First off, thank you to Stella Maris of MD for sharing this great example of DICE with us:
D- Resident urinating in a cup in the dining room and on the floor in the corner of his room.
I- Resident is a retired truck driver and would urinate in empty bottles/ cups in the cab of his truck while traveling long distances.
C- Staff have identified the resident’s cues when needing to go to the bathroom. He seeks out cups and heads toward any corner in the dining room. Staff redirects resident to bathroom which has a bright colored sign on the door indicating it is the bathroom.
Staff also have placed a urinal next to his bed to cue him to use it when needing to urinate at night.
E- Resident has decreased episodes of public from daily occurrences to 1-2 times a week.
We invite you all to send us your examples too. You’ll win a gift for your residents if you do!
Next, since we discussed identifying and assessing pain in residents with dementia last week, this week we are focusing on some pain interventions. The following link is to a list of evidence-based nonpharmacologic interventions for pain that you may find helpful. It was prepared by Linda Keilman, DNP, GNP-BC of Michigan State University, College of Nursing:
Dr. Keilman notes that we should address pain with the following outcomes in mind:
- Improvement in quality of life
- Maintaining function (physical, emotional, spiritual)
- Maintaining cognition
- Alleviating or reducing pain through a combination of medication and alternative interventions
Keilman, Linda (2015). Compendium of Evidence-Based Nonpharmacologic Interventions for Pain in Older Adults. Copyright 2015 by LJKeilman, East Lansing: Michigan State University, College of Nursing.
Some of the many pain interventions to consider in addition to traditional pain medications such as NSAIDS and acetaminophens include:
- environment modifications such as adjusting room temperature, lighting and sounds
- cold or heat therapy (icy-hot lotions, like those with Lidoderm, can be helpful and applied often)
- controlled breathing
- music therapy
- art therapy
- pet visits
- distraction or diversion
Effective interventions will vary by person, so you may need to try several different things before finding an intervention that works for a resident. Considering the many negative physical and emotional consequences for a person in pain, we can all agree that these interventions are well worth the effort.
Have a great week!