The emptiness in her eyes… then a little gleam

HEALTH. The psychogeriatric unit at CHSLD Frederick-George-Heriot is unlike any other. There live people with a high cognitive deterioration and who have lost their orientation. Every day the dedicated staff do their best to rekindle a little spark in their beleaguered heads.

The haggard look, a woman approaches and expresses her chest pain; further on, another clearly shows her refusal to let her hand be touched, while at the other end of the corridor, a confused man cheerfully recounts his morning’s chores at the farm to an employee who holds out her arms. The days go by, but they are never the same in this unit where benevolence, anxiety, serenity, irritability and confusion intersect. During our visit, the atmosphere was much more relaxed than the previous hours. We were warned about unpredictable user behavior and asked not to be too intrusive. For a rare time, we had access to one floor of this CHSLD, because for the past few months, the staff has been experimenting with non-pharmacological interventions to calm the anxiety experienced by most of the 39 residents. This is done as part of a research project led by Vanessa Rondeau-Lavaute, a master’s student in nursing at the University of Sherbrooke and a clinical nurse at the CIUSSS de la Mauricie-et-du-Centre-du-Quebec.

“I wanted to do this study with the intention of optimizing the management of geriatric anxiety with clients with neurocognitive disorders, since according to the literature there is a higher proportion of anxiety in people with dementia. Due to their diagnosis, they have difficulty adequately verbalizing their needs, which generates anxiety and they are unable to express unsatisfied needs, so they fall into a vicious circle. Here, on the 3rd North Side, these are people who have major neurocognitive impairment. Between 70% and 75% of users suffer from anxiety. For these reasons, I really felt the need to explore this unit, especially since the residents are numerous and there is a certain heterogeneity of the problems”, says the student.

To achieve convincing results, Ms. Rondeau-Lavaute first met with all unit employees to educate them on geriatric anxiety and then trained them on the different approaches. She also emphasizes everyone’s openness and good collaboration.

Music therapy, massages, aromatherapy and relaxation activities, here are the proposed interventions aimed at stimulating the senses of users to finally calm them down. Specifically, small radios and essential oil diffusers have been installed in several rooms and corridors with the consent of the caregivers.

“Each interested user has his USB key containing his favorite music and songs. For the corridors, a radio reproduces the sounds of nature; the other more rhythmic music to the taste of the beneficiaries. Music therapy has been shown to instantly decrease anxiety, with many studies even showing long-term effects ranging from 12 to 24 weeks. As for diffusers, it’s the same principle, we went there according to everyone’s favorite scents. As well as calming, it brings back memories,” he explains.

All staff have also received training in hand massage.

“I based myself on what is done in France, because they are very advanced in this. The training was necessary so that the employees know how to recognize when the user is tired, in particular. They also learned some reflexology points. These treatments have been found to promote sleep while obviously reducing anxiety. Finally, we also implement some relaxation activities, such as yoga and breathing. It allows the user to be busy, so during that time he does not think about his anxiety”, explains the clinical nurse who works at the Sainte-Croix hospital.

She was kind enough to demonstrate two approaches in one resident. Somewhat suspicious at first, she managed to establish a bond of trust by offering him music before being able to give him a hand massage that he had initially refused. She went with a relaxed and composed air as she then headed up to her room for dinner.

A few minutes earlier, a beneficiary assistant graciously approached a lady wandering down the aisle, and graciously offered to sing for her. A few words were enough for the resident’s empty face to light up and her eyes to moisten. A moving moment.

They are small and simple gestures, whose impact can be great. These attentions allow you to stop the past, forget the future and enjoy the present moment. Also, to date, the team finds that residents smile more and appear more relaxed.

“We observed good reactions among users: there are people who never smiled who started smiling; others are beginning to have a better interaction with the staff. Sometimes, a dance is nice to see and also, the act of moving avoids physical consequences. And what about the moments when it is necessary to take care of hygiene! With music, it becomes easier, many residents are more accommodating. Actually, we see that users find a certain serenity. They manage to live in the present moment, because these people often ruminate, anticipate, talk about their past. In short, it completely changes the dynamics of the unit”, lists satisfied Ms. Rondeau-Lavaute.

Gain time

And it’s not just the recipients who benefit.

“Based on the feedback received, I have noticed that employees enjoy working much more, there is less stress, the feeling of helplessness is reduced and job satisfaction improves. Being happier, the staff is more likely to look for solutions to optimize the quality of life, which makes users happy”, observes the master’s student.

If this project has led staff to adapt their ways of working, Ms. Rondeau-Lavaute believes it is a winner, especially in a context of labor shortages.

“For my project to be accepted, it had to be easy to integrate, accessible to staff, and realistic in routine care. What

Marie-Pier Mailhot, deputy director of senior autonomy support, South Shore housing component at CIUSSS MCQ. (Courtesy photo)

has been implemented, these are suggestions, nothing is mandatory. However, what we observe is that spending ten minutes with a user, for example, will reduce an escalation of agitation, aggressiveness that can last a long time. So, in the end, there will definitely be a time saver. Also, although this is not the main objective of my approach, it can reduce the taking of antidepressants or any other type of medication, ”he emphasizes.

“The teams were super involved in the project, because it is interesting and applicable in the environment. We quickly saw the effects, even if it required a bit of reorganization,” says Marie-Pier Mailhot, deputy director of senior autonomy support, South Shore housing component at CIUSSS de la Mauricie-and-Centre-du-Québec. .

Delighted with the results, the latter indicates that the establishment aims to implement the project in other parts of the territory, to the delight of Vanessa Rondeau-Lavaute.

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