r/nursing • u/kpsi355 RN - ER 🍕 • Mar 29 '22

Nursing Hacks What’s a little white lie you tell the completely confused patient?

I’m always telling the cirrhosis dude his truck is in the shop. Then I tell him his buddy dared him to “shoot” his lactulose and give him a sprite chaser.

1.0k Upvotes

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411

u/nukafox7 Mar 29 '22

Depends on the situation but sometimes I think it's easier to deal with their confusion by going along with but also steering their story to keep them calm. I know School always said to reorient them but fuck when you got 7 pts and gram gram decides she needs to climb out of bed to visit her family at 9pm and you're still assessing your patients/ passing meds.....well you choose your battles

355

u/KatliysiWinchester RN - Telemetry 🍕 Mar 29 '22

I never reorient them. I do the same thing. Direct their confused story in the direction you want it to go. “I need to go to the grocery store!” “Big winter storm and the roads are closed. We’ll try again tomorrow”

3

u/always2 Mar 30 '22

"better stay cozy in bed!"

109

u/AlexLannister RN - Cath Lab 🍕 Mar 29 '22

Same, newbies look at me like 'wtf dude' but senior just look at me and be like 'oh no, here he goes again'.

I just go along their stories and see what they are thinking behind their confused mind, and I twist it a bit so I can give them their meds or do their obs. It works for me 99% of the time. Meanwhile, those newbies trying to reorient always end up being yell at because confused grandpa doesn't like to be told he's not going down to his favourite pub tonight.

99

u/Bluevisser RN - OB/GYN 🍕 Mar 29 '22

Still in school we were specifically told not to reorient dementia patients. And questions on ATI have indicated that reorienting isn't the way to go. So the education has changed at least which is good, because as family we definitely figured out early that telling my grandma with dementia that her husband was dead wasn't helpful. She would get all upset and then forget and ask where he was a half hour later.

2

u/ticktockclock12 CNA 🍕 Mar 30 '22

When my uncle was dx with dementia I had to keep telling my family to stop trying to reorient him. It's easier for you to step into his world than to steer him back to ours.

1

u/FactAddict01 Mar 30 '22

(Retired RRT & paramedic) Especially in ICU & ER, I would just go into their world and adapt to it. When I started it was big on continuously reorienting them to the present day. That made no sense to me! Why bring them into a world where they’re sick, in pain or discomfort, they’re old, they’re alone, and they’re dependent (and perhaps have lost bodily autonomy)? It’s just cruel. I never did it. I just went into their world. Had some really great conversations, too, through the decades.

234

u/censorized Nurse of All Trades Mar 29 '22

There's a difference between someone with new onset confusion, or confusion related to another medical condition. Those people you should generally reorient. With advanced dementia you'll likely just cause them angst or fear if you try.

152

u/FunPitiful3217 Mar 29 '22

Never reorientate them.

122

u/kjvincent Neuro RN Mar 29 '22

I only reorient if it’s acute confusion or delirium but the patient is alert and oriented at baseline. If they have dementia, it’s just better to play along.

91

u/catcrazyRN BSN, RN 🍕 Mar 29 '22

For reals. Think this was one of the worse things school taught - all it does is distress the patient - how is that helping them?

115

u/countzeroinc Mar 29 '22

Especially when they are asking for a long dead spouse or relative, how on earth does it help to remind them that their loved ones are dead? I just say it's late and everyone is home asleep.

80

u/carlyyay RN - ICU 🍕 Mar 29 '22

Yup. I was a 94 year old woman’s mom for a few minutes to keep her from freaking out worse

90

u/baffledrabbit RN 🍕 Mar 29 '22

I've definitely had a patient in her nineties call me "Mama," and so i went with it. She got a hug and tucked into bed. And you know what? It worked, and she got a few hours of sleep. That's a win in my book.

46

u/Beanakin BSN, RN 🍕 Mar 29 '22

Depressing af when those patients start to panic/worry and ask for their parent that's been dead for 20+ years.

82

u/555Cats555 Mar 29 '22

I was told it's cruel cause each time you tell them they have to reprocess the trauma of that loss... let them forget that those people are gone.

83

u/[deleted] Mar 29 '22

They don't teach it anymore - I'm a first semester student and if their baseline is not alert and oriented, we aren't supposed to reorient. Causes less distress

40

u/celiasem RN - Burn 🍕 Mar 29 '22

I worked at a memory care facility and management would always get on us for not reorienting. Sorry, I’d rather tell the already agitated/combative resident demanding to see his wife that she’s out getting her hair done than reminding him every hour that she died years ago.

29

u/Zorrya RPN 🍕 Mar 29 '22

The only pt I've ever felt the need to reorient was the one who woke up at 2am, rustled through his bag, then accused me of stealing his viagra.

He was then upset I wouldn't call the pharmacy to get him viagra.

17

u/[deleted] Mar 29 '22

[deleted]

18

u/Zorrya RPN 🍕 Mar 29 '22

"Sir, you're in the hospital, I will not get you viagra because you will not be fucking anything tonight" was essentially my reorient. Because honestly.

11

u/whitepawn23 RN 🍕 Mar 29 '22

Sure, try once or twice to see if it’s possible, if there’s a status change, but after that you’re only escalating them.

School was giving you the right answer for a upcoming test.

4

u/PoelyRN RN - Pulmonary Mar 29 '22

Agreed. Worked in assisted living, while in nursing school, many years ago. Every day, one resident asked me if I had seen her (long ago dead) husband. Very chipper I’d say, “Nope! I haven’t seen him today.” She’d smile and go back to whatever she was doing at the moment.
I didn’t feel like I was technically lying to her.

3

u/flamedarkfire Mar 30 '22

Had a paranoid schizophrenic going to the state hospital, bitching the emergency psych ward he was at didn’t do anything to remove the trackers in his arm. I told him they’d take care of that at the hospital. Calmed him down and he was pleasant enough (for a rambling and meandering lunatic) the ride over. The art is playing off the delusion, but not into it.

2

u/[deleted] Mar 29 '22

This. My friend told her 87 year old patient who wouldn’t stop asking for his mom that his mom is dead. He did not take it well; it was a rough day for everyone involved.

2

u/LadyHelpish Mar 29 '22

You were trained to reorient memory care patients?! Oh hell no. Validation Therapy ALL THE WAY!

1

u/Express_Position_805 MSN, APRN 🍕 Mar 30 '22

My school actually said to reorient psych patients but to play along for Alzheimer's / dementia patients. I'm guessing the approaches they teach have changed over time and depending on the school.

1

u/Proof-Plantain4824 BSN, RN 🍕 Apr 01 '22

You shouldn't be trying to reorient patients with advanced dementia. It's needlessly distressing for them. Reorienting is appropriate in acute delerium or early stages of dementia..