AMAZING AND DEDICATED NURSES:THEIR ROLE IN MEMORY CARE

AMAZING AND DEDICATED NURSES:  THEIR ROLE IN MEMORY CARE

            Nurses are a special group for me; I married one.  And that set me up for a special attachment to the profession.  Nurses seem to be among the most consistently caring of the well- trained across the various health professions.  And they seem, in these times, to be underappreciated.  Covid seems to have given them more of the credit they deserve.  In a memory care facility such as Beverly’s, there are so many special skills required of Nurses.  And, as someone suggested to me, Nurses are the “glue” that holds the whole team together.  They fulfill the Physician’s orders under sometimes very difficult circumstances.  They observe and report the various activities and difficulties of the residents.  They supervise the caregivers who manage clothing, bathing, dressing, etc. 

            Of course, medical knowledge is a key.  And there is a surprising amount that these Nurses need to know; of course, they need to know a great deal about these terrible dementias, but not just about dementia.  These residents have many other medical conditions; most residents are older and have various crises, including heart disease, cancer, diabetes, kidney and bladder difficulties, etc.  And they have accidents, including falls.  Many residents in these facilities die there.  So Nurses have to be prepared to manage such a variety of medical issues, including end of life care. 

           And there are various complications for the Nurse.  She/he has a number of patients, each with a different medication regimen.  Drugs need to be dispensed on time and there are a few points in the day where there is pressure to serve everyone in a short time.  A complication is that, at any moment,  half or more of the residents will be somewhere other than their room; sometimes in the dining hall, or attending an activity.  So, unlike a hospital, where patients are mostly in their rooms, there can be time required to search for a number of them.  And the residents walk the halls and/or walk into some other room and stay and/or settle in a chair in one of activity rooms.  And there are many rooms and many yards of hallway.  On occasion, I have spent over half an hour finding Beverly.  Usually she is found in another room; the resident of that room is out somewhere else, and she lies down on a bed and goes to sleep. 

            And then there is the trick of getting some residents to take medications.  Some of them resist all of the time and all of them resist some of the time.  And resistance can get physical, typically from the men who are aggressive anyway.  The Nurses consistently show a calm confident approach and manage to get medications taken nearly all of the time.  Of course, one common problem is when there is a delay in a medication that is central to the control of aggression, anxiety, or repression, with a subsequent strong physical resistance.  I have several times seen Nurses threatened with a physical attack over the patient taking a simple pill into their mouth, and the threatening was close enough to violence that I was unsure of the outcome.  Delays are usually over difficulty with finding the resident, though sometimes a Nurse is slow getting through the medication schedule for all those assigned. 

            The tricky part, of course, is sometimes finding a way to get something down that would be refused or spit out.  But many Nurses are creative at mixing it ice cream or anything else that is great to eat so as to overcome resistance and hide a flavor that is a problem.  Of course, cream puffs and other pastry desserts are even better as they may be quickly ingested without enough opportunity to taste the addition.  In our little group early on, we had fun creating new ways for the nurse to manage one resident who always refused his medications.  Cut the cream puff just enough to slip the medication in (a small pill might work, but not one of much size).  Close it back together.  This usually worked.  There is a general tendency for the resident to forget what went on previously with such a trick, but there was sometimes more awareness than one might think.  If the resident could see the cream puff ripped open, that might cause failure.  One Nurse told me she had worked in a hospital in pediatrics and these Memory Care residents were decidedly more difficult than the children. 

            And Nurses are the record keepers in these systems.  They write reports of every medical intervention, of treatment of a minor wound or major fall, and of every incident (such as a physical fight).  And the end-of-shift verbal report to the next Nurse is a significant duty, including medication changes, the altered functioning of a resident, and so on. 

            And there are issues for Nurses since they supervise the Caregivers.  While in the middle of dealing with dispensing medications, it may be necessary to find a Caregiver in order to get some other process to happen, e.g., bedtime or toileting.  And, of course, there are medical crises, such as falls, for which there are decisions to be made about treating the resident there or sending them to the Emergency Room.  Even something as simple as a minor wound could require an hour of time spent with the resident.  And the Nurse must call the Physician and then call family members to report what has happened and the condition of their loved one who is being treated.  I have seen them deal effectively with all manner of medical issues, from minor first aid to serious falls and other true emergencies.  Early one morning in mid-October 2019, I received an early morning call; the call came repeatedly as I ignored the first two attempts coming from unknown numbers, presumably designed to irritate me at 5:00 AM. Beverly had just fallen backwards and seriously hurt her head and brain.  Should they take her to the Emergency Room at the nearby hospital?  Of course. 

            In a recent blog (Medical Troubles, Thanksgiving 2020), there is a discussion of what happened with Beverly.  The Physician was very involved during the crisis period.  In addition, there was a report and discussion from the Nurse to me every day, for many days.  At first that was for them to report to me about medication changes and additions, as well as other interventions. Then I was calling to get an update on her condition and what changes in her function (oxygen, wheelchair, eating and drinking, participating in activities, walking, etc.).  The Nurses were always patient and helpful through my interruption of whatever they were working to accomplish. 

            It is difficult to know which ones to name since I have respect and appreciation for all of them.  Here are two who are special for me, particularly since they have been involved with Beverly’s care, both recently and for much of her past at the facility. 

            Nurse A is someone who is always willing to consult over whatever issue I raise.  This Nurse is knowledgeable, competent, communicative, and, above all else, positive.  In several recent phone calls, I was able to get quality current information about Beverly; he/she is a caring Nurse.  This Nurse also intervenes directly with Caregivers when that is needed.  If the assigned Caregiver is not immediately present and another is, he/she simply tells the other one to please help out as the resident needs someone to do that now, e.g., take them to the bathroom. 

            Nurse B is an amazingly caring and competent Nurse.  We always have had informative conversations when I call about Beverly, especially following the recent difficulties.  She/he has the happy, pleasant manner that makes conversations work well.  And she/he is also very knowledgeable, always able to answer my inquiries about medical issues.  This Nurse knows whatever has happened when I call, even if away from the station helping another resident.  So she/he has attended to and remembers what is observed and what is in Beverly’s chart. 

            So what suggestions do I have for those who will be caring for someone with dementia?  First, know the Nurses.  In this facility the Nurses work 12 hour shifts, so there is always a day Nurse and a night Nurse.  And 7 days to fill every week and in two different areas, with one nurse each, at least in the daytime.  So there must be 8 – 10 of them at this facility.  I have not been there for 8 months (because of COVID) but I can always reach a Nurse I know.  And they always give me good information and answer all of my questions.  Of course, it is important to realize that Nurses cannot say anything to anyone who is not authorized in the system.  If you have a relative or friend that you want to help you with understanding what is happening, you should so authorize. 

            The Nurses know and provide the most detail about a variety of issues, many of which are significant to family & friends.  They know exactly whether Beverly is resisting her medications or not, how difficult it is to get her up walking (an issue now), how well she is eating today, and so on.  And when they say she is not walking much, I always indicate how much I want her to be walking as much as possible. And there is follow through on such requests. 

            Appreciation is always recommended.  These are professionals and they do not require appreciation; still they generally deserve it.  So show your appreciation.