Woohoo!
I got the time off to go to Faerie Fest, and so did Patsfan. We've got the week off leading up to it, and hopefully his days off will change to Sun-Mon so that we don't have to head back until the 3rd. Now to work on planning the trip and all the stuff we want to do along the way.
And I have only one more installment of clinical before I'm a certified "Dementia Specialist." I have no idea whether anyone other than Three Rivers Community College recognizes that designation, but I do think it's been a valuable class. It would be even more valuable if given to administrators of hospitals and long-term care facilities, though, because some of the interventions involve facility design and maintenance. For example ...
Shiny floors=bad: people with dementia frequently have failing eyesight as well as good reason to fear falling. Nice shiny hospital floors look like either standing water or ice, and you can end up with people afraid to walk, or walking as if they were on a slippery surface ... and falling because of it.
Black lines, squares, or whatever on the floor, also bad. Same basic reason: loss of mental acuity coupled with poor eyesight. Black stripes or squares in the flooring look like holes, so you get people trying to high-step or jump over them ... and falling. Or perhaps just plain refusing to leave one room or hallway for another, in the case of those popular black borders that go along the side of many hallways, effectively blocking the doorways to patient/resident rooms with big long "ditches." Conversely, if you need to keep someone from wandering off, a largish black throw-rug outside the door may provide a disincentive to leave a safe area.
Busy patterns in floor tiling, rugs, and wallpaper seriously increase agitation. Yes, the floral pattern may be pretty and, to most of us, even soothing. But for someone with dementia, already struggling to make sense of their environment, it can be hugely frustrating and cause them to become restless and agitated without any seeming provocation.
Yeah, the average CNA can affect all of these decisions. :-(
Music therapy is something I'd like to see in action: take a bunch of rambunctious people with various forms of dementia and play them some music that starts with thrash metal and works down to nice soothing "easy listening" over the course of about ten minutes. It's supposed to work. I'd be really interested to see if it works with Pick's, which seems to have agitation and violence as more primary symptoms, as opposed to Alzheimer's and other more common forms of dementia that tend to have agitation and violence as almost side effects, usually brought on by frustration in/with the environment.
Aromatherapy is supposed to be very effective ... as long as nobody has allergies. Lemon verbena is supposed to be the scent that works best for people with Alzheimer's. I don't know if there's any research yet with other forms of dementia and specific scents, though.
The most critical thing, though, for someone at the CNA level, is stepping into that person's world. Asking how old they are, to get a clue what stage of their life they think they are living in. Asking questions about what they want to do, in order to try and determine how you can try to accommodate them in a way that they will find reassuring and yet will keep them safe. Working within the context of the world they believe they are in -- like responding to an insistent "I have to go to work!" with something reasonable, like, "The foreman called and there's no work today. Why not take the opportunity to work on this project over here?" and have something ready. And for all the Gods' sakes make it something that suits their interests and doesn't infantilize them. Way too many dementia units, even good ones, look at least partially like pediatric units. Which is fine for folks who *are* back in their childhood. But most aren't that far back yet, and would much rather do something adult.
And most of that, you'd think, would come with experience. Sadly, I've seen several nurses with years and years of experience with dementia patients trying futilely to "reorient" them.
You. Can't. Reorient. Someone. Who. Won't. Remember. What. You. Said. In. Ten. Minutes.
Reorienting is great for people with thought disorders like schizophrenia. It may or may not work, but at least they'll remember what you told them. It's worse than useless with someone who has Alzheimer's, in particular. Some are actually damnfool enough to remind someone on a regular basis that they've been widowed. For all the Gods' sakes, don't make them grieve all over again! Tell her that her husband called and he'll just be a bit late. Tell him that his wife had to run to the store for milk. If they have advanced Alzheimer's, they may need to be told this frequently, because they won't remember what you said. But at least they won't endure "finding out" their spouse died over, and over, and over.
Huh. I didn't mean to rant. I started this post off in a great mood, in fact! And I still am. I'm looking forward to clinical on the 21st, and seeing how a dementia unit works in an assisted living setting, as opposed to a hospital setting or nursing/convalescent home.
And even more than that, I'm looking forward to Faerie Fest. Woohoo!
And I have only one more installment of clinical before I'm a certified "Dementia Specialist." I have no idea whether anyone other than Three Rivers Community College recognizes that designation, but I do think it's been a valuable class. It would be even more valuable if given to administrators of hospitals and long-term care facilities, though, because some of the interventions involve facility design and maintenance. For example ...
Shiny floors=bad: people with dementia frequently have failing eyesight as well as good reason to fear falling. Nice shiny hospital floors look like either standing water or ice, and you can end up with people afraid to walk, or walking as if they were on a slippery surface ... and falling because of it.
Black lines, squares, or whatever on the floor, also bad. Same basic reason: loss of mental acuity coupled with poor eyesight. Black stripes or squares in the flooring look like holes, so you get people trying to high-step or jump over them ... and falling. Or perhaps just plain refusing to leave one room or hallway for another, in the case of those popular black borders that go along the side of many hallways, effectively blocking the doorways to patient/resident rooms with big long "ditches." Conversely, if you need to keep someone from wandering off, a largish black throw-rug outside the door may provide a disincentive to leave a safe area.
Busy patterns in floor tiling, rugs, and wallpaper seriously increase agitation. Yes, the floral pattern may be pretty and, to most of us, even soothing. But for someone with dementia, already struggling to make sense of their environment, it can be hugely frustrating and cause them to become restless and agitated without any seeming provocation.
Yeah, the average CNA can affect all of these decisions. :-(
Music therapy is something I'd like to see in action: take a bunch of rambunctious people with various forms of dementia and play them some music that starts with thrash metal and works down to nice soothing "easy listening" over the course of about ten minutes. It's supposed to work. I'd be really interested to see if it works with Pick's, which seems to have agitation and violence as more primary symptoms, as opposed to Alzheimer's and other more common forms of dementia that tend to have agitation and violence as almost side effects, usually brought on by frustration in/with the environment.
Aromatherapy is supposed to be very effective ... as long as nobody has allergies. Lemon verbena is supposed to be the scent that works best for people with Alzheimer's. I don't know if there's any research yet with other forms of dementia and specific scents, though.
The most critical thing, though, for someone at the CNA level, is stepping into that person's world. Asking how old they are, to get a clue what stage of their life they think they are living in. Asking questions about what they want to do, in order to try and determine how you can try to accommodate them in a way that they will find reassuring and yet will keep them safe. Working within the context of the world they believe they are in -- like responding to an insistent "I have to go to work!" with something reasonable, like, "The foreman called and there's no work today. Why not take the opportunity to work on this project over here?" and have something ready. And for all the Gods' sakes make it something that suits their interests and doesn't infantilize them. Way too many dementia units, even good ones, look at least partially like pediatric units. Which is fine for folks who *are* back in their childhood. But most aren't that far back yet, and would much rather do something adult.
And most of that, you'd think, would come with experience. Sadly, I've seen several nurses with years and years of experience with dementia patients trying futilely to "reorient" them.
You. Can't. Reorient. Someone. Who. Won't. Remember. What. You. Said. In. Ten. Minutes.
Reorienting is great for people with thought disorders like schizophrenia. It may or may not work, but at least they'll remember what you told them. It's worse than useless with someone who has Alzheimer's, in particular. Some are actually damnfool enough to remind someone on a regular basis that they've been widowed. For all the Gods' sakes, don't make them grieve all over again! Tell her that her husband called and he'll just be a bit late. Tell him that his wife had to run to the store for milk. If they have advanced Alzheimer's, they may need to be told this frequently, because they won't remember what you said. But at least they won't endure "finding out" their spouse died over, and over, and over.
Huh. I didn't mean to rant. I started this post off in a great mood, in fact! And I still am. I'm looking forward to clinical on the 21st, and seeing how a dementia unit works in an assisted living setting, as opposed to a hospital setting or nursing/convalescent home.
And even more than that, I'm looking forward to Faerie Fest. Woohoo!