Tag: john

Music To His Ears….What A Classic

Brett0 comment

I talked a few weeks back about a resident in the nursing home called ‘Barney’ who loves classical music. He had escalating behaviours but was able to be calmed by changing his environment with classical music.

Today at the nursing home every resident was unable to watch television due to building works and I believe the hot water was also affected. I decided to visit the home this afternoon to help with the residents as I thought they may be bored and need some extra lifestyle activities.

When I turned up the entire place was “angry” with residents protesting and demanding to know why they were in the building. Some refused to participate in activities until they were given a good reason why they were there, and were encouraging others to fire up. The lifestyle carer had no control of the group, as she was difficult to understand (due to her struggling with english) and was frustrated and appearing ‘snappy’ with residents. The residents could feel her tension and were reacting accordingly and began arguing . I took over some of the ladies and we played cards, and I whipped up a very simple game of ‘snap’.

Resident Barney looked lost and distant and was aimlessly walking in circles. I decided to once again change his environment and walked him back to his room. I knew he loved his music so I sat him in his comfy chair and asked him if he would like his favourite classical music played? He smiled and said “yes please”.

I then could not get his stereo to work and after several minutes was struggling to get any music to play. I was determined to get to the bottom of the problem. I pressed nearly every button with no success. In desperation I then wiggled the speaker wires and a short burst of sound was heard…SUCCESS! I re- set the wiring in the speakers and the music poured out.

Barney instantly closed his eyes…smiled…and said “isn’t Beethoven amazing?”. He shook my hand and I left him to his music. My big question is ” how long was his music system not working for?”. I would suspect days (if not weeks) as all the buttons were on with no sound coming out.

If music is Barney’s No. 1 passion, then as carers we need to be switched on to ensure that everything is in working order for him when it comes to his music. I could tell carers had tried to turn the music system on without success, but had given up. Did someone report it to maintenance or family members? Did anyone think that maybe Barney may no longer have music in his daily life until this is fixed?

These small things may seem insignificant at the time as it is not an ADL, but I want to highlight that televisions and music systems are often the most treasured possessions in people’s lives and we should ensure they come on each morning to set the right mood and tone for each day. This helps us care for them better…..

**FURTHER LESSON:
When the residents were angry and were demanding to know “why they were there” and “when they were going home”
 
I possibly answered the wrong way. I said ” you have been here several weeks now and this is your new home. You love it here”. This did not really calm them but perhaps gave them a further reason to argue.
 
After researching this situation it is suggested to say, “You have an apartment to stay here whenever you want. You are just staying with us until your _____ (insert ailing body part here) is healed.” ( or something similar eg. House is being painted.
 
The best way to tackle the ” I want to go home” situation is to FACE IT not evade it. Another example:
 
“We wanted to introduce you to some of the people here, so you could meet some new friends. You will be going home in a few days.
 
The above option would have been best on this occasion as I had multiple residents asking the same question at the same time. This probably would have worked best as I am a trusted face and the answer is possible and more plausible.
 
This dementia stuff is not easy!….

A Chair was Thrown!….This is What Happened Next

Brett0 comment

I recently went back to Bob’s nursing home to collect some items when I found myself in the middle of a hostile situation with a resident. There were two carers, a nurse and several others ‘milling around’ a resident called Barney in one of the lounge areas.Unknowingly, I walked up to Barney and shook his hand as always, and said “good morning”.

Within seconds the registered nurse (RN) pulled me away and told me to be careful as Barney was outta control and had just thrown some chairs and had tossed a glass of water over a carer to ‘cleanse him of his evil’.
The nurse also informed me that Barney had recently smashed his own television in a rage by throwing something at it. I have always had a good rapport with Barney so I asked the nurse if she was ok if I tried to calm him? She said “no problem”.

Straight away I jumped on to Barney’s side and asked him if he could show me his new room. I felt he needed to be away from others, and the change of environment may de-escalate the situation. I took him by the hand and once in his room I asked if he would mind if we sat down together for a while? He was ok with this and then I asked him how he was feeling. Barney answered “I am frustrated”. This answer was pivotal as it told me where to start digging for clues as to why he was violent. I asked him “tell me what things are frustrating you?”. Barney replied “I do not trust those people, they have messed with the chemistry and composition of the food and the drinks, and they are evil”. He said ” The Japanese cannot be trusted and the women have the codes and they can still be easily broken”. Straight away I knew he was talking about wartime and breaking secret codes.

I then tried to soothe him by playing his favourite classical music in his room. He told me it was Bach and he enjoyed it very much. I started to dig for clues as to why he was upset, and asked him some more questions. He then said to me “I only trust one person in here , but I can’t tell you who it is, we only communicate by morse code”. I was starting to think he was having some real delerium issues at this point. Barney then asked me if he could have my hand?. He held my hand and with his thumb and started to pulse and tap my palm . What I then realized was that he was typing the international morse code signal for help….SOS! (I took this as him telling me that he trusts me).

I excused myself to go and talk to the nurse to see what the medication situation was with Barney. She advised that he was refusing all meds and no-one could get near him. I knew it was unconventional, but I asked if she wanted me to try and give him his medication? The nurse said “it’s worth a try”. I then grabbed two fresh cups and his tablet and headed for Barney’s room. He was dozing in his chair listening to the music. I poured myself some water from his jug and made sure he saw me swallow it. I then poured him a drink and re-assured him that “the water is fine and is ok to drink”. (he had told me previously that the food and drink was tampered with). Because I had Barney’s trust he drank his water,and when I asked him to place the tablet in his mouth and swallow… he happily did so. I was so pleased and was silently cheering to myself.

We then sat for a few more minutes listening to his music and just talked. I advised Barney I had to leave, but thanked him for the water and the chat and shook his hand. He held my hands tightly and just kept saying to me ‘thank you, thank you for visiting me and listening to me.”

What I learnt:

  • gain the trust of the resident first and then distract them
  • remove them from crowded areas (eg. away from who he is arguing with)
  • change the environment to a much calmer one (eg music)
  • spend 5 mins or so just listening to their story, the clues may emerge.
  • get into their head space, and understand how they are thinking at that very moment of time
  • be creative – think outside the square when trying to find solutions
  • dementia is about being flexible and changing things to suit the individual. (you cannot have a ‘one size fits all approach)
  • By spending a small amount of time listening to the resident can save hours of stress and bad behaviour which can impact on the entire nursing home.

images (32)

1294a

 

Detective Work in Dementia – ‘Where There’s Smoke, There’s Fire’

Brett0 comment

12391056_10154321867754918_873162102883045505_n

Dementia is all about watching body language, noticing small changes and thinking like the person with dementia. They often cannot express their pain or thoughts, so it is up to carers, nurses and family members to notice these subtle changes and take action. It is very much like being a detective and looking for clues.

Alzheimers Disease in the early stages usually impacts the short term memory but may not affect the long term memory until it progresses. Some people with dementia believe they are still living in older times and may re-live events or incidents from their past.

I would like to share a recent story at the nursing home that sparked my interest and I am sure many of you may have had similar situations occur that may make you think differently about them.

There is a resident called Barney who communicates well and every story he has shared with me to date has been 100% true. A week or so ago the staff told me ‘Barney flipped out’ . His behaviour was strange (non violent) but not his normal self and very peculiar. He was difficult to manage and was hard to distract when he became fixated on things. One of the staff told me that Barney was talking about a fire at the time.

This week I decided to visit Barney to see how he was and he instantly told me about an incident with a fire. He told me he his father built a fire-proof house in the country and he watched his father walk into the fire and he was killed. I have no idea if the story was true, but I would bet there was a heavy element of truth in what he was saying to me.

Afterwards I thought about what he had told me and I was wondering what was really going through his mind at the time. Why did he behave so strangely and what sparked the behaviour? I then went into his room and I noticed that his room smelt of smoke. There is no smoking allowed in the rooms, however I couldn’t get past the fact I could smell smoke. I have read that with people with dementia often have heightened senses including ‘smell’. If Barney was smelling smoke, this may trigger an unpleasant thought process causing the behaviours.

I then asked myself the following questions:

-Is the smoke smell in his room triggering a bad memory and reminding him of a previous traumatic incident?
-Is he re-living the past in his head and did he believe he was stuck in his burning house and was in a panic, and hence behaved the way he did?
-Does he have an old relic in his room from that fire that is making his room smell?

People are often too quick to ‘blame the dementia’ and increase or add more medications to control the behaviours. When in fact, maybe if the room was aired out, and the staff aware of his past history, they may be able to tackle the behaviour in a different manner?

Anyway, this is a small insight as to how it can be beneficial to step into the shoes of a person with dementia to truly understand their behaviours.