Communication Skills for Health Professionals Working with People with Dementia
The utilisation of effective communication skills by health professionals serves as a crucial aspect in the delivery of quality healthcare and has been proven to improve coping, mitigate medical errors and ultimately increase treatment adherence (Peterson, Calhoun, & Rider, 2014). Successful therapeutic communication is achieved through the appropriate use of verbal and non-verbal mechanisms in conjunction with careful consideration of differences in communicative abilities, cultural orientation, social backgrounds and personal beliefs. Communication barriers frequently identified between health professionals and people with dementia (PwD) have been shown to significantly impact their quality of life, treatment effectiveness and progression of their condition (Eggenberger, Heimerl, & Bennett, 2013).
Dementia is characterised by a progressive decline in memory function along with reasoning, expressive and comprehension abilities (Downs & Collins, 2014). Although the prevailing symptoms pose challenges to communication from health professionals, adopting a strength orientated approach by exploiting the many communication abilities retained by PwD allows the development of strategies to overcome existing barriers. The following report aims to examine the effectiveness of two communication skills, vocabulary and visual aids, in facilitating the provision of quality healthcare for PwD.
Language choices and speech complexity dictate the ability of an individual receiving information to understand the message and therefore must be appropriately selected based on the receptive capabilities of the listener. Accordingly, the presence of comprehensive difficulties as a core symptom in PwD indicates the necessity to adjust vocabulary use as a health professional. Small, Gutman, Makela, and Hillhouse (2003), conducted an experimental review to compare the effectiveness of multiple communication strategies through analysis of questionnaire responses provided by dementia carers. It was reported that among carers, the use of short, simple sentences with reduced word complexity was perceived to be the second most successful communication skill in ensuring clear communication with PwD (Small et al., 2003). These findings were further reinforced in the same study as analysis of other experimental research revealed higher rates of comprehension and recall of grammatically simple as opposed to complex sentences in PwD.
The significance of reduced grammatical complexity in the cognitive processing of PwD can be more specifically recognised when considering the interpretive demands posed by complex sentences. Weirather (2010) explains that conjoining information into complex sentences such as “I’d like you to slowly stand out of your chair and walk to the bathroom around the corner”, requires the comprehension and recall of two verbs and directions simultaneously. This will likely result in failure of the patient to recall the instructions and consequently experience frustration. Instead, simple sentences containing one verb should be used, corresponding with the recommended sentence length of four to six words when working with PwD (Weirather, 2010). Furthermore, the implementation of this strategy to assist with performing activities of daily living (ADL) was examined by Wilson, Rochon, Mihailidis, and Leonard (2012), as carers guiding PwD in handwashing revealed that the utilisation of simple language and short sentences resulted in a significant task completion rate.
Another example of a vocabulary adjustment to be made towards effectively communicating with PwD is avoiding the use of pronouns (Weirather, 2010). Memory impairment, experienced by PwD, hinders the ability to ‘co-reference’ which is the cognitive skill required to recognise a pronoun as the person or item it refers to (Weirather, 2010). Accordingly, sentences such as “Your daughter contacted me yesterday. She seemed quite worried”, require the connection of the word ‘daughter’ and pronoun ‘she’ across a sentence boundary to create meaning, which is thereby found difficult by the patient, especially while trying to process the remaining parts of the message. Consequently, the cognitive overload experienced by the patient in this case acts as a barrier to successful communication and can likely cause misinterpretation and confusion (Weirather, 2010). Despite leading to repetition, the referent word should be solely used in order to avoid pronoun inclusion and ensure clear communication with PwD.
It is important to note that, like anyone, PwD possess their own unique communication preferences in terms of the words they often use and their mannerisms (Wick, 2016). Therefore, it is imperative to become familiar with the patient in order to recognise and become equipped with particular words, phrases or ideas that resonate the strongest with them and thereby effectively facilitate clear communication (Downs & Collins, 2014). As this is achieved, rapport is simultaneously developed as the patient feels a greater sense of willingness to cooperate and trust in the care and treatment delivered by the health professional; both vital aspects in ensuring quality health outcomes.
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- Samuel Lehmann (Author), 2019, Communication Skills for Health Professionals Working with People with Dementia, Munich, GRIN Verlag, https://www.grin.com/document/514359