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Handling Confusion and Dementia-Part II

LTC Nursing Assistant Trainer, July 21, 2005

While confusion and dementia are not diseases, they are symptoms of a disease or of extreme stress. They can be reversible, irreversible, or both, and the nursing care provided differs according to each specific type. CNAs need to handle patients affected by confusion or dementia with patience and understanding. The following are useful measures for handling these situations. This is the second of two parts; the first part ran in the July 14 edition of LTC Nursing Assistant Trainer.

• Approach patients from the front. Before touching a patient, you should make certain he or she knows you are there.

• Repeat the person's name and your name. Say both the person's name and your own name each time you start to communicate with him or her.

• Begin each conversation by saying something positive. Tell the patient, "Your hair looks very nice," or, "Isn't it a lovely day?"

• Make eye contact. Meet the patient's eyes while you communicate, and if the patient is sitting, lower yourself to their same level. The patient can watch your mouth to both lip read and gauge your mood.

• Use reassuring body language. Often, patients will stand very close to you, and it is important that you do not appear nervous. If the person is comfortable being touched, an occasional hug is a good idea.

• Toilet patients at regular intervals. Patients who exhibit agitated or aggressive behavior toward CNAs often need to void or defecate. To reduce aggression or daytime incontinence episodes, follow an hourly toileting schedule during the patient's waking hours.

• Provide as much non-glaring light as possible. If a patient cannot clearly see his or her surroundings, disorientation is more likely to set in. Often patients will go into other patients' rooms and rummage around trying to recognize something that will identify it as their room.

• Reduce the patient's fear of certain procedures. Because of their personal nature, bathing and dressing can often trigger aggression in patients. CNAs should spend five minutes simply talking with the patient and calming his or her mood. This may seem like wasted time, but it saves time in the end.

• Check for pain or illness. If a patient's behavior changes suddenly from one day to the next, look closely at his or her physical condition. Patients are usually not able to tell you about pain or discomfort, and a drastic change in behavior can indicate that an illness is developing.

• Encourage social interaction. Social interaction is important for confused and demented patients. The content of conversation of more severely impaired patients often will not make sense to you, but you can respond to their moods with comments such as, "Oh, yes" or, "That must have been fun." Use an appropriate tone of voice and facial expression to calm the patient.

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