Agitated - Older Nursing Home Patients - YouTube.mov
welcome the people you see behind me are professional actors they're about to doctors and nurses and some of the most common situations related to the topic of agitation as many of you know these situations which older persons are they're becoming agitated or are already agitated can be frustrating time-consuming and even dangerous to them and those who care for them you are also about to see possible solutions there are three guiding principles when trying to manage these situations anticipate tolerate and don't agitate anticipate certain behaviors and actions are common not normal but common among nursing home residents with dementia being able to anticipate these behaviors and actions may help you avoid an episode of agitation tolerate this one's tough but if we can tolerate behaviors and actions that are not normal this may allow us to remain calm and help our resident remain calm when we tolerate behaviors it also allows us to observe some of these behaviors that may give us clues as to what is causing the agitation don't agitate perhaps the most difficult of the three principles in health care we've learned standards and norms that may not always apply to the older person with dementia for example reorientation may not always help a confused older person it may be better to try and understand what the resident is perceiving in their world for perception is their reality this may help lessen the agitation finally when trying to implement any of these three principles for a given situation keep in mind finding solutions often involves creativity trial and error and a lot of patience it's lunchtime in the nursing home mrs.
Williams who is in the background pacing has lived here for over a year mrs. Johnson who is sitting at this table has only lived here a week my lunch no this isn't my lunch no this is my lunch I want to eat lunch my lawn don't touch me go get your own lunch how long you want mrs. Williams my lunch my lord this is her lunch help me my lunch help me I'll get your lunch just wait here don't touch me I want to eat now I'll get your lunch what would you like let's stop and analyze the situation what's the problem is mrs. Williams the problem is this one of those behavioral problems is she anxious is she depressed does she have a UTI the answer is probably something quite different what does she mean when she says my lunch my lunch my lunch place remember she's lived here for over a year routine is very important to her if the nurse had remembered this she might have been able to defuse the situation let's see if this works hello mrs.
Williams are you ready for lunch hungry Mallos can't eat lunch mrs. Johnson this is mrs. Williams could I ask you to move over to this chair I'm sitting here well I know if I could ask you to move over to this chair I'll be your chair i sat here first I know that this chair is mrs. Williams it's very important to her this chair view will be yours and mrs. Williams can sit in hers and we can all have lunch my lunch I'll get you lunch that was a good solution and the nurse did a good job of anticipating a potential problem but not everybody was happy at the end let's look at the same vignette with yet one more possible solution hello mrs.
Williams are you ready for lunch hungry time for lunch mrs. Johnson this is mrs. Williams mrs. Williams has been with us for over a year you two aren't to have lunch together today my lunch I'll get your lunch the solution in the last vignette took a proactive nurse she also used creativity and anticipation did you notice as she introduced each resident to each other that she slid the lunch tray to the other seat there are many solutions to a situation like this the key here was creative anticipation you the next three vignettes are about mr. Jackson mr. Jackson is only 72 years old he has early onset Alzheimer's he has been in three nursing homes in the past three months let's see why hello mr. Jackson you ready for a nice lunch today look yes Oh mr.
Jackson mr. Jackson what a mess Bob will you help me please mr. Jackson can you mr. Jackson look you you can't do this here in public okay we just can't do it you can't be in a plant okay please nope let's go no look yes of course let's go how can we have handled the first situation why was mr. Jackson more agitated was there a way to tolerate his behavior let's see hello mr. Jackson ready for a nice lunch today lunch is Oh mr. Jackson think let me help you out here okay Bob uh can you take mr. Jackson back to his room please sure mr.
Jackson come with me lunch we'll be right back we'll be right back so in the second vignette we saw the solution was calm Toleration now let's see the nurse use anticipation hello mr. Jackson you ready for a nice lunch today look yes mr. Jackson are you ready for lunch Bob mr. Jackson is ready for lunch would you help him please absolutely mr. Jackson come with me nurse Bob reacted in this first vignette like many of us might he got angry however in the second and third vignette he stays calm he also kept his language calm and simple he did not try to get mr. Jackson to stop the behavior or teach him that it was wrong remember mr. Jackson has dementia at a stage that probably prevents him from understanding this lastly it is important to ask the question why is mr.
Jackson doing this well he probably can't tell us but if we were to get into his world his reality we would probably realize that he couldn't find the bathroom and he couldn't ask anyone where it was we also might realize that as we know patients with dementia have visual spatial defects he saw the round planter as a toilet so keep in mind the basic principles tolerate anticipate and don't agitate you what happens when a resident in a nursing home wants to go home our main character in this scenario is mrs.
Owens she's 84 years old and has Alzheimer's dementia her daughter recently moved her to this nursing home the setting is this it's early evening there happens to be a doctor at the nurse's station but the doctor is not mrs. Owens is doctor let's see what happens when miss Owens arrives at the nurse's station can you help me what is it I want to go home you want to go home yes I don't like this hospital I want to go home well you can't and this isn't the hospital oh you don't fool me I'm not sick anyway what am I on the hospital and this is a nursing home no it's not I want to call my daughter of course what's her number what her number ma'am your daughter what's her number it's sum is it what can I go home tell you what you give me that number and I'll I'll call your daughter before we get to a possible solution for this situation let's just focus on the agitation what was agitating mrs.
Owens before you say well it was just the mood of the doctor and the nurse let's look at one thing that the doctor did and the nurse did first the doctor something we always all of us have learned reorientation if you reorient someone and it doesn't work don't keep doing it the nurse what did he do he asked her a simple question what's your daughter's phone number without knowing it he probably challenged her by asking that short-term memory question so let's look at the scenario again where the doctor and the nurse their mood might not change but how they approach the situation they're getting one step closer to mrs. Owens perception of what's going on I don't like this hospital of course you don't ma'am nobody likes being in the hospital that's right I want to call my daughter okay you can do that my daughter I must talk to her name is Jane right yes J that's my daughter okay I'll get her number for you come on over here we go hello Jane yeah this is the nurse that takes care of your mom as you know she doesn't really like being in the hospital she was wondering if she could talk to you she really wants to come home okay here she is hi Jane I want to come home I don't like this hospital oh you can't come give me why not oh the doctor thinks I should stay well well I'm not sick well I guess I am feeling a little better oh you can you can come get me tomorrow okay well I guess I see you tomorrow although this type of creativity might seem like your trick in the resident let's look at it from a different perspective trying to understand where your resident is and what their perception of the situation is may help you meet that person in their world at that moment remember mrs.
Owens perception that she's in the hospital is her reality anything that might refute that may not only be scary to her but it could cause agitation on the other hand trying to get a little bit into her reality whether it's with words mood or action could help you find the solution you need for that certain situation let's see this time how our doctor and nurse perform I don't like this hospital of course you don't dear no one likes to be in the hospital that's right I want to go home I'm afraid I don't know you ma'am I don't like this hospital I want to go home I understand ma'am what's your name I'm Barbara Owens so mrs.
Owens I'm dr. Simmons how have you been feeling okay I guess how about we just take a look and make sure everything's okay all right okay well everything sounds okay okay but I still want to go home I understand want to see my grandchildren I understand tell you what let me see if I can help you out how about we get your nurse okay mrs. Owens I hear you're feeling a lot better you know I'm very proud of you you know that your therapy is going really well I have an idea why don't we go for a walk oh well I'm gonna do that yeah good deal you know what we can do we can take a look at that photo album of yours that you like so much with all your family in there and if I'm not mistaken you're a grandmother aren't you yes my pitch the doctor a nurse in this last vignette demonstrates some good techniques that might be useful in some similar situations for example the doctor starts out by asking mrs.
Owens water name is this diffuses the agitation right off the bat then the doctor came around the nurse's station to interact with her face-to-face and she used the doctors secret weapon for calming patients the stethoscope while offering to help notice all this took the doctor less than a minute the nurse he was calm and positive but not so positive as to increase mrs. Owens to stress finally he changes the subject to take her mind off the reason for her distress now not every technique will work in every situation for example the stethoscope it can frighten an agitated patient if they don't understand what it is keep in mind we are showing you some of these techniques to help you develop your own creative techniques so you can help your patient in these situations in this situation our resident is mrs. Mahoney mrs. Mahoney has lived in the nursing home for three years ever since her stroke it's important to know that mrs. Mahoney's stroke was in the right side of her brain which affects the left side of her body on any given day mrs.
Mahoney likes to go to the nurses desk after breakfast to talk with the nurses however today the nurse is quite busy let's see what happens hello Gayle hello Gayle have you seen my daughter hello mrs. Mahoney um I'm really busy right now okay uh my daughter I I don't know where she is have you seen her no I don't know where she's at I'm sorry a Gail have you seen my daughter I don't know where she is hello mrs. Mahoney oh why don't you come with me we'll go back to your room okay why I'm just trying to help I'm okay I'm okay so what went wrong here remember mrs.
Mahoney's had a stroke on the right side of her brain which not only affects the left side of her body but affects her visual fields she has what's called a left-sided neglect she has a blind side the nurse approached her from her blind side no wonder she's startled let's see how we could have done it Kayle Kayle do you know where my daughter is my I've been looking everywhere I can't fucq turn I sure don't duck Alice could you help me over here I can help you mrs. Mahoney oh that's sweet dear but do you know where my daughter is I I don't but I can sure try to help pink everywhere for her I can't find a few final points did you notice how the nurse the busy nurse maintained her calm while trying to bring Alice around to miss Mahoney's right side and Alice did you notice how few words Alice used did you notice how Alice approached Miss Mahoney and had her attention before she spoke with him and when Miss Mahoney asks again where's my daughter Alice gives an honest but hopeful answer I don't know but I can sure try to help mr.
Chairman is 82 years old on any given day his mood can fluctuate between happy-go-lucky and angry and demanding recently he's been fixated on calling his daughter every day the situation today though is a little bit more challenging because when he approaches the nurse's station he's already agitated good news mr. Sherman I want to call my daughter I don't think there would be such a good idea I don't think your daughter wants you to call every day would you talk to my daughter I can't let you use this phone give me the phone I want to talk to my daughter she needs to hear from me I'm sorry mr.
Sherman I'm really busy and I'm sure your daughter understands that you're being well taken care of and I'm sure she'll call you in a few days now I want to talk to my daughter do you blame this nurse for being upset it would take a very patient nurse to tolerate this behavior and come up with the solution to keep mr. Sherman calm let's see I want to call my daughter what we call my daughter now okay here you go mr. Sherman you can use this phone do you need some help number but it's I don't reap me I don't remember maybe this will help yes she wants to hear from me assure me Stan mr. Sherman are you hungry what do you say we we come back to this a little later we'll go get you a snack sir yeah okay okay although this situation turned out fine a couple points to remember in a solution like this sometimes you're going to have to involve the daughter the second point to remember is even if something worked today it may or may not work tomorrow but don't be afraid to try new techniques new creative ideas to find that solution you need you you
