I started my first clinical for nursing assistant class yesterday. I was assigned a gentleman with dementia. he is fiercely independent, has only been in the nursing home for 2 weeks, so the flow sheets/care plan are not in the book yet.
He refused any help at all with anything.
I am trying to research some more info on dementia than what my class provided. Any tips or tricks from experienced CNA's would be greatly appreciated!!
He was quite confused at bedtime, and said he was going home, trying to pack up his walker with all his belongings, he refused HS care, stating he would do it tomorrow when he got home. he was getting quite agitated. Even the employee CNA offered to help me, but still to no avail, he was quite stubborn in not wanting any help. Eventually the LPN said she would give him something to settle him down and they would do the HS care later.
I started my first clinical for nursing assistant class yesterday. I was assigned a gentleman with dementia. he is fiercely independent, has only been in the nursing home for 2 weeks, so the flow sheets/care plan are not in the book yet.
In all honesty, I'm surprised that there hasn't been a care plan or even flow sheets written up for someone who has been there for two weeks. LTC is busier than most people think but, from at least this RN's perspective, some sort of rudimentary care plan should be done, even if it is not individualized but is based on standard protocols in that facility.
I think the folks who have given you responses already have given you some great advice, especially on how to protect yourself when a resident becomes (or could become) violent by leaving the room or having someone accompany you. A few other suggestions passed along to me by a couple of experienced, wise CNAs (but please check with your instructor on these first...)
Lavender oil---just a few drops on a pillowcase or cotton ball---might help decrease anxiety and agitation enough so that you can do cares and/or the resident is able to get some rest.
Hand massage---the skin to skin contact and soothing smell and sensation of the lotion can help reduce anxiety and agitation (but if the resident does not want a hand massage or does not seem to want physical contact, back off.)
Soothing music---can also decrease agitation. Just make sure that the music is not too loud or too stimulating (Lady GaGa is probably not appropriate...) I noticed when I worked LTC that some people did indeed get a bit more agitated if rock music was on in the background---and I hated it whenever the residents watched war coverage or disaster coverage on the news. The loudness of the news, any background footage of shooting or people crying or shouting definitely made people more agitated.
Don't rush through your cares. Often that's hard to do when you have other residents who need you but if you rush and are at all harsh with the resident, it only increases the chances that the person will become more agitated (and you could get hurt.) Studies indicate that bathing is often associated with agitation so be aware of that when you bathe or do AM (or even PM) cares on someone.
Don't engage in baby talk with the residents. Just read a study in which researchers found that baby talk can lead to resistance to cares and, most likely, agitation. Be kind, respectful, and don't talk to a resident the same way you might talk to a child, puppy, or kitten. Speak in normal, conversational tones and make sure that your voice does not relay any anxiety that you might feel.
Lastly, make sure you report signs of aggression and agitation to your nurse. If there is ANYTHING unusual about someone's behavior--and you will get a better sense of this when you have a bit of experience----tell the nurse. The nurse can and should document the intensity, frequency, and other characteristics of the behavior so that it is in the record for others to see. Additionally, if the nurse ends up giving the resident a PRN (as needed) sedative, it is important that he/she document the type of behavior that led to his/her decision. State surveyors do look at the use of sedatives, antipsychotics and other medications and it is important that the nurse document WHY he/she is giving a medication and what the resident's response to that medication might be. You are, in many ways, the eyes and ears of the nurse so it is important for you to be aware of any changes in behavior and to communicate with the nurse.
Hope this helps! Best of luck to you as you complete your training!
Moogie
1 Article; 1,796 Posts
In all honesty, I'm surprised that there hasn't been a care plan or even flow sheets written up for someone who has been there for two weeks. LTC is busier than most people think but, from at least this RN's perspective, some sort of rudimentary care plan should be done, even if it is not individualized but is based on standard protocols in that facility.
I think the folks who have given you responses already have given you some great advice, especially on how to protect yourself when a resident becomes (or could become) violent by leaving the room or having someone accompany you. A few other suggestions passed along to me by a couple of experienced, wise CNAs (but please check with your instructor on these first...)
Lavender oil---just a few drops on a pillowcase or cotton ball---might help decrease anxiety and agitation enough so that you can do cares and/or the resident is able to get some rest.
Hand massage---the skin to skin contact and soothing smell and sensation of the lotion can help reduce anxiety and agitation (but if the resident does not want a hand massage or does not seem to want physical contact, back off.)
Soothing music---can also decrease agitation. Just make sure that the music is not too loud or too stimulating (Lady GaGa is probably not appropriate...) I noticed when I worked LTC that some people did indeed get a bit more agitated if rock music was on in the background---and I hated it whenever the residents watched war coverage or disaster coverage on the news. The loudness of the news, any background footage of shooting or people crying or shouting definitely made people more agitated.
Don't rush through your cares. Often that's hard to do when you have other residents who need you but if you rush and are at all harsh with the resident, it only increases the chances that the person will become more agitated (and you could get hurt.) Studies indicate that bathing is often associated with agitation so be aware of that when you bathe or do AM (or even PM) cares on someone.
Don't engage in baby talk with the residents. Just read a study in which researchers found that baby talk can lead to resistance to cares and, most likely, agitation. Be kind, respectful, and don't talk to a resident the same way you might talk to a child, puppy, or kitten. Speak in normal, conversational tones and make sure that your voice does not relay any anxiety that you might feel.
Lastly, make sure you report signs of aggression and agitation to your nurse. If there is ANYTHING unusual about someone's behavior--and you will get a better sense of this when you have a bit of experience----tell the nurse. The nurse can and should document the intensity, frequency, and other characteristics of the behavior so that it is in the record for others to see. Additionally, if the nurse ends up giving the resident a PRN (as needed) sedative, it is important that he/she document the type of behavior that led to his/her decision. State surveyors do look at the use of sedatives, antipsychotics and other medications and it is important that the nurse document WHY he/she is giving a medication and what the resident's response to that medication might be. You are, in many ways, the eyes and ears of the nurse so it is important for you to be aware of any changes in behavior and to communicate with the nurse.
Hope this helps! Best of luck to you as you complete your training!