I've spent the past two nights working with a bunch of really confused patients. One was a homeless man taken off the streets of Yuma brought to our facility by EMS. For two nights, I've spent most of the night sitting in one of those La-Z-Boy type chairs (usually used by families spending the night). For whatever reason, he is completely bat-shit crazy until I sit down by him, and then, after we have about an hour of an amicable (although completely unintelligible) discussion about the fact that we are in a hospital, he was not arrested, and the his insurance will cover the bill, he drifts off to a fitful sleep. He asks the same questions (I am filipino, I am not a cop, I am a nurse, no I am not married) night after night. At least once a night, I will help him wobble like a weeble into the bathroom, where we have the most gentlemanly (albeit unintelligible) discussion while he is seated on the toilet and I am sitting in a chair in the room. All I did was provide encouragement. I tend to say, "You are getting better every day," or "You are going to feel much better tomorrow, I am sure," or "You will think more clearly tomorrow." But I have no idea if that will happen. But the constant repetition of positive statements tends to make these patients calmer. They might not totally comprehend what you are saying, but they key in on the positive intonations of your voice. In an almost reflexive manner, they calm down. At least for a little while.
I listen to a lot of nurses interact with the (bat-shit crazy) demented patient, and when they are tired, or rushed, or frustrated, what comes out is a lengthy barrage of negative statements. I admit I do that as well, especially when the patient is really difficult to manage. I think nurses sometimes try to reason with the patient, and use if-then-else types of arguments to get them to make the rational decision to behave better. Of course, since they are bat-shit crazy, this approach is less than successful. The nurses that do bettter are the ones that can switch from the rational approach to a more instinctive nurturing approach. Tell them they will fell better tomorrow. Tell them they will be more with it tomorrow. Tell them they are improving. Give them something to build on, even if it's more based on hope and faith than medical science.
The other patient I sat with suffers from dementia. I got the feeling the dementia would clear up once the medical problems were taken care of (she has a urinary tract infection and pneumonia). As I sat by her bed, a Christian music channel came on. They broadcast hymns and spiritual music while showing these panoramic nature shots. She could not read the words, but got some comfort having someone watching the screen with her. We didn't talk hardly at all; we just sat there quietly watching, until she eventually dozed off. At first, I went in there to give the nurse a break, thinking I could work on the next shift's assignments. So I sat myself down and started pulling out my pencil, shuffling the papers containing all of the names for day shift. But she was so much more quiet and relaxed when I put everything aside, kicked back in that La-Z-Boy chair, and watched the screen with her. After a while, I found myself really reading the words. I found myself trying to really experience the program, as my patient was obviously experiencing it. After the 45 minutes, I really did get the feeling the sun would come out the next morning (on really bad nights, I sometimes wonder).
I am off one night, then back on for three. I plan on watching all of the episodes of Invasion at one sitting. We've got about 9 episodes Tivo'd that we stopped watching because I was getting frustrated that the story line was taking too long to develop. But I find that consuming entire seasons at one sitting moves that process right along (the notable exception is Lost, a story line that still is completely incomprehensible after two seasons.)
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