Nurses in all specialties and in all 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, especially for nurses who aren’t used to the intricate interactions that might give them the most success.
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 their own 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. But nurses who haven’t worked with that person before don’t have the same advantage. And sometimes what worked last week won’t work this week with the same patient.
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 says. “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 redirect a patient enough so that they are able to talk about their loved one and they do not continue to want the person with them, but not always. If, for instance, a patient repeatedly calls out for his wife or wants to see his wife and redirecting doesn’t work, Keith suggests a different approach for nurses who are especially aware of the patient’s memory. “Then if he persists and his mind cannot be redirected, 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 says.
This kind of “therapeutic fib,” she says, can often defuse a tense or ongoing situation. It also helps build trust so you’re able to provide the care they need. The important “if” factor is that you must be sure the patient won’t remember what you told them in an hour. If that approach works, then other staff can use it to help calm the patient at other times. “Remember that a smile and gentle touch go a long way to getting them to trust you,” she says.
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,” Keith says. 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? Keith says you don’t have correct patients when they talk about being in a different time. “Get into their reality,” she says. “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.”
Nurses who work with patients who have Alzheimer’s or dementia, should recognize that delirium is quite frequently present along with the dementia, says Keith. People may think they are in a time that was decades ago—situations like that are common when you’re working with patients with Alzheimer’s disease.
And, says Keith, 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 with a problem or causing a problem.
“They know they are an adult,” she says, “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.” So redirect your instructions and continue to check in with yourself to see if you are communicating with respect and humor and with a calm, gentle manner. Watch for how you say something, especially when you’re 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 each new patient, you’ll find ways of communicating effectively when you aren’t sure how they are going to present to you. Learning how to navigate each case is going to help your team give the best care which is the end result everyone wants.