“No—no!” shrieked my 95-year-old patient with dementia as I turned her to her side with the help of my nursing assistant (now called a patient care tech, 30 years later).
The three daughters sitting at her bedside inhaled deeply, their eyes wide. I looked over at them, calmly explaining that their mom was just frightened, and then in a soft voice said to my patient, “Don’t worry, Mrs. Smith, we won’t let you fall,” as she continued to scream. We positioned pillows against her back, and another between her knees. As we saw the family relax, and the patient’s screams turn to a barely audible whimper, I caressed her back and felt satisfied that all was well.
Fast-forward to my retirement. Having inherited my parents’ degenerative joint disease, at age 72 I have certain specific ways to sleep so that my left shoulder doesn’t hurt, my left hip bursitis doesn’t flare, and my right arm doesn’t get numb and tingly from a pillow that’s too puffy, causing hyperflexion of my cervical vertebrae.
Never assume what the patient’s feeling.
I have flashbacks from the days I thought I was an efficient nurse—I dread having someone, someday, assume that I am just frightened in their attempts to keep me on a turning schedule to prevent pressure ulcers. While it’s possible that I was right about that patient years ago, since sometimes patients with dementia truly are just frightened, we should never assume.
I remember a caregiver getting annoyed when some patients refused to roll to their sides, telling them they were at risk for getting a bedsore. Maybe it would be better to try to figure out why a patient seems so set on lying on their back, or the reason for a confused patient’s screams. Positioning, if we are are tuned in to a patient’s cues, can work. But there is more than one solution to achieve a goal—for example, massages, alternating pressure pads, and air mattresses.
If the young knew what it was like to be older.
Imagine if we, as nurses and caregivers, aged in reverse, experiencing a fractured hip, arthritic joints, vision loss, and yes, dementia, in the first part of our lives, eventually outgrowing our infirmities and becoming young enough to have wisdom and complete empathy with our patients.
A fantasy, of course, but hopefully nursing educators are encouraging their students to hone the skill of perceiving the subtle needs within a patient’s whole being—never assuming. This approach embodies the art and science of nursing.
Mary Ann Hoyt is a retired medical-surgical nurse. Her last post for this blog was “A Proposal to Ensure Patients Don’t Fall Through the Cracks.”
When I taught first year “skills” lab (really, task acquisition, but I digress) I paired up my students and told them one was the patient and one was the nurse. “Nurses” could help other nurses, but the “patients” were to be completely flaccid, silent, and immobile. The nurses were to position them side-lying with pillows, then pull the curtains and wait for further instructions.
The “nurses” got everybody settled and then gathered in the center of the lab and made chit-chat about this and that. I made them wait for a full ten minutes before releasing the “patients” from the bonds of immobility, and we all sat to talk about it. The “patients’ ” comments were eye-opening.
“I felt abandoned,” “I could hear everybody talking but nobody talked to me the whole time,” “I wasn’t comfortable at all, and somebody pulled my hair,” “I had no pillow under my neck and my shoulders were stiff in two minutes,” “It was scary to be all alone behind the curtain,” were common responses. The “nurses” learned a lot from this, and, of course, so did the “patients.”
I was in my thirties when I did this. Now, a lotta years later, I too have a pinched nerve in my neck with paresthesias in one arm (no floofy pillows for me either), two newish knees (avoid any lateral torque at all, please support my feet), and an evil temper when uncomfortable. I would pity the poor nurse who tried to position future nonverbal me without checking “How’s this?” at every step.