Upsetting Foley Insertion in a Confused Dementia Patient

[wernicke]

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Ever since, she has been a bit more withdrawn.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. 

[amoLucia]

I doubt that any different positioning would have made a difference.

It's all about the 'touching' there and the instrumentation entry that is the psychological feeling of violation.

Not much is going make a diff with dementia.

[wernicke, BSN, RN]

On 3/27/2021 at 4:08 PM, amoLucia said:

I doubt that any different positioning would have made a difference.

It's all about the 'touching' there and the instrumentation entry that is the psychological feeling of violation.

Not much is going make a diff with dementia.

Sadly this was correct. 

The same patient has a wound vac. I did a dressing change for her today, found that she was soiled so cleaned her up. When she was on her side, and I was wiping her, she yelled out "no! no! no!" then whimpered "why John why" [name has been changed] before repeating the exact same phrase of " "I'm a good girl! Why? What's going to happen to me now?" 

Other staff say she's said this name before during peri care. It is not the name of anyone in her family that we know of. 

One staff person said that she was once sitting and rocking, saying "it's my fault I sinned I was alone with a boy". 

The idea that she is reliving her sexual assault every time we clean her or care for her makes me sick to my stomach. Given her age, and the age she seems to revert back to during these episodes, it seems she's been living with this for over sixty years, probably closer to seventy. She had a successful life beyond this, and seemed happy. But the whole time this trauma was there. Utterly heartbreaking. 

[Hannahbanana, BSN, MSN]

On 3/28/2021 at 10:00 PM, wernicke said:

The idea that she is reliving her sexual assault every time we clean her or care for her makes me sick to my stomach. Given her age, and the age she seems to revert back to during these episodes, it seems she's been living with this for over sixty years, probably closer to seventy. She had a successful life beyond this, and seemed happy. But the whole time this trauma was there. Utterly heartbreaking. 

It’s not just the old ladies. I was helping to disimpact and clean up an old man once and we heard him saying, “Tom, stop it, stop it, no, Tom, don’t do that.”