tips for dealing with dementia

KlareRN · Jul 12, 2002

ktwlpn-

You are the kind of nurse most of us would like to clone to work on our dementia units. Too many are too quick to pop a pill than to take the time to be human. I agree that if a person doesn't want to be in bed at 10pm; let them be up. In fact- get them a snack and help them find something on the television or a magazine to look at. Better yet- put down the magazine you are looking at and have a conversation with them. No- they may not understand the meaning of the conversation and they may not remember it even took place; but for that short period of time you are validating their value as a person. Too many times these folks are people who may have worked 3rd shift- or never got up before 10am...then they become confused and we force what we think is right for them and tell them what to wear, what and when to eat, when to bathe. when to go to bed or when to get up, not wearing a nightgown to breakfast, etc....

It takes a special person to be able to work on secured units. I believe it is the most challenging area in any facility. The behaviors can escalate quickly and the repetiveness of the daily routine can be draining. Unfortunately it sounds like you work with a difficult bunch that may need to work in another area. Telling a confused resident that their mother is dead is not only cruel- but can be verbal abuse if it causes any anguish or mental distress to the resident (even for a minute).

We are also careful about our choice of words for that same reason. Our babies wear bibs- our residents wear "clothing protectors"...our babies wear diapers- our residents wear "incontinent briefs" etc...

Your local alzheimers association may be able to supply you with some teaching materials or at least point you in the right direction. Good luck to you- I hope you can continue to make a positive difference in the lives of the ones you care for...

KlareRN

Tookie · Jul 12, 2002

I use a really good local site for both inforamtion and as a useful resource for students - this is excellent - they have a lot of 'help sheets - particularly for people just learning about the disease

please let me know if this is of any use

For dementia

http://www.alzvic.asn.au

then go to the helpful information and to help sheet s- they have loads of handouts and many different subjetc s- l have made up a folder from this

If the website isnt OK (I am not sure how to refer websites onto people - type in Alzhiemers Association Victoria Australia

Hope this helps - this is so important - keep up your good thoughts and actions - l want to be looked after by people like you if l ever get into this situation myself - l wish every nurse/thought your way

Hang in there

Tookie

nakitamoon · Jul 12, 2002

ktwlpn,,,,, you can come work with me anytime,,,,

I agree 100% with you and Klare RN,,,,,, Staff coming to me all the time,,,, fix this ,,,,,, I remind them,,,, this is why the have thier job,,,,, use you imagination and compasion,,,,,

Also think it does me good to enter the pt's world for few moments,,,, forget about reality,,,, does both the pt and I good,,, Moon

adrienurse, LPN · Jul 13, 2002

Contary to what people think, psychogeriatrics is a very challenging field to work in and is NOT for everyone. I suspect the nurses you are discribing lack the temperament as well as the insight needed to properly care for these people. It is just unrealistic to expect these people to be quiet and do as they are told -- It's just not gonna happen, the comprehension is just not there! The sooner they "get it" the better off everyone will be. Please continue to set an example for all of us.

night owl · Jul 14, 2002

This is a great thread! I too often wondered "what's all the fuss about?" When some one refuses their meds, or refuses to go back to bed, (I work nights). If they want to be up so what? I will be that person someday...Give them a snack, sit and converse with them, walk with them, let them watch TV or read. Some make such a fuss..."Get back to bed, you don't belong up at this hour!", which sometimes angers them and then the battle begins...I always intervene and say, "Let him go, he's alright" As long as he's not trying to leave the building, it's ok for him to be OOB. Alzheimer pts do alot of walking day or night as long as they're not hurting anyone or themselves, let them walk.

I try to set the example and hope that other staff members will pick up on it, but it doesn't always sink in. The thing is, they were taught these things in their orientation classes...I think it all boils down to having alot of patience when working with the demented patient. Too many short fussed people want a quick fix so they don't have to deal with them for too long. Lack of patience in this type of setting ultimately leads to patient abuse. If they don't have the patience, they shouldn't be working with the demented...simple. Maybe when hiring employees for an Alzheimer's unit they should give them some kind of a test to see how much patience they really have. If they fail, they don't get hired...It just might save someone from from being abused.

skl0923 · Jul 14, 2002

Let's all hope that we have the patience also to remember some of the following:

Is this new behavior for this resident.

Have the medical needs been addressed, (UTI, URI)

meds reviewed, et cetera?

Has this nurse been working too many hours

Does she have a new patient load?

How many residents is she trying to "supervise".

How many staff is she supervising.

Is administration addressing the nurses needs?

We sometimes forget that nurses are human, and once in awhile they also are short of patience.

Just had to address all this myself. Worked in long term care past 5 years, and I love it, and my patients. I was short with a resident last week and reported, out of context...alzheimer patient that cannot walk attempting to get out of bed, even after medication per hospice protocol...CNA's nowhere around, patient thinks I am her daughter...doesn't stop talking while you are trying to get her to lay down, husband insists she is in bed...et cetera.

New administration..now have 30 residents on days and evenings. I have been telling DON that it is too much, cannot take extra time to sit with resident to calm them down, usually do not take more than three 5 minute breaks, sit and eat while charting.

have to spend 1hr to 1.5 hr twice a day in dining room and pass meds to 30 residents, on dayshift. Spend precious minutes trying to find staff to address residents needs. Phone rings all the time.

Nursing supervisors position eliminated, desk clerk position eliminated. We have to now do total care for 30 residents.

Went to HR to see what would happen, if I reassigned while on workers comp? Injured tailbone was told no light duty for Nurses..behind on monthly paperwork for past two months. On the verge of nervous breakdown, broke down in HR.....can't work like this any longer.

Scared to death state survey will walk in....!

Been working 13 shifts every two weeks for over a year.

Did not get vacation last year just too short of staff.

New Staff Development Coordinator trying to get caught up on CEU for survey/HCFA...pulls us off the floor for 45 minute in service one whole week...refused to go to last two, just can't get med pass done in time if I do.

Ready to give it all up..............just can't cope with this any longer

Do not want to be this kind of Nurse..short of time and patience, have to be aware of every minute to get things done, no time to do treatments, monthly summaries, care plans, admission assessments and paperwork, too many things being missed!

Phone doctors, fax doctors, transcribe orders and labs and whatever else comes up, dietraty orders, pt/ot orders and their asking me to look at resident because they are doing this or that.

Dealing with family inquiries, other nurses demanding I do this or that, usually their admission paperwork.

Can't imagine why I thought I could give good patient care!:imbar

Sorry...but you touched my button, and yes I have 5 days off and am using it to assess myself. May need to look elsewhere for work. Checking it out!

adrienurse, LPN · Jul 14, 2002

Sounds like a hellish experience. It's these kind of expectations that ruin geriatric nursing for everyone. Administration needs a really good reality check. It's under these conditions that nurses get burnt, disasters with patients happen (newspapers just love to report these), staff members get physically hurt and the facility fires scapegoats -- not necessarily in that order. Are there any other options of employment for you. Psychogeriatrics can work! Only took me 4 years and 3 jobs for me to realize this. I really have a good job now -- so they do exist.:kiss

ktwlpn, LPN · Jul 14, 2002

Originally posted by skl0923
Let's all hope that we have the patience also to remember some of the following:
Is this new behavior for this resident.
Have the medical needs been addressed, (UTI, URI)
meds reviewed, et cetera?

Has this nurse been working too many hours
Does she have a new patient load?
How many residents is she trying to "supervise".
How many staff is she supervising.
Is administration addressing the nurses needs?
We sometimes forget that nurses are human, and once in awhile they also are short of patience.

Just had to address all this myself. Worked in long term care past 5 years, and I love it, and my patients. I was short with a resident last week and reported, out of context...alzheimer patient that cannot walk attempting to get out of bed, even after medication per hospice protocol...CNA's nowhere around, patient thinks I am her daughter...doesn't stop talking while you are trying to get her to lay down, husband insists she is in bed...et cetera.
New administration..now have 30 residents on days and evenings. I have been telling DON that it is too much, cannot take extra time to sit with resident to calm them down, usually do not take more than three 5 minute breaks, sit and eat while charting.
have to spend 1hr to 1.5 hr twice a day in dining room and pass meds to 30 residents, on dayshift. Spend precious minutes trying to find staff to address residents needs. Phone rings all the time.
Nursing supervisors position eliminated, desk clerk position eliminated. We have to now do total care for 30 residents.
DON stated just last week "I can't understand why these nurses can't get all the paperwork done. If they would just shut up and quit complaining they could use that time to work"
I asked her Friday when she wrote me up, this "Can you take the cart and let me follow you to see if I can learn what I am doing wrong?"
When I left that day went to HR to see what would happen, if I reassigned while on workers comp? Injured tailbone a week ago, when new chair dumped me on the floor. She also told me there is no light duty for Nurses..even though we are behind monthly summaries (54) for past two months. On the verge of nervous breakdown, broke down in HR.....can't work like this any longer.
Scared to death state survey will walk in....she has me off 5 days, and then on a straight 8, with weekend supervisor duties (12 hrs)
next weekend! This is light duty.
Been working 13 shifts every two weeks for over a year.
Did not get vacation last year just too short of staff.
New Staff Development Coordinator trying to get caught up on CEU for survey/HCFA...pulls us off the floor for 45 minute in service one whole week...refused to go to last two, just can't get med pass done in time if I do.
Ready to give it all up..............just can't cope with this any longer
Do not want to be this kind of Nurse..short of time and patience, have to be aware of every minute to get things done, no time to do treatments, monthly summaries, care plans, admission assessments and paperwork, too many things being missed!
Phone doctors, fax doctors, transcribe orders and labs and whatever else comes up, dietraty orders, pt/ot orders and their asking me to look at resident because they are doing this or that.
Dealing with family inquiries, other nurses demanding I do this or that, usually their admission paperwork.
Can't imagine why I thought I could give good patient care!:imbar
Sorry...but you touched my button, and yes I have 5 days off and am using it to assess myself. May need to look elsewhere for work. Checking it out!

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>I had to double check your location-sounds like the l.t.c. I left last fall...Don't sacrifice YOUR HEALTH AND CAREER for this place....I am so happy that I left...I am now at a county run facility-we are the best staffed facility in the area and the bottom line is salary and benefits.We have some of the same b*llsh*t as any other place but the money and bennies are quite attractive and we do have the staffing.When I leave at the end of the shift I KNOW that my residents were well cared for by the aides and that I actually had the time to check out each and every one of them myself...We do have bad days but usually I have time to for some interaction with individuals and it's great...I am on a 40 bed unit-never less then 2 nurses and usually 3-a unit clerk Mon through Fri-usually 6 aides and often 7-and now and then even 8! Get out as soon as you can before you are so burned out that you HATE nursing....And learn to say NO!-don't let anyone guilt you and don't make your self a martyr.....

jschut, BSN, RN · Jul 15, 2002

I agree soooooo much with you ktwlpn!

Why do we have to do a "reality check" on folks who are no longer with reality and won't ever be again? Why can't we hold their hands and talk to them "in the past" where they are?

Wish there were more like you in charge of dementia units everywhere....really I do......

God bless you

Julie :)

adrienurse, LPN · Jul 16, 2002

Reality orientation is never a good idea for people with dementia. It leads to anger, frustration and more confusion. It is better just to validate their feelings, their questions and just let them keep looking for whatever they are looking for. Redirect prn when you see agitation is building. Try to engage them in a task, change the subject etc. Gets easier with practice.

Good luck!

skl0923 · Jul 16, 2002

went back and edited some of my post

d/t another post here about someone being reported to their facility................that would do it for sure!

:eek:

Go back to work tomorrow. We'll see what reception I get:confused:

REally need to find outlet to vent, I guess..not recreational!

If you know what I mean.