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.
Visual aids such as items, pictures or written information, serve as an effective engagement tool implemented with the purpose of reinforcing verbal directions or conversation via stimulation within the occipital lobe of the brain (Egan, Berube, Racine, Leonard, & Rochon, 2010). The significance of visual aids in assisting to communicate with PwD comes as they often experience difficulties maintaining a topic of conversation and recalling short-term information (Egan et al., 2010). Comprehension deficits in PwD can therefore be overcome by presenting appropriate visual aids to remind them of the current task or topic of conversation, permitting effective communication through access of semantic information stored in long-term memory (Egan et al., 2010).
An experimental review undertaken by Teten, Dagenais, & Friehe (2015), evaluated the effectiveness of utilising images as visual redirections in maintaining conversations with PwD surrounding ADL such as recreational activities, grooming and food. It was discovered that visual aids yielded a significantly greater level of topic engagement and factual recall in comparison with baseline tests involving no redirections, thereby proving their effectiveness in enabling effective communication. Accordingly, this technique could be applied in clinical settings by placing medications, or images of someone consuming them, on the table when discussing required medications, or the development of step-by-step task completion guides including diagrams (Social Care Institute for Excellence, 2015). An alternate strategy would be the construction of a life-story book or memory album to establish a shared reference for initiating and maintaining conversation and to continue to build rapport (Downs & Collins, 2014).
Impaired communication between health professionals and PwD can threaten the delivery of quality healthcare that entirely meets their physical and psychological needs (Downs & Collins, 2014). For instance, older PwD may experience unrelated pain in need of treatment however lack the ability to communicate at the required level for an accurate diagnosis to be performed. Consequently, a reliance is placed on health professionals recognising non-verbal signs indicating pain, resulting in a lack of detection and subsequent undertreatment (Downs & Collins, 2014). To overcome this barrier, visual aids could be employed by using a graphical pain scale system that allows patients to circle their experienced pain level on a one to ten scale or select a facial expression that best reflects how they feel about their pain.
Through consideration of the crucial nature of ensuring effective communication in clinical settings, it has become conclusively clear that the implementation of verbal and nonverbal communication strategies is imperative towards achieving quality health outcomes for PwD. An array of evidence was uncovered to evaluate and support the appropriate utilisation of vocabulary and visual aids by health professionals to overcome the communicative barriers posed by expressive and comprehension difficulties experienced by PwD. Overall, application of these research validated communication techniques will result in the increased likelihood of achieving positive health outcomes for PwD.
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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