Zhao Jiale, a year–two nursing student, shares insights into his encounters with persons living with dementia during his internship at the hospital.
Every case offered a unique lesson in caring for persons living with dementia (PLWD).
Looking Beyond Aggressive Behaviour
John seldom followed instructions. He would do things like pulling out his IV or catheter whenever nurses attended to him. I felt frustrated by his behaviour as I thought he was rebellious and deliberate. Despite how he behaved toward the nurses, he always had a soft spot for student interns like me. He would share his biscuits he had taken with us, and being patient with us, especially when he saw us struggling. Seeing this side of him made me realise that there was more behind his behaviour than I thought.
When I started putting myself in his shoes, I realised that his actions were a response to his reduced independence, and his inability to communicate clearly.
As I spent more time with him, John began telling me about his family and how he had taken care of them. He also shared how afraid and confused he felt about being hospitalised.
It was then that I found out that a major reason for his behaviour stemmed from missing family time such as not being able to attend his much-doted granddaughter’s wedding.
Caring for John taught me that certain behaviours of a person with dementia could be a form of communication. What I first thought was aggression and non-compliance were a result of frustration, fear, and loss of control over his ability to clearly communicate.
The Value of Reassurance
Richard had a stroke before he was diagnosed with early-stage dementia. He was a cheerful and warm person. However, there were occasions when he would appear noticeably sad and discouraged. This was particularly evident during his morning showers. Regardless, he always cooperated whenever we lifted or repositioned his body while we bed-sponge, even though there were times when he was unable to maintain his position and fell back into his bed. During these moments, he would repeatedly apologise and express that he felt like a burden to the healthcare team and his family.
I tried my best to encourage him by acknowledging the efforts he was making and reminding him that any attempt he made to shift was helpful. At times, I also told him that his physical strength was improving and encouraged him to focus on the progress he had made rather than on what he was unable to do.
My words of encouragement occasionally lifted his spirit, and he would smile again. However, due to dementia, he would sometimes forget these reassurances and expressed the same feelings of being a burden over and again. We would encourage and comfort him every time he felt discouraged.
I looked forward to seeing and interacting with him, despite me knowing that he might have forgotten me. His sweet smile and soft ‘thank you’ after each bed shower touched me deeply and gave me a sense of purpose. I was also reminded that encouraging words could have a positive effect on their dementia journey.
Caring for persons living with dementia requires patience, empathy, and consistency. Even when they may not remember a previous conversation, the reassurance provided at a moment can make them feel supported, respected, and valued.
Textbooks Don't Have All the Answers
During my internship, I had the chance to care for Adrian who was living with dementia. He was identified as having a high risk of falls. He was frequently confused and disoriented. He would shout at nurses when he was agitated and repeatedly attempted to leave the ward, wanting to go home. As a result, he was put under close monitoring that required frequent reorientating and redirecting.
One evening, Adrian became increasingly confused and attempted to leave the ward again. I approached him calmly and applied the TPP¹ approach (Time, Place and Person) that I learnt from school on him. I reminded him that it was nighttime (Time), explained that he was in the hospital (Place), and identified myself as a student nurse (Person) who was there to help. I would then help him return to his bed to avoid falls.
The "Time, Place and Person" Approach (TPP)
The TPP approach helps healthcare professionals assess, support, and reorientate persons living with dementia. By checking whether they know the date and/or time, and who and where they are, healthcare professionals can better identify their needs and provide adequate assistance.
I was taken aback when Adrian started shouting at me despite my effort to calm him down. When a senior nurse saw that, she attentively listened and reassured him by explaining that it was late and the MRT had stopped operating. He accepted her explanation, returned to bed, and eventually fell asleep.
Observing her approach taught me that communication with people living with dementia needs to be flexible and adaptive toward their needs and their ability to understand.
Conclusion
Each of these cases taught me something new: to look beyond behaviour, to value the power of reassurance, and to adapt my approach to their needs.
A diagnosis of dementia does not define who a person is. Their personality, desires, and fears remain even as their ability to express themselves may change. As nurses and caregivers, it is our responsibility to listen, understand, and be there for them. It is through learning about their needs, preferences, and routines that we can advocate care and respect for persons living with dementia to uphold their dignity.
(All the names mentioned in this blog are fictitious.)
- McDougall G. J. (1990). A review of screening instruments for assessing cognition and mental status in older adults. The Nurse practitioner, 15(11), 18–28. https://pubmed.ncbi.nlm.nih.gov/2255423/
ABOUT THE WRITER
Jiale Zhao
Zhao Jiale, a nursing student, is passionate about learning, growing as a professional, and making a positive difference in his patients’ lives. In his free time, he enjoys travelling, exploring good food, and baking.