Upsetting Foley Insertion in a Confused Dementia Patient

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Specializes in Oncology.

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I had an elderly female patient with advanced dementia who required a Foley Cath. Her family very much wanted it done, and before her disease progressed, she herself wanted everything done for her as well. Her survival was at risk without the catheter. 

Myself, another nurse, and an aide all helped as she is not mobile, has a rigid muscle tone, and is heavyset. 

She became terribly upset. At first she began yelling "no! no! no!" then began crying, saying "Why? Why? Why?", "I'm a good girl! Why? What's going to happen to me now?", "I'm ruined", etc. 

By her words and demeanor, I think she was perceiving this event as a sexual assault. I tried explaining what was happening as we were working but with her stage of dementia I do not think she was able to understand. I did explain in simple terms on a loop as she got upset (p sure my colleague thought I was nuts but I always do that just in case they somehow understand. It does work sometimes). 

Ever since, she has been a bit more withdrawn. I do not think she remembers the event but I do think it impacted her a bit mentally. 

Is this inevitable? I have had stuff like this happen before but it was never as visceral or as bad as this. There is no known sexual assault history but given her generation and devout Catholicism (I grew up Catholic myself) alongside tendencies of survivors to feel unjustly ashamed, I do not know if she would have told anyone if she had been. 

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Oh, that's so sad. I don't have any words of wisdom, but I just wanted to say I'm sorry for both you and the patient. It sounds like a lose-lose situation. 

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Specializes in Psych (25 years), Medical (15 years).

This was a difficult situation and I empathise with both you and your patient, Wernicke.

1 hour ago, wernicke said:

 Her survival was at risk without the catheter.

As was her future comfort, for a distended bladder is horribly painful.

1 hour ago, wernicke said:

I do not think she remembers the event but I do think it impacted her a bit mentally. 

It's odd what those with advanced dementia will and won't remember, on some level. I too have seen behavioral changes in geriatric psych patients diagnosed with dementia after a relatively traumatic event.

Wernicke, it is an emotionally painful experience to need to inflict pain for the greater good, but it is what it is. Try to take comfort in the facts that you did your duty to the best of your ability, felt empathy, and did everything you could to make the situation less traumatic for the patient.

Take care.

 

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Specializes in retired LTC.

OMG!

Word for word, some 20 or so years ago, I had the same experience like you trying to cath an elderly demented LOL. Midway the cath, she unexpectedly started violently reacting. I was halfway thru; I just finished the cath as fast as poss, even as I was trying to explain things. I had 2 CNAs helping me and they were trying to calm things with me.

An odd thing, I too, believe her behavior was different afterwards. How could I measure that ---- it was just my gut telling me. But I knew it to be true.

I truly do believe that that lady believed that I was assaulting her. I NEVER WANT TO EVER EVER EVER EXPERIENCE CAUSING SUCH A TRAUMATIC PROCEDURE AGAIN. I swore I would never again continue if a situation spiraled out of control like it did that shift. I've cath'd a gazillion pts - this one started out as innocuous as any other. But something went awry. I think I remember being very shook up after. I even talked with the UM in the morning. I tried my best for the situation.

I've been recently hosp, and I required a foley. As I was being cath'd, I remembered that lady. Her trauma has stayed with me all this time.

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Kudos to you for successfully placing the foley. Nobody knows what the patient remembers. Consider backing off and administering a mild sedative .. before the procedure.

 

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Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

I had a 90s woman who was brought up by the nuns, lived c her beloved Papa and Mama til they died, married late in life, never had kids, and was widowed. I was arranging home supports for her and checking in from time time, but after a few years it became clear that she was failing mentally and needed to be in a more structured care setting. 
I went to see her there when she was nearing the end; her nurse was getting ready to change her, so I helped. As I held her over and her nurse was washing her somewhat excoriated bottom, I started hearing what she was saying. “No, Father, no, no, please stop it, Father, no, it hurts, no, Father, no...” The nurse and I just stopped and stared at each other. It brings tears to my eyes even now. 
We got her settled and went out in the hall. And agreed that we hoped that particular priest was burning in hell that very minute. 
It never goes away. 

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Specializes in retired LTC.

Hannah - I got chills reading your post. I initially thought her paternal Dad, but then you commented a religious.

Regardless, something happened to your pt some time ago.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

So sorry you had this experience. We had a similar event in our ICU a few weeks ago. The patient was so violently upset by the experience that a few of us actually tried to stop the nurse doing the insertion. Her screams sounded more terrified than I have ever heard in a patient and we could only figure that maybe she had a past trauma event that caused her reaction. The rest of us were silent while she screamed and for the whole rest of the night the staff lacked any of our usual banter and joking. It was upsetting. Fortunately, later the next afternoon when I came back, the patient appeared to be back to her baseline mentation and interactions with staff. Hoping you find the same with your patient. You did what you had to do, not that it makes it any easier. 

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Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

She told me many stories about her Papa, never called him “my father” or Father. Gave me chills too. Poor little girl... 

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Specializes in Oncology.
On 3/25/2021 at 3:27 PM, JBMmom said:

So sorry you had this experience. We had a similar event in our ICU a few weeks ago. The patient was so violently upset by the experience that a few of us actually tried to stop the nurse doing the insertion. Her screams sounded more terrified than I have ever heard in a patient and we could only figure that maybe she had a past trauma event that caused her reaction. The rest of us were silent while she screamed and for the whole rest of the night the staff lacked any of our usual banter and joking. It was upsetting. Fortunately, later the next afternoon when I came back, the patient appeared to be back to her baseline mentation and interactions with staff. Hoping you find the same with your patient. You did what you had to do, not that it makes it any easier. 

Thank you all!

 

And this thankfully happened. After three days off, I came back to her back to her baseline. She is a lot more "there" than given credit for-she has dementia that's quite advanced and cannot really communicate (lots of word salads) but she understands things. At one point today during wound care, she grabbed and held my hand which felt great honestly. 

It still haunts me honestly because she definitely experienced the insertion as a sexual assault I think. Other staff suspect she has an undisclosed sexual assault history. Really, really sad stuff. 

On 3/24/2021 at 6:19 PM, Hannahbanana said:

I had a 90s woman who was brought up by the nuns, lived c her beloved Papa and Mama til they died, married late in life, never had kids, and was widowed. I was arranging home supports for her and checking in from time time, but after a few years it became clear that she was failing mentally and needed to be in a more structured care setting. 
I went to see her there when she was nearing the end; her nurse was getting ready to change her, so I helped. As I held her over and her nurse was washing her somewhat excoriated bottom, I started hearing what she was saying. “No, Father, no, no, please stop it, Father, no, it hurts, no, Father, no...” The nurse and I just stopped and stared at each other. It brings tears to my eyes even now. 
We got her settled and went out in the hall. And agreed that we hoped that particular priest was burning in hell that very minute. 
It never goes away. 

Oh wow...that brought tears to my eyes. That poor, poor lady. 

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Specializes in Psych, Addictions, SOL (Student of Life).

Your story remminds me of a time when I had to put in a foly on a LOL with dementia and we literally took three nurses and had to practically stand her on her head to get it done. She didn't seem terribly bothered by it and we were all suprised when the police showed up due to patient calling 911 from her room to report a rape! we assited the officers in being able to interview LOL and determin that no rape had occurred.

Hppy

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It is often easier to put the catheter in if the pt is lying on her side. 

Maybe the pt feels less exposed.

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