RE: question for group

[Connie L. Frank]

Again I say AMEN to that topic. I come from a background of acute and chronic psych and psychogeriatric and I cry nightly at the care I see daily in the nursing homes because they just don’t know the significance of appropriate inservice and supervision to promote accountability and insure patience, time, understanding, (not RUSHING, ie Resident paced care) and the financial limitations to promote adequate and consistent caregivers. Medications are important if used appropriately and monitored for lowest effective dosage and adverse side effects. But not too much just to quiet them down and make them “easier” to fade into the woodwork.   -----Original Message----- From: Faye Jones [mailto:[EMAIL PROTECTED] Sent: Friday, February 06, 2004 8:11 AM To: [EMAIL PROTECTED] Subject: RE: question for group   Doesn’t it just break your heart when the unfamiliar happens and you see that “deer in the headlights look” on their face.  It is even sadder to realize that in this stage they “know” what is going on and they are scared, anxious and often very depressed leading to misinterpreted behaviors.  There are so many articles now about treating dementia residents r/t depression and I say---About D---- time they are treated correctly and we nurses in the long term care industry stop being frowned upon for “medicating” them.  About the saddest thing I ever heard was a doctor say “how can they be depressed they can’t think straight?”  Well off my soap box for now.  This topic just touches me deeply.   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Holly Sox, RN, RAC-C Sent: Friday, February 06, 2004 8:20 AM To: [EMAIL PROTECTED] Subject: Re: question for group   Faye, Thanks for sharing this about your mother. My mother has early Alzheimers as well, and my sister absolutely refuses to accept the diagnosis, because Mama "can remember things when she wants to."    Mom got lost on the interstate going to my sister's house (which is the house that I grew up in) because a new sign had gone up on the interstate, confusing her as to which exit to take.   I see the biggest deficits for her in the area of decision making ability.  She can certainly remember things, and knows who, where and when she is.   But when faced with an unfamiliar situation, she is paralyzed, because she does not know what to do.   I agree that decision making is at least as important as orientation in determining whether someone is refusing or declining care versus resisting care as a behavior.   Holly Holly F. Sox, RN, RAC-C Clinical Editor   www.careplans.com   [EMAIL PROTECTED] ----- Original Message ----- From: Faye Jones To: [EMAIL PROTECTED] Sent: Friday, February 06, 2004 8:28 AM Subject: RE: question for group   Just my opinion.  Just being alert and oriented x 3 is insufficient evidence of the ability to make a sound judgment or decision.  Many dementia residents in the early and sometimes into moderate stages with the assist of appropriate medication can answer appropriately to questions r/t orientation and yet do not have the ability to organize their day and/or make appropriate decisions about their care and well being.  We see it everyday here and I deal with it in my personal life.  My mom has Alzheimer’s and is totally alert and oriented most of the time, can relate her past right down to word for word conversations but has to be supervised day to day or she would forget meals, wear the same clothes day after day etc.  I have to attend all MD visits etc cause she can’t manage her own health care decisions.  I use both orientation and decision making ability as a basis to determine resistance vs informed refusal.  To me the ability to refuse has in it the ability comprehend/process information given and understand the negative outcomes involved.    -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Thursday, February 05, 2004 9:00 PM To: [EMAIL PROTECTED] Subject: Re: question for group   In a message dated 2/5/2004 7:34:34 AM Pacific Standard Time, [EMAIL PROTECTED] writes: Now we are wondering how long we would continue to mark that or is he resisting care (E4e)?  Remember, if he is alert and oriented, he can't be considered as "resisting care."