Safety a priority when working with patients and residents with dementia

Tips for working with clients who have dementia What do you do when you've had an incident? What's PIECES?

Mrs Jones is just having a bad day. She's agitated and striking out at people. She's focused on picking up the kids from school, (even though they are well past college age) and insistent that she needs to get supper on the table.

"People with dementia don't live in the past, they live in the here and now, even if their memories might be from 30 years ago," explains Luana Whitbread, Clinical Nurse Specialist with the Winnipeg Health Region Personal Care Home Program.

Confronting the client or resident with reality can backfire, adds Whitbread.

"If I'm convinced I need to get home and cook dinner for my husband but you keep telling me he's dead, it may re-traumatize me and I may relive his death." Validating the person's feelings instead or distracting them maybe less traumatic for them

How can you work safely and respectfully with someone who has experienced damage to the brain due to dementia?

That's a question Whitbread aimed to answer at the Safe HealthCare Conference in 2010. It's also a subject explored in the workshop Prevention is 9/10 of the Law: Practical Tools for the Prevention and Management of Aggression and Violence in the Workplace.

So what's the answer?

For you and the client, safety is the priority.

"In order to enable staff to have a 'patient first' focus, we must first ensure safety and security for the staff," says John Van Massenhoven, Vice President and Chief Human Resources Officer for the Region.

"Empathy is important because dementia can be very frightening. Our goal is to understand and assist. Even if we do everything right staff may still be faced with challenges of aggressive and violent behaviour. Always err on the side of caution. Your safety is very important," says Sharon Boychuk, a Nurse Educator at Health Sciences Centre.

Best practice and good care still don't trump safety. Sometimes a shift in timing or approach might be a way to achieve care goals - follow the resident's cues to keep them and yourself safe.

A gentleman in a personal care home took a long time to wake up. If the staff insisted he got out of bed immediately, he became upset and angry. On the days when he was given the chance to wake up slowly, a way that worked for him, while staff checked in on him every 20 minutes or so, he was much more pleasant and the day progressed with greater ease.

There are just some situations when charting "care was offered but declined" is the best and safest option. Consider allowing residents to make choices as much as possible, including refusing care, as an option.

Tips for working with clients who have dementia

The right choice and how to appropriately respond to the client given the situation depends on where the damage to the brain has occurred. The frontal lobe, for example, is like the supervisor of your brain and is responsible for thinking, problem solving, abstract thinking and impulse control. The parietal lobe oversees reading, writing and our perceptions of space. Language and memory, along with new learning, are responsibilities of the temporal lobe. Recognition of shapes, colours and movement are the responsibility of the occipital lobe.

"Understanding the brain and its losses can help guide our responses and interventions," says Whitbread. "All behaviour has meaning. We just need to figure it out."

Here are some tips for working with clients who have dementia:

• If a person is verbally aggressive, try distracting them. It may diffuse the situation. "I see that you have a picture of your dog, tell me about him"
• Set up a scenario so they want to follow your direction. "I'll help you get dressed so we can join the others for breakfast."
• When an individual is out of control, the hospital code is "code white." If you're in the hospital, dialling 55 and using the intercom will alert others to the fact that you need help.
  
• If you're in a community setting, pick up the phone to ask for help. Also consider using the "red mushroom" distress call-button activated internally through the alarm system. There is a process already in place and falls under the response duties of a first responder.
• How you approach someone may be as important as what you're saying. If your body language is threatening, it can trigger cues for someone with dementia. Empathy and thoughtfulness are important.
• Ask for help. Bring a colleague in to help you if someone is verbally or physically aggressive.

What do you do when you've had an incident?

Your facility's Occupational and Environmental Safety and Health Department routinely works to prevent and reduce injury to workers. They also routinely review injury and near-miss incidents to provide recommendations about how to prevent reoccurrences.

Report an incident - fill out a Report and Injury/Near Miss form

What's PIECES?

Whitbread is also one of the provincial P.I.E.C.E.S. facilitators. The P.I.E.C.E.S. education program (examining the Physical, Intellectual, Emotional, Capabilities, Environment and Social aspects of behaviour), is a learning program for professionals providing care to older adults with cognitive needs. It is a collaborative project with the Winnipeg Health Region and the Alzheimer Society of Manitoba, with funding from Manitoba Health.