Dementia Wrangling

One of the more time-consuming patients is the demented. They are ever trying to get out of bed, wanting to "go to the kitchen" or "feed the cows" or just "go". They pull out IV's, Foley's, NG tubes, other various drains, dressings, etc. They are always on the verge of falling and breaking something.

On a med/surg floor their medical issue(s) are what they are there for so safety is paramount.
The use of bed alarms, posey vests, soft restraints, and Ativan/Haldol pushes are used frequently.
Sometimes, even with the full use of that arsenal, the demented still struggle with their frustrated and pressing agendas. The human will is amazing.

What's interesting, though, is their response to you, the nurse.

If you choose to go against their flow and constantly attempt to remind them where they are and why they're there, their reaction is often defiant. They'll either ignore you or become more agitated. Uptight or power-play nurses struggle with the demented almost to comical extreme.

But if you ride their river a bit, it's amazing how calming it can be (at least for awhile). Sometimes it's just good to agree with them that the cows need to be fed and that you just came back from spreading hay, or to tell them that the kitchen floor is wet right now and won't be dry until morning. Just tweak the direction of their focus and gently bend it back to the hospital bed.
Often an effective thing to do is to just get them out of bed and walk or wheel them up and down the hall to get 'wherever' they are wanting to go, and if you keep up a good game that 'wherever' turns out to be right back to their room.

Wrangling the demented is an art, but an easy one to learn. Just go with their flow. It may not last, but sometimes it'll buy you enough time for to see another patient or two before that bed alarm goes off again.









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