John Gotelli, Geriatrics Nurse Practitioner at UNC Hospitals Hillsborough Campus
John Gotelli, Geriatrics Nurse Practitioner at UNC Hospitals Hillsborough Campus

Somebody with dementia, says John Gotelli, MSN, GNP, a Geriatrics-trained Nurse Practitioner at Hillsborough, “lacks the ability to process information that you and I take for granted. So with a foodservice person who comes in to deliver a tray of food, you or I, if we were in the hospital, would understand that interaction. Someone with dementia may think that that person is coming in to poison them.”

With dementia, the use of language and verbal ability is often impacted first, so patients struggle to both understand information they receive and to express their wishes and needs. A dementia patient who is fearful, confused, or in pain may not be able to describe what they’re experiencing. They may not understand why they are at the hospital, how they got there, or what the motives are of the people who keep entering their room.

“Imagine if you don’t know what’s going on, you’re in this place, it’s very bright or it’s dark, you’re connected to wires, people are doing things to you … With a dementia patient their go-to is often to lash out and tell people to ‘leave me alone, stop bothering me,’” says Krista Wells, MSN, RN, CCRN, Hillsborough Hospital’s Clinical Nurse Education Specialist.

Without awareness of what the dementia patient actually experiences, staff focus first on stopping behaviors, rather than trying to understand what’s creating the problem from the patient’s perspective. If difficult and unsafe behaviors (including striking out, pulling IVs, or trying to leave the room) can’t be stopped, medication is a too-frequent default.

And with medication comes increased risk for delirium, falls, and further cognitive decline. Dementia-friendly training helps staff create an environment of trust among patients. With greater trust comes more cooperation and fewer difficult behaviors that can lead to over-medication and poor health outcomes after hospitalization.

Krista Wells, MSN, RN, CCRN, and Clinical Nurse Education Specialist at UNC Hospitals Hillsborough Campus describing DFHI at a dementia and Alzheimer's caregiving conference in February 2019.
Krista Wells, MSN, RN, CCRN, and Clinical Nurse Education Specialist at UNC Hospitals Hillsborough Campus, speaks on the Dementia Friendly Hospital Initiative at a regional caregiving conference.

The benefit of training all staff who interact with patients is that every encounter with dementia patients now has a better chance of going smoothly. Dementia-friendly staff have a new set of skills to use in a variety of situations and are empowered to act with greater empathy and understanding.

“The biggest piece of this is awareness and understanding,” says Jenny Van Gils, OTR / L, an occupational therapist at Hillsborough. “We have to change our behavior, because patients with dementia can’t change theirs.”