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  1. HangInThere

    Who is in Charge Here?

    "Who is in charge here?" said Mr. D, a 67-year-old retired police sergeant with dementia. "Mr. D., I'm the Charge Nurse tonight," I said. "What's your concern?" "No! Who is the manager of this institution? I wish to make a formal complaint," said Mr. D. "The manager's name is Ms. G.," I said. "This place is run like a madhouse!" he shouts. "I don't know when my blood will be taken and I don't know when my medication is coming!" His voice deepened and he fixed his stance. "They took my phone, and my mother is worried about me, and how can I call my mother? They took my damn belt, and my pants are falling down!" "Okay, let's take one thing at a time," I said. "You took my phone! Who has my phone? Where's my phone?" he said as he glared at me. "That, oh Charge Nurse, is against the law!" Just then, my colleague Nurse Maria approached us. She stood about 8 feet to the side of Mr. D. She said, "Mr. D., do you have your mother's phone number?" Still staring at me, Mr. D answered, "I have it in my mind." "Let me write it down for you," Nurse Maria offered. "It's 3:30 a.m. You're in the hospital, and everyone is sleeping. In the morning after breakfast, the phone is turned on. I can help you make the call. Let me write that number down." Mr. D nodded while still glaring at me, and said the telephone number. She wrote it down and said, "Now you can rest, Mr. D., because you will call her in the morning. Remember, Juliana and I will help you make the call." Mr. D. did not break eye contact with me but also nodded. Nurse Maria said, "Now, it's a good idea to go back to bed." Mr. D. nodded and turned toward his room. What happened? As the interaction escalated between the patient and me, a more experienced nurse interpreted the emotional nature of Mr. D.'s demands and acted as a third party to diffuse the situation. Veselinova (2014) writes, "An individual with dementia may be sensitive to the tone of voice and may feel intimidated or frustrated by extreme levels of speech and tone" (p. 164). Nurse Maria introduced a calm, measured verbal redirection that was fluent with Mr. D.'s actual need for emotional support. Nurses who adapt the way they communicate can encourage increased communication with individuals with dementia (Veselinova, 2014). Through the night, to build the rapport initiated by Nurse Maria, I returned to Mr. D. to address his needs. He told me he could not sleep, so I offered to set up a recliner near the TV in a quiet corner of the unit. Once his feet were up with a pillow behind his head, he said, "This is fine." Later on, when he said, "I'm tired of this," I walked him to the dining room for a change of scene. The next night at 4:00 a.m., I asked if he would like to play cards to pass the time. He replied, "Black Jack." We played until 5:00 a.m., and that's when he began to tell me about his memories, his family life, and his police work. The interactions with Mr. D showed me that once a patient has at least one of his needs met, he feels heard and understood. Nurse Maria's keenly placed offer to redirect the patient initiated a workable relationship between a patient with dementia and me. Not only did this diffuse a situation that might have escalated, but it also opened a door to a trusting relationship between Mr. D. and me. The next night, Mr. D actually slept a few hours and at 4:00 a.m., he asked me to play Black Jack with him again. When your patients angrily confront you, what do you do? Reference Veselinova, C. (2014). Influencing communication and interaction in dementia. Nursing and Residential Care 16(3), 162-166. Retrieved from http://www.magonlinelibrary.com/toc/nrec/current