'My Children Are Waiting for Supper'

Do not argue with the reality; work with the feeling.

Correcting her ('you live here now') has already been tested: it produced tears, then anger, then a strike. Repeated correction of a memory she cannot update is what escalates her.

What I do:

1. Approach alone, from the front, at eye level, with a calm low voice and my hands visible - two people converging on her was part of yesterday's problem.
2. Validate the feeling underneath the words: 'You miss your kids. You've been waiting all day to see them.' That is true whether or not the supper is real.
3. Redirect to something that uses the same impulse. She wants to go home to feed her children, so give her the job: 'I could use help folding these napkins before supper - will you do it with me?' Take her arm only if she takes mine.
4. If she still heads for the door, walk beside her rather than blocking, and redirect toward a chair, the kitchen, or the bird feeder.
5. Start earlier tomorrow: at 1530, before the coat goes on, offer an activity and a snack, and report to the nurse so the care plan is updated with a 1530 trigger.

What I do not do:

• Tell her 'your kids are dead' or 'you live here now.'
• Physically block, pull, or two-person escort her - that is what produced the strike.
• Use a lap belt, a chair that tips, or any device to keep her up, or ask for a medication to 'calm her down.' Restraints and chemical restraint require an order and are an emergency, not a convenience.

Treat the behavior as communication, not as a dementia symptom.

She cannot reliably say 'my wrist hurts,' so her body is saying it: grimacing, guarding, pulling away, refusing touch. Guarding is one of the most consistent pain signs there is, and it started today.

What I do:

1. Report it now, with the details: grimacing, guarding the left wrist, refusing contact from about 1700, and how she reacts when the arm is moved.
2. Ask the nurse for a structured pain assessment such as the PAINAD, which scores breathing, negative vocalization, facial expression, body language, and consolability. Her self-report is not available; the scale is how it gets documented.
3. Look at the wrist only as far as she allows - no forcing, no 'let me just see.' Consider what could have happened: a fall no one saw, a tight bracelet or watch, a splint, an IV site, a hand squeezed in a wheelchair armrest.
4. Offer comfort in the meantime: support the arm on a pillow, warm cloth if she allows, keep it still, distract with a familiar activity.
5. Do not wait for Sunday's visit, and do not chart 'agitated, no complaints.'

Judgment point: if her plan is updated with better pain control, the 1630 exit-seeking behavior may also improve - untreated pain makes agitation worse. These are not two separate problems.

Answer with observations, not with a recommendation about medication.

I am not licensed to suggest or request a specific drug, and 'something to settle her down' is exactly the request that leads to chemical restraint.

What I say:

• 'Here is what I saw: at 1630 she was at the door, tearful, then loud; she struck out when two of us took her arms. At 1700 she was guarding her left wrist and would not let anyone near it.'
• 'What helped was one person, going along with what she was saying, and giving her a job. What made it worse was correcting her and taking her arms.'
• Then ask what the nurse wants me to try before anything else, and offer to start the activity at 1530 tomorrow.

What I do not do:

• Say 'she needs a sedative' or 'the last aide just left her.'
• Stand in for the nurse's assessment or make promises about what the provider will do.
• Describe her as 'manipulative' or 'aggressive' - that language follows her into her record and changes how the next shift treats her.

Why this answer is the right one: the nurse asked for my judgment, and my judgment is grounded in what I observed and what worked. That is the part of the decision I actually own.