What Dementia Teaches Me About Patient Care

 I am a very flinchy person. I plug my ears when I hear a toilet flush, I jump when I drop an object and it makes a loud noise, and I scream whenever someone sneaks up from behind me. You can imagine, then, how difficult it was for me to adjust to the concept of working with dementia patients during a night shift. 


About 80% of dementia patients in residential or hospital care settings experience “sundowning”. Sundowning is exactly what it sounds like: when the sun goes down, patients start to experience hallucinations, paranoia, anxiety, restlessness, and agitation. They start to pace around, talk to themselves, or become combative. A patient who was perfectly normal when the sun was out suddenly turns into an entirely different person as soon as the sun sets. While the exact cause for sundowning is unknown, a few factors may trigger these episodes. Fading daylight can create confusing shadows and increase anxiety, and changes in the brain can alter a patient’s sleep-wake cycle. When I worked at night, almost all of my patients with dementia would scream, kick, yell, and even bite. I was never a day shift CNA, as I was in high school when I was working, so I would work weekend nights. I never got to see the real patient behind the dementia; I only saw the sundowned version of them. 


CNAs normally take the vital signs of all their patients at the start of their shift. I had a patient who would allow me to take their pulse, respirations, and temperature, but the second I started to put the blood pressure cuff on her, she would begin to yell at me and curse at me. She would try to scratch my hands while I put on the cuff, and eventually, two nurses would have to hold her down while I took her blood pressure. Small triggers like that can define someone’s dementia. You truly never know what can make your patient turn into someone you don’t recognize. Regardless, it is important to be cognizant of this. I used to always tell myself that the version of them that lashes out on me for no fault of my own is not the human in them; it’s the disease in them, and that they deserve to be treated the same way as any other patient. 


It breaks my heart when I hear stories of CNAs and nurses neglecting patients because of their dementia. Although it may be difficult to change the patient or feed them, they deserve as fair of a chance as anyone else at treatment. We should still try our best, but if it gets to the point where we are putting ourselves in harm's way, that is when we consider pausing and recalibrating our strategy. I am also an Emergency Medical Technician (EMT), and both CNAs and EMTs emphasize prioritizing your own safety in a situation where you could get hurt. Obviously, EMTs work in ambulances, so they are oftentimes more in danger than CNAs, but the principle is worth noting. 


Compassion is a right. Especially in long-term care facilities, where one’s autonomy is already diminished as is, every patient deserves our compassion and our best care, no matter what mental battles they may be fighting. It sounds difficult, yes, it is difficult to not hate someone after they try to hurt you physically and verbally. But that is the line that separates a CNA from a non-CNA; compassion is a right and compassion is inherently a part of the job. We cannot blame the person who is not in control. We can only blame the forces that caused them to lose control, and we can only blame dementia, not the patient. 

Comments

Post a Comment

Popular posts from this blog

What I Learned About Life From 3AM

  I’m going to throw in some miscellaneous takeaways that I haven’t covered in other posts into this one. Now is my chance to throw as many cliches at you as possible, so stay wary. First, never be afraid to step out of your comfort zone, both as a CNA and in other aspects of your life. Humans were never meant to keep repeating things that don’t scare them. There is a reason we have adrenaline in our body. That adrenaline excites us, and it pushes us past our personal limits. Do things that scare you, even if it’s difficult, because after you do it once, it never seems scary again. Applying this to the CNA realm, if you’re asked to, take on a section you’ve never had before. Ask questions to charge nurses. Don’t be afraid to pick up that extra shift just because you’ve never worked on that floor. People will teach you what to do, and every step outside your normal boundaries is an opportunity to learn and grow.  Tying into stepping out of your comfort zone, never hesitate in s...
Read more

Why Caregiving Can Be Difficult

  Take it from me, working as a CNA has never been and will never be easy. I was a junior in high school, working 6pm to 6am on Friday night, going to a Speech and Debate tournament all day on Saturday, and then going back to work on Sunday night, only to clock out and drive straight to school Monday morning. I was working on my research paper at 3am while all my call lights were off, and doing homework assignments during my 4am lunch break. And worst of all, I am the sleepiest person you will ever encounter. Prior to working as a night CNA, I had never pulled an all-nighter. You will never catch me staying up late doing schoolwork, or waking up early to go to the gym. Sleep is (was) non-negotiable for me.  I had a patient who asked me how old I was, and I told him I was 16 years old in high school. He said, “Wow, that’s badass.” At that moment, I felt proud of myself. I was the badass 16 year old CNA who was juggling it all so well. From school to work to home to my other job...
Read more

What Night Shifts Reveal About Connection

  Living in a facility is an emotional toll in itself. Losing all privacy, the comfort of your own home, and the support of your family can push people into a bad place mentally. To add to the pressure, strangers enter your room everyday, and overwhelm you with information you may not understand. They wake you up at 6am to take your vital signs, and they control when and what you get to eat. Oftentimes, residents in long-term care facilities need some sort of other emotional support. In fact, nighttime is when all the emotions come to the surface, because that is the loneliest time of day. Constant overthinking leads to restlessness, so many patients are awake at night simply pondering. Family and friends eventually stop visiting, and the person that residents rely on ends up being the CNA. Let’s take a second to appreciate this privilege. Someone, who doesn’t know anything about you, trusts you enough to confide their deepest emotions in you, and they blindly trust you to respect ...
Read more