Course content – PFLEGE-16
3. Module 2 · Understanding the inner world
3.3. Case, consolidation & transfer
Two cases and what to take away
The wish to go home
Mrs K. becomes restless in the evenings and urgently wants to go ‘home’ – she stands at the door, becomes anxious and presses to leave. A staff member could correct her (‘But you are at home’) – which would only unsettle Mrs K. An experienced carer understands the need behind it (Mrs K. feels strange and insecure in the evenings and longs for security). She responds to the feelings, conveys security (‘I am with you, you are safe here’), lovingly distracts her and talks about Mrs K.’s former home (positive memories). Mrs K. calms down. The case shows how understanding the inner world (the need for security behind ‘home’) leads to helpful care.
Ms Novak and the nurse’s shift
Ms Novak (fictitious), 88, was a hospital nurse for her whole working life. At 6.30 in the evening she goes from room to room, opens doors and says, “I have to check the patients.” Other residents are woken. A night carer says several times, “You are retired, go to bed”. Ms Novak becomes tense and tells the carer off. One evening a new colleague hands her a clipboard with a list of names and says, “Could you check on these three for me, Sister?” Ms Novak walks calmly to the three rooms, comes back and sits down with a cup of tea.
Analysis. (1) The statement “I have to check the patients” expresses a lifelong role and a need to be useful. (2) Correction raised her tension and woke the others. (3) The new colleague did not claim that she was still on duty, yet gave her a meaningful, safe task that matched her role. (4) The team should record this and consider a regular evening task. (5) Check also whether the walking is a sign of pain, boredom or a need for the toilet. The case shows how a view of the inner world turns a “disturbing” behaviour into a resource. It also shows its limit: a task can help, but it never replaces a check of physical causes.
What does “change of perspective” mean in dementia care?
What is the time shift?
What does “I want to go home” often mean?
Name the five steps for a puzzling situation.
Why is your interpretation only a guess?
Key messages
- Behaviour is communication. Behind it are needs and feelings.
- Many behaviours make sense from the person’s inner perspective, especially in the light of the time shift.
- Correcting the person rarely helps; responding to the feeling does.
- Always check physical causes such as pain, thirst, toilet or fear first.
- Your interpretation is a guess. Try it out gently and share what you learn with the team.
- German care law treats behaviour and psychological problems as part of the need for support (section 14 SGB XI).
- Think of a person whose behaviour you find hard. What need might it express?
- When did you last correct someone instead of responding to the feeling? What happened?
- What would you want from a carer if you woke up in a place you did not know?
- ☐ I ask first what the behaviour is trying to say.
- ☐ I check pain, thirst, toilet, temperature and noise before anything else.
- ☐ I use the person’s past roles to find a meaningful task.
- ☐ I avoid arguing facts that the person cannot keep.
- ☐ I note what helped and tell the team.
Exercise: Choose a behaviour of a person with dementia that you have so far found ‘difficult/senseless’. Put yourself into their inner world: how might they be experiencing the situation, what need/distress lies behind it? How could you respond to it?