Agitated - Older Nursing Home Patients - YouTube.mov
Summary
TLDRThis script explores the challenges of managing agitation in elderly nursing home residents with dementia. It emphasizes three key principles: anticipate behaviors, tolerate abnormal actions, and avoid further agitation. Through various vignettes, it demonstrates how professionals can creatively and patiently address these situations, often requiring trial and error to find effective solutions that promote calm and understanding for both residents and caregivers.
Takeaways
- 😖 Agitation in elderly individuals, especially those with dementia, can be challenging and potentially dangerous for both the person and caregivers.
- 🔮 The three guiding principles for managing agitation are: anticipate, tolerate, and don't agitate.
- 👵 Anticipation involves recognizing common behaviors among dementia patients and preparing for them to prevent agitation.
- 🤔 Tolerance requires accepting behaviors that are not normal but are common in dementia patients, which can help maintain calm for both the caregiver and the patient.
- 🧐 Understanding the patient's perception as their reality is crucial, as reorientation may not always be helpful and could exacerbate agitation.
- 👨⚕️ Caregivers should approach situations with creativity, trial and error, and patience when finding solutions to agitation.
- 🍽️ Routine is important for residents, and disruptions can cause agitation; recognizing and respecting this can help avoid conflicts.
- 🌿 Visual spatial defects in dementia patients can lead to misunderstandings, such as mistaking a planter for a toilet, which caregivers should be aware of.
- 🏠 When residents express a desire to go home, it's important to understand their perception and reality, and to approach the situation with empathy and creativity.
- 📞 Communication techniques, such as asking for a resident's name or involving family members, can help diffuse agitation and provide comfort.
- 👂 Listening and responding to a resident's concerns with patience and understanding can lead to more effective solutions for agitation.
- 👨🦳 Fluctuating moods in elderly residents can be managed with a calm and positive approach, even when the resident is already agitated.
Q & A
What are the three guiding principles for managing agitation in elderly care settings as mentioned in the script?
-The three guiding principles are anticipate, tolerate, and don't agitate. Anticipate certain behaviors common among residents with dementia, tolerate behaviors that are not normal to remain calm, and avoid actions that may further agitate the elderly person.
Why is it important to anticipate behaviors in elderly care?
-Anticipating behaviors can help caregivers avoid episodes of agitation by understanding and preparing for common actions and reactions among residents with dementia.
What does the script suggest about tolerating behaviors that are not normal?
-Tolerating abnormal behaviors can allow caregivers to remain calm and assist the resident in staying calm as well, and it may provide clues to the underlying causes of agitation.
How does the script illustrate the principle of not agitating further?
-The script shows that understanding the resident's perception as their reality, such as not forcing reorientation on a confused person, can help in reducing agitation.
What is the situation with Mrs. Williams at lunchtime in the nursing home?
-Mrs. Williams is agitated because she believes her lunch has been taken away. The nurse resolves the situation by recognizing Mrs. Williams' routine and seating preferences and addressing them accordingly.
What is the issue with Mr. Jackson's behavior in the script?
-Mr. Jackson, who has early onset Alzheimer's, is agitated and acting inappropriately, likely because he cannot find the bathroom and is unable to communicate his needs.
How does the nurse handle Mr. Jackson's agitation in the second vignette?
-The nurse in the second vignette calmly tolerates Mr. Jackson's behavior, avoids getting angry, and asks for assistance to take him back to his room, demonstrating patience and understanding.
What is the main challenge for Mrs. Owens in the script?
-Mrs. Owens, who has Alzheimer's dementia, is agitated because she wants to go home and believes she is in a hospital. She is also struggling with the recent move to the nursing home.
How does the doctor and nurse approach Mrs. Owens' agitation in the last vignette?
-The doctor and nurse approach Mrs. Owens' agitation by acknowledging her feelings, using calming techniques like the stethoscope, and redirecting her focus to something positive, like a photo album of her family.
What is the issue with Mrs. Mahoney's interaction with the nurse in the script?
-Mrs. Mahoney, who has had a stroke affecting her visual fields, is startled because the nurse approached her from her blind side, causing her agitation.
How does the nurse in the script handle Mr. Sherman's agitation about calling his daughter?
-The nurse initially tries to calm Mr. Sherman by offering a snack and changing the subject. When that doesn't work, she allows him to use the phone to call his daughter, demonstrating flexibility and understanding of his needs.
Outlines
😖 Managing Agitation in Elderly Care
The video script addresses the challenge of agitation among elderly patients, particularly those with dementia, in nursing homes. It introduces three key principles for managing such situations: anticipate, tolerate, and don't agitate. The script uses a scenario with Mrs. Williams to illustrate these principles, emphasizing the importance of understanding and respecting the resident's perception of reality. The video also highlights the need for creativity, trial and error, and patience when finding solutions to agitation.
🤔 Creative Solutions for Agitated Behaviors
This paragraph explores various ways to handle agitated behaviors in elderly patients with dementia, focusing on Mr. Jackson who has early onset Alzheimer's. The script presents different vignettes showing how calm tolerance, anticipation, and understanding the patient's reality can lead to effective solutions. It emphasizes the importance of not forcing reorientation if it's not effective and suggests that getting into the patient's world can help in managing their agitation.
🏥 Dealing with the Desire to Go Home in Dementia Patients
The script presents a scenario involving Mrs. Owens, an 84-year-old Alzheimer's patient who wants to go home. It discusses the agitation that can arise from her perception of being in a hospital and the importance of understanding her reality. The video suggests techniques such as reorienting the conversation, using a calm demeanor, and offering alternatives like a phone call to her daughter to alleviate her distress.
🤗 Techniques for Calming Agitated Patients
The video script continues with examples of how to approach agitated patients, such as Mrs. Mahoney who has had a stroke affecting her visual fields. It points out the mistake of approaching from her blind side and suggests maintaining calm, using simple language, and offering honest but hopeful responses. The script also includes a scenario with Mr. Sherman, who is fixated on calling his daughter, and how offering alternatives and involving family members can be part of a solution.
🔄 Adaptability in Elderly Care Solutions
The final paragraph emphasizes the importance of adaptability and creativity in finding solutions for agitated elderly patients. It suggests that what works one day might not work the next and encourages the use of new techniques. The script concludes by reinforcing the need for patience and the willingness to try different approaches to address the unique needs of each patient.
Mindmap
Keywords
💡Agitation
💡Dementia
💡Anticipate
💡Tolerate
💡Don't Agitate
💡Creativity
💡Trial and Error
💡Reality Perception
💡Nursing Home
💡Reorientation
Highlights
Introduction of professional actors to demonstrate common situations related to agitation in elderly care.
Three guiding principles for managing agitation: anticipate, tolerate, and don't agitate.
Importance of understanding that agitation behaviors in dementia are common, not normal.
The value of anticipating behaviors to avoid agitation episodes in nursing home residents.
Tolerance as a method to remain calm and observe behaviors that may indicate the cause of agitation.
The challenge of not agitating further and understanding the reality of the elderly person's perception.
Practical example of Mrs. Williams' agitation due to routine disruption and its resolution.
The necessity of creativity, trial and error, and patience in finding solutions for agitation.
Different approaches to handling Mr. Jackson's agitation due to early onset Alzheimer's.
The significance of understanding the patient's reality in reducing agitation, as seen with Mr. Jackson.
Scenario of Mrs. Owens wanting to go home and the importance of addressing her agitation with empathy.
The role of reorientation and its limitations when dealing with agitated elderly patients.
The effectiveness of meeting the patient in their world to understand their perception and reduce agitation.
Mrs. Mahoney's case study illustrating the impact of stroke on perception and agitation.
The importance of approaching patients from their aware side to avoid startling them.
Mr. Sherman's fluctuating mood and the challenge of managing his agitation for calling his daughter.
The need for involving family members in managing agitation and the potential of creative solutions.
The reminder that effective techniques may vary and require continuous adaptation for different situations.
Transcripts
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
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