My brother has extreme wounds on his legs that cause him excruciating pain. He will not keep the bandages on. Now the nursing home is sending him to the wound clinic. The results are amazing, but John still won't keep the wraps on. He has been in this condition for 4 years. My question is, is it appropriate to scold him? I am not sure he understands once the pain starts and he rips off the dressings and digs into the wounds. I am at a loss to help him.
How about distractions- are there any table activities that he could do that could keep him from reaching the wounds at least part of the time? Jig saw puzzles, modeling clay, painting, bead stringing, a ukulele or other simple musical instrument?
If you have access to a CERTIFIED music therapist, amazing things are now being done with OCD type conditions AND pain relief, using music as a tool. A therapeutic musician (a DIFFERENT DISCIPLINE) might also be helpful.
Finally, have any specific, structured rewards been tried? Your mention of his outings with you being a reinforcer is a VERY positive sign. Can you think of any more things that he LOVES and would potentially want to EARN by keeping his hands away from his legs?
”Scolding” is usually a pretty poor reinforcer, but “treats”, praise, and pleasant experiences usually have a better result. If you could get your brother to actually select some things HE might enjoy, so much the better.
It sounds as though you’re really an asset to your brother and he enjoys being with you, and that’s a positive reinforcer already!
I think you’re on the right track. Please post if any of these ideas work!
Can you scold an infant for spitting out food, or for letting their nose run, or not using the toilet?
You need to prevent the reaction he has to feeling the pain.
How often do you scratch a mosquito bite or scratch poison ivy when you itch even though you know you should not scratch. And often when you begin to scratch that releases feelings that make what you are doing feel even better so you scratch more. Same thing is going on in your brothers head. Difference is you realize what is going on he doesn't.
If there is a way to apply a numbing agent to the area so he will not have the urge to scratch that might work.
If there is a medication he can be given to possibly suppress the OCD feelings that he may have this might stem the urge to scratch. Once the wounds are healed the medication could be cut back or discontinued.
Possibly changing the type of pants he wears to ones that have a tighter cuff at the ankle (like sweat pants with the cuffed ankle)
Last resort there are mittens that he could be fitted with that would prevent this but not sure if this would be considered a "restraint" and it would have to be approved by a Doctor and he would have t be supervised and I am sure that there are a lot of other regulations that go with something like this.
But it is also absolutely pointless.
Even if the scolding were to frighten him into compliance one moment, the very next moment he'd be at it again. You can't stop his doing this any more than you can stop him blinking. It's a reflex response to a source of discomfort.
Ask the wound clinic about techniques and (possibly, depending on all kinds of approvals) appliances that will help to prevent further harm.
I'm sorry, and I well remember how frustrating it is when someone you're responsible for does this (post cataract surgery, lip picking and hand scratching, in our case); but even if it worked scolding would not be justifiable. Please don't!
A few ideas.
1. keep pain adequately medicated. All pain is pain.
2. Keep nails short and filed smooth. Hands need to be cleaned thoroughly as digging spreads infection.
3. If Digging is happening at night. Soft gloves - mittens can be introduced as this will can decrease scratches.
that is a few
You can reward when they do something right, but don't expect them to remember anything.
Try asking your brother why he is removing the wraps. A lot of people are sensitive to them and yes, they will remove them. Ask the Wound Center to use Sterile Gauze Wraps instead. There is also a gauze sleeve that can be used - my DH never minded any gauze and left his wounds alone.
PLEASE EXCUSE COMPUTER ISSUES..WISH YOU THE BEST
The others on this list have good ideas about having adequate pain relief. Benadryl will also relieve itching, if that seems to be the issue.
Make sure that you ask the doctor for help with any type of medicines to help with the pain and infection and bandages that might not be as easy to tear off.
I visited him today. It has been 3 weeks since he went to the wound center. His wounds look horrible. There is slough (white dead skin and blood) all around both of his legs. The wounds are about 1/4" deep. At the center they used a currett instrument to scrap everything off and they actually looked like they where healing - even without the bandages.
The NH won't let him out of his room without them or if he has blood on his fingers. So, he is room bound. No activities - no socializing - just watches TV. I try and try to get through to him, but it isn't and won't happen. Now I go visit and bring a game or craft to do in his room. I feel so horrible for him. God is good to people with dementia - they don't remember the bad stuff. :(
I do have his applications at a few other NH's that are set up for his medical and mental conditions. When he went to this one he was no where near the stage he is now. I don't think the place is a bad place, but the complexity of his medical issues is huge. Oh, did I mention his kidneys are failing and he isn't manufacturing enough blood - just had 2 pints this week....... S T R E S S S T R E S S S T R E S S S TRESS
thanks for hearing me and my gripes. xo