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1st Day at Memory Care ALF

Posted

I just passed my state exam a month ago and am finally working as a CNA. So this is my first job as a CNA ever, and I will be at an assisted living facility that specializes in memory care.

I had 4 days of orientation. Day 1 was about 8 hours of paperwork and a tour of the facility. Days 2-4 consisted of me shadowing and assisting the CNAs on the floor--like it was for clinicals. Everything went smoothly. I love the residents, I have no aversion to BM or voiding, and I am the most patient, easy going person you will ever meet. But on my last day of orientation, two residents had really bad tantrums for no reason at all. It broke my heart, and I felt helpless. I am still waiting for my facility to get me scheduled to take a Mental Health and Dementia class, so I wasn't sure how to calm them. And at that moment, the CNA I was shadowing had left me to grab something while I had to keep an eye on the fall-risk residents. I was so at a loss.. So it was disheartening that this was how my last shift ended.

And now.. Today, I am on my own. And I am so dreadfully nervous. Any words of advice or encouragement?

Thanks in advance

duskyjewel

Specializes in hospice.

Dementia patients often act out in ways that seem unrelated to what they need help with, because they may not understand what is wrong or be able to communicate it.

Start with the basics, because usually it's one of these: hunger/thirst, need for bathroom, hot/cold, or boredom. Yes boredom! Memory impaired doesn't equal stupid and they still need mental stimulation.

When a resident gets very upset, speak to them QUIETLY. Don't try to outshout them. Get right in front where they can see you, and then say their name. Hopefully it will only take a couple tries, because they will know you're talking to them and might calm down of curiosity. If that works, then you can ask questions. However, questions might agitate them again if they don't know how to answer. Maybe offer to go for a walk with them, and let them take your arm. As you walk by a bathroom, point it out and say, "Hey, maybe it would be a good idea to stop in here." And they will probably comply. Plus, they just got a little exercise walking around with you. You can use the same strategy for offering snacks and drinks. If you have a kitchen area, as you're walking you can say, "Hey, we have some juice and cookies (or whatever is there) in here. Want some?" Another good thing about letting them take your arm while walking is that you can feel if they seem hotter or colder than normal.

If speaking quietly doesn't help you get their attention, music might. Learn some songs they might have learned as children, like " Daisy" or "Meet Me in St. Louis" etc. If you start singing it's almost guaranteed to get their attention, and they may even join in. Then you've defused the tantrum and can try the strategy I mentioned above.

Activities to alleviate boredom can be as simple as bringing a stack of washcloths and saying, hey can you help me fold these? With some people they will do that for hours! Does your unit run activities for the residents and offer things like art and craft supplies, building toys, and physical activities like dancing? Because those are needed to help release energy and banish boredom.

Also, don't forget the importance of soothing touch, of which these people often get very little. Holding hands, patting shoulders, rubbing backs, even hugs if the resident wants one. Brushing hair can be soothing for some people too.

And let them tell you their stories. They usually are so happy to tell them, and you will be amazed by some of what you hear! :)

Anyway, sorry for the book. Hope it's helpful. My employer offers pretty good dementia training, so I thought I'd pass some along.

Most important, please ALWAYS remember their humanity and treat them like you'd want grandma treated.

Missingyou, CNA

Specializes in Long term care. Has 20 years experience.

Sometimes it's just a matter of knowing your residents. What works and what doesn't.

In the meantime, depending on what it is, and you may never know what the trigger was that caused the "outburst", sometimes it's a matter of listening to them and reassuring them. Sometimes it's just leaving them be, because there is too much stimulation in that moment. Your talking, the radio on, others in the background, lights etc can all be just too much for some people.

They can be fearful of a new face/new employee. You are a stranger to them and now you have to undress them!!!!! If you were in their shoes, wouldn't that make you defensive?

There is also "sundowners" with dementia patients that often occurrs in the late afternoon hours. Do a google search with some tips on how to handle that.

SeattleJess

Specializes in None yet..

Dementia patients often act out in ways that seem unrelated to what they need help with, because they may not understand what is wrong or be able to communicate it.

Start with the basics, because usually it's one of these: hunger/thirst, need for bathroom, hot/cold, or boredom. Yes boredom! Memory impaired doesn't equal stupid and they still need mental stimulation.

When a resident gets very upset, speak to them QUIETLY. Don't try to outshout them. Get right in front where they can see you, and then say their name. Hopefully it will only take a couple tries, because they will know you're talking to them and might calm down of curiosity. If that works, then you can ask questions. However, questions might agitate them again if they don't know how to answer. Maybe offer to go for a walk with them, and let them take your arm. As you walk by a bathroom, point it out and say, "Hey, maybe it would be a good idea to stop in here." And they will probably comply. Plus, they just got a little exercise walking around with you. You can use the same strategy for offering snacks and drinks. If you have a kitchen area, as you're walking you can say, "Hey, we have some juice and cookies (or whatever is there) in here. Want some?" Another good thing about letting them take your arm while walking is that you can feel if they seem hotter or colder than normal.

If speaking quietly doesn't help you get their attention, music might. Learn some songs they might have learned as children, like " Daisy" or "Meet Me in St. Louis" etc. If you start singing it's almost guaranteed to get their attention, and they may even join in. Then you've defused the tantrum and can try the strategy I mentioned above.

Activities to alleviate boredom can be as simple as bringing a stack of washcloths and saying, hey can you help me fold these? With some people they will do that for hours! Does your unit run activities for the residents and offer things like art and craft supplies, building toys, and physical activities like dancing? Because those are needed to help release energy and banish boredom.

Also, don't forget the importance of soothing touch, of which these people often get very little. Holding hands, patting shoulders, rubbing backs, even hugs if the resident wants one. Brushing hair can be soothing for some people too.

And let them tell you their stories. They usually are so happy to tell them, and you will be amazed by some of what you hear! :)

Anyway, sorry for the book. Hope it's helpful. My employer offers pretty good dementia training, so I thought I'd pass some along.

Most important, please ALWAYS remember their humanity and treat them like you'd want grandma treated.

This is a GREAT "book," DuskyJewel. It could be an article all on its own. Thanks for taking the time to share excellent tips.

Getting in front where to resident can see you, looking into his/her eyes and smiling at him/her as if that person were your first love also helps. (Actually remember that "first love" or darling child or whoever gets your heart glowing so you can channel that feeling.) Dementia patients are still firing on all cylinders when it comes to the basic emotional part of being human, even though the "executive function" may be diminished or gone.

Thank you! I so very much appreciate the support and advice. This forum continues to amaze me with its kindness.

My first day on the floor solo went surprisingly well, thanks to all of you. :) The residents definitely love the reassuring back rubs and gentle hand squeezes. I also tried linen folding, sweeping, and asking them to help with setting up and cleaning up the dining room tables, which helped since the Activities Coordinator and volunteers leave around 4:00, and there are generally no more activities for the more active/ambulatory residents in the evening. I feel bad that there aren't more of us CNAs in the evenings, or else I would gladly host a bingo night, but the residents do like being helpful, and there is almost always laundry to be done. I experienced them get frustrated with me because they couldn't hear me, so speaking face-to-face, slowly and clearly helped, especially with hand gestures. I have also found that leaving them alone is sometimes the only thing you can do, and just to check back later.

I think the most difficult thing I have encountered during orientation and my first day alone was trying to help a resident change clothes when they didn't want to. Some void through their pants or they just get food all over their clothes, but they insist on wanting to sleep in them. I want to respect their wishes, but at the same time, it feels like I'm neglecting them if I allow them to stay in those same clothes. What should I do? What is it that you guys do?

Thanks again!

If you have given your best efforts in trying to have them change and they still refuse just document it in charting that you tried to have Mrs. Jones change into a clean nightgown but she refuses. If you chart the refusel of care then I believe you have nothing to worry about being accused of neglect.

Maybe just like when we offer them choices for what they wear for the day you can try to see if you can give them a choice in what they wear at night. Also maybe what they are wearing is one of their favorite and comfortable clothes and maybe they are afraid that it might get lost. Try to reasure them they will get it back as soon as it is fresh and clean again if they wear something else tonight

Missingyou, CNA

Specializes in Long term care. Has 20 years experience.

This may not work with everyone but, I take care of a woman who firmly refuses to be changed. She offers no reason for the refusal but I suspect she is afraid of being hurt during the process or her clothes being lost. She has dementia and is total care.

I tell her every single time I change her that I promise to take good care of her and I will be gentle. I tell her I have a BRAND NEW night gown her kids brought her and it's beautiful!! (even if it isn't "new" she loves the idea of putting something brand new on). It works every single time.

I fuss and tell her how nice her hair looks and just gush out the compliments and she loves the attention. She also dislikes being "dirty" and is agreeable when I tell her I will wash it myself to make sure it gets back. By the time I leave the room, she's forgotten about it. It works for her. Sometimes a little harmless white lie is what you need to do if it works with someone....again, you MUST know your residents! or it could back fire.