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I say “Yes, we tell folks with dementia about the death of their spouse….at least once”

It is a tricky decision whether to tell patients who have dementia that their husband or wife of many years has passed away. After all they may forget by the next day and telling them again (and again and again and again) seems like trapping them in some twisted cycle of grief. Yet not telling them robs them of the chance to grieve at all and puts caregivers in a position of continually lying and subjects patients to a diversity of stories that could add to anyone’s confusion.

Your wife is shopping.
Your wife is visiting your daughter.
Your wife is getting the car fixed,… sleeping,… has the flu,…. will be here in a minute….

In my opinion, many people, even with advanced Alzheimer’s, can tell whether they are being told the truth or not and there is some fundamental and powerful human relationship stuff going on, such as building trust (or not) in our interactions.

Here’s what I think we should do in the event of a tragic life event:

Agree upon a finite period of truth-telling. 1-3 days or perhaps a week where staff have a short, truthful, and consistent answer to the question: Where’s my husband?

I’m sorry Mrs. Smith, your husband passed away last week. He had a heart attack and died peacefully in his sleep”

Engage help from the social worker, chaplain, and/or family members.  It is hard to quantify the grieving process and provide exact evidenced-based response, but honoring the human experience of loss seems vital.  Shock, tears, increased anxiety are all manageable with a compassionate and skilled healthcare team.  There are judgement calls for healthcare professionals such as when to medicate for anxiety or depression and when to simply offer a hug and sit with someone for a few minutes validating their emotional pain.

I’m so sorry, Mrs. Smith. You will miss him a lot.

At some point, the truth-telling becomes more of a tragic reminder and an alternative, consistent story should be agreed upon.  The objective is NOT to make someone remember the loss but to allow for the grieving process to occur.  There may be levels of acceptance that occur that we won’t be able to measure or document, other members of the community may be able to offer consoling gestures, and new albeit different relationships can form.  There are, I believe, changes going on in our cells and in the community that contribute to healing, if we let them happen.

I’ve seen people walk down the hall holding hands.  They don’t know each other’s name or diagnosis, but they are connected in some meaningful human relationship.  I’ve also spent time with residents as they go through the heart-wrenching adjustment of joining life in a secure i.e. locked unit.  Their acceptance is not a constant and yet having been through this process with a number of people, I can attest to a lasting sense of trust and some limited acceptance that at times is quite profound.  These are very privileged moments in nursing and I believe part of the art of our work.

Guest post by Beth Boynton RN, MS

Beth Boynton, RN, MS, is a nurse consultant, author, and teacher specializing in communication and collaboration among healthcare professionals and within organizations. She offers interactive workshops, leadership coaching, a ‘whole systems’ approach for culture change efforts, and a new method for building ‘people skills’ called ‘Medical Improv’. She has recently completed her second book, a core text called: Successful Nurse Communication: Safe Care, Healthy Workplaces, and Rewarding Careers which is scheduled to be published by F.A. Davis Publishing Co. Spring 2015. She writes about related issues at, “Confident Voices in Healthcare” blog. Her video, “Interruption Awareness: A Nursing Minute for Patient Safety,” and blog have drawn audiences from all over the world. She is trained in the Professor Watson Curriculum for Medical Improv through Northwestern University Feinberg School of Medicine. She has one grown son who is works in India, loves improv, Zumba dancing, walking, and swimming, and lives in Portsmouth, NH.

You may view Beth's online contiuing education course - 4 Essential Stratefies that Promote Patient Safety. This is a 2 contact hour course that features Beth in 10 short video's designed to engage and teach the student.  This instructional continuing education course is designed for nurses who are in direct care or middle management positions in hospitals; long-term care facilities, and other frontline in- and out-patient practice settings.  Despite 15 years of national focus on improving patient safety outcomes, we continue to have staggering statistics involving preventable deaths, illnesses, and injuries that are due to medical errors. And because communication breakdowns and associated problems with inter-professional relationships have long been major contributors to these alarming problems it is imperative for nurses to develop skills and promote positive interpersonal dynamics. Respectful interactions and effective communication seem simple on paper, yet successful efforts to practice them in the field remain elusive.  In this course, students will examine patient safety statistics and root cause analysis data in order to understand the scope of the problem and how persistent issues with communication and human dynamics are interfering with providing safe care.  This foundation will provide the incentive to commit to exploring and practicing communication strategies that will help to solve them. A basic knowledge of assertiveness, listening, and emotional intelligence is required as students take a ‘deeper dive’ with Beth Boynton, RN, MS to develop their abilities to:  set limits, delegate tasks, and give and receive constructive feedback.

Pedagogy offers several online continuing education courses for nurses and accredited courses for long term care administrators dealing with the management of dementia.

Dementia Diagnosis and Treatment for Administrators 
Dementia Diagnosis and Treatment: An Overview
Diagnosing Dementia
Introduction to Dementia
Massage and Compassionate Touch® in Dementia Care
Problem Solving Strategies in Dementia Care
Treatment of Dementia

Click on each title to learn more.
Posted: 4/13/2015 3:23:59 PM
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