Nurses in all specialties and areas will, at some point, work with patients who have Alzheimer’s disease or dementia. Because the disease impacts each person in a different way, caring for patients can be challenging.
Cindy Keith, RN, BS, CDP, owner of M.I.N.D. in Memory Care, and author of Love, Laughter, & Mayhem – Caregiver Survival Manual for Living with a Person with Dementia, offered some tips for nurses who work with patients and families about how to find effective ways to care for those with Alzheimer’s disease or dementia.
Families often find out how their loved one responds best through trial and error. The music that may soothe one person may trigger agitation in another. A soft wrap that one person finds comforting may feel confining to another. Sometimes what worked last week won’t work this week with the same patient.
But nurses who haven’t worked with that person before won’t have the same knowledge or insights as a family member might. Keith suggests nurses begin by meeting the patient where they are.
“First and foremost, they live in an alternate reality, and it does more harm than good to try to orient them to the current reality,” she said. “You must get into their reality and work with them on that level.”
What does that mean for a typical interaction?
Keith suggests that when a patient with Alzheimer’s disease repeatedly calls for a loved one, a nurse can ask about that person in a calm manner to redirect the conversation. Sometimes that will help, but not always. If redirecting doesn’t work, Keith suggests a different approach for nurses.
“Say something like ‘Your wife has told us she is on her way and will be here in an hour or so. She asked that we remind you that she loves you and is on her way,'” she said.
This kind of “therapeutic fib,” she said, can often defuse a tense or ongoing situation. An important caveat is the nurse must be fairly certain that the patient won’t remember what was said an hour later.
Nurses can also use a team approach to help patients cope with processes or procedures they may not understand or may not like.
“If the person is in the ER and the lab staff has just drawn blood and the elder is furious about it — then you can be the good guy and tell the elder you’ll make sure that person never touches you again,” she said.
Having that kind of balance helps caregivers, the patient and the family who can become upset when their loved one is upset or agitated.
What other tips come in handy?
Nurses who work with patients who have Alzheimer’s or dementia should recognize that delirium is quite frequently present as well. Keith said it’s not necessary to correct patients when they talk about being in a different time and place.
“Get into their reality,” she said. “If the guy thinks he’s back in the war in a POW camp, then act like a comrade who is going to help get him out. Say anything to help calm the person.”
And, Keith added, “remember that a smile and gentle touch go a long way to getting them to trust you.”
Keith explained that nurses have to learn that patients aren’t going to always say nice things to you, but it’s best to not take it personally. Again, their reality is altered and they may think they are perfectly healthy or okay and that you are actually the one causing a problem.
“They know they are an adult,” she said, “and they will get angry if you treat them like a child. They will do childlike things, but you will make the situation worse if you talk to them or treat them like a child.”
Keith says to continue to check with yourself to see if you are communicating with respect, humor and a calm, gentle manner. Watch for how you say something, especially when you feel frustrated. Saying “No, you can’t do that! You have to do this whether you want to or not!” will probably not result in your patient complying and may, in fact, make things worse.
As you work with a new patient, you will find ways of communicating effectively with that person. Learning how to navigate each case is going to help you and your team provide the best care.
This story was originally published by Minority Nurse, a trusted source for nursing news and information and a portal for the latest jobs, scholarships, and books from Springer Publishing Company.
Last Updated October 23, 2020