Nurses On The Front Lines

Posted By DAVID NESSETH
Article Source: Standard-Freeholder.com

Inside Belle's Room, Alzheimer's patients are transported into the 1950s, a time when many of them were raising children, and life was clearer.

With its blue carpet, old women's magazines, antique telephone and gaudy drapes, it's like the set from the TV classic "I love Lucy", only it's not for laughs, but designed to diffuse patients when their emotions boil over.

"They can remember themselves as moms and dads," says Debbie Kitchen, director of care at Woodland Villa in Long Sault, where 85 per cent of the patients have dementia or a related illness.

"They feel right at home in this room."

The room was named after a former patient at Woodland who would often lash out when having an episode, Kitchen said. She would often incite others around her when this would happen. But the room relaxed her.

Flashbacks, frustration, tantrums, side effects and mental illness are just some of the reasons patients in care homes can end up in conflict with the nurses who tend to them, says Woodland administrator Michael Rasenberg.

A new study from Statistics Canada shows that one-third of surveyed nurses across the country have experienced physical conflict at the hands of a patient. Of the 12,200 nurses who completed the questionnaire in 2005, 47 per cent reported emotional abuse by patients. That figure jumped to 70 per cent among nurses working in psychiatry and mental health.

The statistics don't surprise Rasenberg, who has worked in nursing for more than 30 years. It's a profession, he said, that requires empathy and compassion.

"It's all about handling the situation properly, which can be diffusing it before things get out of hand," he said.

There are about 150 personal support workers and nurses that work with Woodland's patients.

Rasenberg said dementia is a growing problem with many of the patients that come to long-term care facilities. As seniors have started to live longer, more and more patients struggle with the cognitive issues.

Sometimes you don't approach the patient because he or she could lash out, Rasenberg explained. Other times, putting on music or simply changing the topic of conversation to something innocuous like the weather can make all the difference.

"If they're attacking someone, you have to act to prevent that from happening," Rasenberg said. "Normally when you're coming into an aggressive situation, or when someone appears to be very upset, you try to approach them calmly and always give them a back door to get away from you. They can feel you've encroached in their space. It's just the way you'd want to be approached if you were upset."

Nurses and all Woodland staff, even the hairdresser and custodian, have access to ongoing training for patient intervention, Rasenberg said.

Outside patients' rooms at Maxville Manor, where 77 per cent of the patients live with forms of dementia, photo collages tell stories about their lives. There's also a posted one-page life history that gives nurses background and insight into the lives of patients whose minds have become muddled by disease.

The information, gained from family or the patient when he or she is lucid, helped the manor to understand some of the cultural differences that made one Alzheimer's patient resistant to bathing. The patient had issues with personal space and being touched, but the manor's staff was able to work with the patient's family to change the care plan.

Another nurse was able to learn about a patient's difficult marriage through the life history information. The patient, she learned, was very strong-minded and independent. The information allowed the nurse to be more patient when treating her.

"It's an art in terms of how you connect with people and provide service," said Sally Munroe, Maxville Manor's director of care.

Munroe has been with the facility for 20 years and loves the challenge of the job. But sometimes it's tough.

"The emotional and physical burdens are quite high," she said.

Two years ago, the manor participated in a pilot study for the Journal of Gerontological Nursing. It focused on the care facility's use of the life history information.

Kathryn Wilkins, one of the authors of the Statistics Canada study, noted that female nurses were less likely to have reported violence than male nurses, despite male nurses comprising only about six per cent of nurses in Canada. She said previous studies have found that male nurses are more frequently placed in a position of handling agitated patients, or they jump to the protection of female nurses who are in danger of being assaulted.

"So in fact, it's probably a question of exposure," Wilkins said. "They're exposed to more risk."

After taking gender and job characteristics into account, the report found several factors were linked to patient conflict with nurses. They are adequacy of staffing and resources, nurse-physician working relations, and support from supervisors and coworkers.

(With CP files)