Orientation for Geri Psych Staff

Orientation for Geri Psych
The rapid growth of the aging population is
associated with an increase in the
prevalence of progressive mental health
Geriatric nurses and other clinical staff have a
central role in assessment and
Orienting Geri Staff on Medical
 Dementia is a clinical syndrome of cognitive
deficits that involves both memory
impairments and a disturbance in at least
one area of cognition.
 Dementia affects about 5% of individuals 65
and older.
 13.2 million patients are projected to have
AD by 2050.
Orienting Geri Staff on Medical
Issues cont.
 It is important to orient
the staff on the
parameters of
 This will alert the staff
of any cognitive or
functional decline in
our older adult
Cognitive Parameters
 Orientation: person , place , time
 Memory: ability to register, retain, recall
 Attention: ability to attend and concentration
on stimuli.
 Thinking: ability to organize and
communicate ideas.
 Language: ability to receive and express a
Physical Assessment
 The Geriatric nurse is taught to complete a
physical assessment with a focus on the
neurological and cardiovascular systems.
 Complete a thorough evaluation of all
prescribed, OTC, herbal, and nutritional
products taken.
 Proper evaluation of laboratory test
Nursing Care Strategies
 Monitor the effectiveness and potential side effects
of medications given to the elderly.
 In particular, look at changing your night med pass
time to earlier in the shift to avoid drug hangover
effect, around 7:30-8:30 p.m.
 Provide appropriate cognitive-enhancement
techniques and social engagement.
 Ensure adequate rest, sleep, fluid, nutrition,
elimination, pain control, and comfort measures.
 Avoid the use of physical restraints as much as
How to Communicate with
Cognitively Impaired Patients
Choose simple words and use short sentences.
Use a calm tone of voice.
Don't "baby talk."
Reduce noise and other distractions to help your loved one focus.
Do not to interrupt.
Avoid criticizing or arguing.
Be sure to listen when your patient talks.
Don't get too close or crowd your patient when talking.
If your patient gets confused, take a break. Talk about something
else if it helps.
 Choose a time of the day when your patient tends to be calm and
receptive for your talk.
How to treat patients with Behavioral
 Combative Behavior
 Stay calm and avoid arguing.
 Reduce noise and other distractions to help
your patient focus.
 Reassure your patient that they are safe.
 Offer your patient a choice of relaxing
activities like taking a nap or going for a short
 Avoid crowding or "cornering" your loved one.
Sleep Problems
 Set a calm, quiet tone in the evening to
encourage sleep.
 Keep the lights dim.
 Play soft music.
 Stick with a bedtime routine.
 If you are going to use a sleep aid with
the patient make sure to start out with
the lowest dose first to try and minimize
a drug hangover in the mornings.
Wandering Behavior
 Softly redirect the patient back to their room.
 Have therapeutic activities scheduled during the most
prevalent wandering times. This is also known as sun
downing, usually from 3:00 p.m. until 9:00 p.m.
 Since they are in a new environment (hospital) you will
need to spend a great deal of time re-orienting the patient
to the unit, over and over due to short term memory loss.
 Make signs to put on the patients door to help them find
their room.
 Exercise is also helpful along with keeping a routine.
Hallucinations and Delusions
 Some people with Alzheimer's confuse
TV and reality. So avoid violent or
disturbing TV shows.
 Distract your patient with a short walk.
 If you can, turn the patients attention to
a favorite activity.
 Make sure your patient is safe. Be sure
your patient cannot hurt themselves or
Environment of Care Safety Issues
 Make sure the patient room is not cluttered so the patient
does not trip or fall.
 Most avoidable falls occur when a patient is trying to get to
the bathroom. Placing a bedside commode within reach
and eye sight of the patient can help reduce these falls.
Also, nursing staff making frequent pee rounds and offering
to take patients to the bathroom even if they may say no
can also reduce falls.
 Make sure the day rooms are under constant supervision
to ensure patient safety in the day rooms.
 Matte finish floor wax minimizes glare and reduces falls.
EOC, Safety Continued
 Have small boxes on the unit of things the patient can go through and
just touch or smell and keep themselves busy.
 Might be helpful to give a patient a “work assignment on the unit” so
they can feel valued and still feel like they are offering something to the
human race.
 Make sure the hallways remain clutter free so the patients can see their
routes and not fall.
 Highly recommend chair alarms that attach to the patient and the chair
to alert staff when a patient moves too much in their chair.
 Highly recommend bed alarms and they be turned on anytime a patient
is in the bed not just sleeping.
 Make sure the unit doors automatically lock so when a patient wanders
they can not leave the unit.
Family Involvement
 Have open visitation times except in the early
mornings when you are providing morning care.
 Meet regularly with the family member’s and utilize
their assistance when appropriate, also take these
opportunities to educate the families on better
ways to manage their loved one in the home.
 Disease education is paramount for affected family
members, they will never get enough….
 Helping connect family members to outside
resources and benefits to reduce caregiver
burnout will be very important.
Staff Well-Being
 Don’t forget to take care of each other when
working on a Geri Psych unit.
 Nurse are great caretakers but sometimes
struggle caring for themselves.
 Remember this is about team work, not job
titles (PCA,RN,LPN. Etc).
 It truly takes a village to work on a Geri
Psych unit, you will survive and be better for
your patients working together as a team.