COLORADO SPRINGS — Angela Waterbury is a nurse, not a soldier, but there are days when combat pay would seem to be in order.
“You name it — I’ve been grabbed, pinched, hit, kicked,” she said.
The source of her injuries is, on the surface, an unlikely group: hospice patients, primarily seniors, with dementia. Even though they’re sick and, perhaps, weakened by age and illness, they have enough physical oomph to injure people when they’re alarmed or discombobulated and injure themselves in the process.
“That’s sometimes a surprise. Most people think about our patients as being on their last breath, on the brink of death,” said Martha Barton, president and chief executive of Pikes Peak Hospice & Palliative Care, where Waterbury is nursing services manager.
“But combative behavior is not unusual in patients that have had long-lasting dementias. It poses a risk to the patient as well as to those who are caring for the patient.”
Facilities with patients who have dementia teach some methods for dealing with the crisis at hand, including the Crisis Prevention Institute’s gold-standard program, Nonviolent Crisis Intervention.
But after observing patient-staff interaction when he went to work for Pikes Peak Hospice last year, social worker Jeff Lujan decided the techniques are too reactive and not comprehensive enough to ward off combative behavior or fully protect patients and caregivers against injury.
So Lujan brought an alternative approach to Pikes Peak Hospice last year, one he began developing when he worked at a Pikes Peak-area youth facility in 2005. Called Therapeutic Chi Sao, its roots lie in Lujan’s background as a martial arts instructor, and it relies on a combination of body language, gentle defensive moves and comforting touches to keep patients calm or defuse a combative situation, if it gets to that point.
“This is an approach to patient care, not an intervention,” Lujan said recently to a group of health care professionals attending a monthly meeting of the El Paso County Medical Society’s Extended Care Ethics Committee. “It becomes a holistic approach that’s constantly applied.”
Lujan said patients with dementia don’t process the world around them the same way that others do and may not pay attention to what people are saying because they may be more focused on body language. So they’re more inclined to be spooked by a sudden movement or an aggressive stance that can escalate into a situation where the health care worker is injured.
In turn, the patient is at risk of injury as the worker attempts to break away.
“If a dementia patient is agitated — as soon as I tense my muscles, it changes the timbre of my voice, and she’s not going to cue off my words because she has dementia,” Lujan said. “She cues off my body language.”
With Chi Sao, “they feel calmness when you walk in, not tension,” said Todd Ikehara, an instructor and partner at Therapeutic Crisis Solutions LLC, a business Lujan started with Pikes Peak Hospice’s blessing to teach the technique to others who work with dementia patients.
