530 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
together” approach. The nurse reassures the client
that he or she knows what is happening and can take
care of things when the client is confused and cannot
do so. For example, if the client is confused about get-
ting dressed, the nurse might say, “I’ll be glad to help
you with that shirt. I’ll hold it for you while you put
your arms in the sleeves”(offering self /suggesting
collaboration).
Supportive touchis effective with many clients.
Touch can provide reassurance and convey caring
when words may not be understood. Holding the hand
of the client who is tearful and sad and tucking the
client into bed at night are examples of ways to use
supportive touch. As with any use of touch, the nurse
must evaluate each client’s response. Clients who
respond positively will smile or move closer toward
the nurse. Those who are threatened by physical
touch will look frightened or pull away from the nurse
especially if the touch is sudden or unexpected or if
the client misperceives the nurse’s intent.
PROMOTING INTERACTION
AND INVOLVEMENT
In a psychosocial model of dementia care, the nurse
or caregiver plans activities that reinforce the client’s
identity and keep him or her engaged and involved in
the business of living (Allen-Burge et al., 1999). The
nurse or caregiver tailors these activities to the client’s
interests and abilities: they should not be routine
group activities that “everyone is supposed to do.”
For example, a client with an interest in history may
enjoy documentary programs on television; a client
who likes music may enjoy singing. Clients often need
the involvement of another person to sustain atten-
tion in the activity and to enjoy it more fully. Those
who have long periods without anything to engage
their interest are more likely to become restless and
agitated. Clients engaged in activities are more likely
to stay calm.
Reminiscence therapy(thinking about or
relating personally significant past experiences) is
an effective intervention for clients with dementia
(Spector, Orrell, Davies & Woods, 2000). Rather than
lamenting that the client is “living in the past,” this
therapy encourages family and caregivers also to
reminisce with the client. Reminiscing uses the client’s
remote memory, which is not affected as severely or
quickly as recent or immediate memory. Photo albums
may be useful in stimulating remote memory, and
they provide a focus on the client’s past. Sometimes
clients like to reminisce about local or national events
and talk about their role or what they were doing at
the time. In addition to keeping clients involved in the
business of living, reminiscence also can build self-
esteem as clients discuss accomplishments. Active lis-
tening, asking questions, and providing cues to con-
tinue will promote successful use of this technique.
Clients have increasing problems interacting with
others as dementia progresses. Initially clients retain
verbal language skills, but other people may find them
difficult to understand as words are lost or content
becomes vague. The nurse must listen carefully to
the client and try to determine the meaning behind
what is being said. The nurse might say, “Are you
trying to say you want to use the bathroom?”or “Did
I get that right, you are hungry?”(seeking clarifica-
tion). It is also important not to interrupt clients or
to finish their thoughts. If a client becomes frustrated
when the nurse cannot understand his or her mean-
ing, the nurse might say, “Can you show me what
you mean or where you want to go?”(assisting to take
action).
When verbal language becomes less coherent,
the nurse should remain alert to the client’s non-
verbal behavior. When nurses or caregivers consis-
tently work with a particular client, they develop the
ability to determine the client’s meaning through non-
verbal behavior. For example, if the client becomes
restless, it may indicate that he or she is hungry if it
is close to mealtime or tired if it is late in the evening.
Sometimes it is impossible to determine exactly what
the client is trying to convey, but the nurse can still be
responsive. For example, a client is pacing and looks
upset but cannot indicate what is bothering her. The
nurse says, “You look worried. I don’t know what’s
wrong, but let’s go for a walk”(making an observation/
offering self).
Interacting with clients with dementia often
means dealing with thoughts and feelings that are
not based in reality but arise from the client’s suspi-
cion or chronic confusion. Rather than attempting to
explain reality or allay suspicion or anger, it is often
useful to employ the techniques of distraction, time
away, or going along to reassure the client (Finnema
et al., 2000).
Distractioninvolves shifting the client’s atten-
tion and energy to a more neutral topic. For example,
the client may display a catastrophic reaction to the
current situation such as jumping up from dinner
and saying, “My food tastes like poison!”The nurse
might intervene with distraction by saying, “Can you
come to the kitchen with me and find something you’d
like to eat?”or “You can leave that food. Can you come
and help me find a good program on television?”
(redirection/distraction). Clients usually calm down
when the nurse directs their attention away from the
triggering situation.
Time awayinvolves leaving clients for a short
period then returning to them to re-engage in inter-