?highlight=pacify

Ooooh, that thread got pretty heated. Lots of very passionate geri nurses!

[txspadequeenRN, BSN, RN]

Yes, I had to put myself in time out.

Ooooh, that thread got pretty heated. Lots of very passionate geri nurses!

[justthefacts8]

As a new CNA that just tested with the Red Cross. We were taught to not play along with Dementia Residents, but to remind them of who was actually in the room and the real date. I personally found this to be harsh. However, that is what folks are learning!

I would just ask that during orientation for new employees in a field where Dementia is present, please inform the new staff not to re-orientate. Otherwise, new staff doing what they had just been taught and tested on, will inadvertenly harm patients and upset more informed staff.

Many thanks for the information!

[Finallydidit]

I think it depends on the Resident and the stage of the dementia. I have Ms. Ruth, 98yo has had illness many years. I have been her daughter, sister, neighbor, and best friend. At times she is 16 and in trouble with her father for being out with boys, other times she is 35 and just found out her father has died. We always tend to go along with whatever period of her life she is re-living.

Now Ms. Edna on the other hand is a recent admit, very early in her illness, and when she is "somewhere" else we tend to remind her that she is "here" with us, and the events that led up to her coming to stay with us, and the benefits etc. She usually snaps back into reality rather quickly, saying I don't know why I was thinking that, now of course this get her thinking that she is losing her mind and that in itself can be upsetting to her, but at this point we don't want her thinking that she is surrounded by strangers and to panic either.

So yeah, I think it totally depends on the Resident.

[debRN0417]

I would like to think that if I am severely demented that my caregivers will let me live in whatever place I am in...unless it is an unhappy place. Then I'm sure I'd appreciate a little "re-orientation" back to a happier time....

[rn/writer, RN]

Reorienting is for those who have delusions and hallucinations, not those who have advanced dementia. A key difference in those conditions is that, while delusions and hallucinations can be unpleasant, the patient/resident still has their mental faculties about them. Dementia, on the other hand, literally means a losing of (de-) the mind ("mentis" in Latin).

The outworking of this is that the delusional patient often has the capability to process the information being given to them about what's real and what isn't. The dementia patient (in the mid to later stages) no longer has the tools to process or to cope.

A dear older aunt who was once a business executive lost her husband about five years before she started the long downward slide of Alzheimer's disease. At first when she asked, "Where's Uncle Bert?" those around her gently reminded her that he had died. When they saw how fresh her anguish was each and every time, they started saying he was away for the day or had gone to the store. She was content with that. The main message was that he was okay and she didn't have to worry. Or grieve anew.

To insist on reorienting a person, even though doing so will upset them or cause them pain, is nothing short of emotional assault.

[NurseSuzann]

I go with the flow unless it is harmful or scary what the resident is thinking. I go with the flow and try to direct their thoughts somewhere else, don't tell them outright they're wrong. I love doing this because it tells me so much more about the patient and their life. I say use your judgement and experience. Maybe this nurse was having a bad day and forgot in her frustration etc. that that may upset the patient or be inappropriate for her particular care.