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Learning Plan - Dementia and Communication

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Erika Grace

on 20 March 2014

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Transcript of Learning Plan - Dementia and Communication

Importance of Communication
The inability to find the right words (substitute an incorrect word or not find any word at all), especially names of objects, is an early sign that a person's capacity to communicate is compromised by dementia. This progressively leads to forgetting and confusing names and relationships of friends and family.
Responsibility of the Nurse
It is the nurse's responsibility to help the patient communicate.
Every patient with dementia is unique.
It is vital to assess specific receptive and expressive communication abilities to understand the patient's specific communication difficulties and promote effective communication.
Assessing receptive and expressive communication & facilitating communication
The deteriorating communication abilities of a patient with dementia generate numerous barriers that create unique challenges for nurses. Thus, the quality of care can be compromised due to the possibility of an avoidance of interactions, which resulted in frustration for the nurse and patient.
Learning Plan
Dementia is a compilation of symptoms caused by numerous diseases affecting the brain.
There is a progressive decline in several areas in regards to cognitive functioning.
These areas include memory, communication, judgement and reasoning.
Mood and behaviour are also affected.
Contributing factors of dementia: inflammation, hypoxia, chronic stress and neurotransmitter imbalance.
Approximately 500,000 people (1.5%) in Canada have dementia
Dementia is most prevalent in older adults
Prevalence between ages 65-74 years: 2.4%
Prevalence between ages 75-84 years: 11.1%
Prevalence older than 85 years: 34.5%
(Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2013)
(Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2013)
Assessing Receptive Abilities
Can the patient understand a yes/no option?
Ask direct questions that only require a yes/no answer.
Can simple instructions be read by the patient ?
Can simple verbal instructions be understood by the patient?
When given physical cues can the patient understand instructions?
When presented with two objects or options, can the patient make a choice?
Assessing Expressive Abilities
Does the patient experience any difficulty when finding the correct word?
Does the patient experience difficulty constructing sentences or a logical flow of ideas?
Are offensive or aggressive language or behaviour used by the patient?
Does the patient completely avoid verbalization or mumble in different tones?
Provide instructions that are easily visible to the patient.
Utilize short and simple sentences. To enhance the patients ability to process use one-step instructions.
Use gestures. Act out the desired behaviour. Keep in mind that the patient can read body language, sincerity and mood, although the patient might not be able to understand words.
When given physical cues can the patient understand instructions?
Confusion and frustration may arise if the patient is given too many options. It will be helpful to limit the options.
Repeat the word that the patient is trying to say only if you are sure of the word they are trying to articulate. If not, do not try to make guesses otherwise the patient's confusion and frustration will be increased.
Try to listen and identify the key thoughts and ideas. Do not quickly assume that that patient is "totally confused".
Do not scold the patient. Do not respond to the words but respond to the emotions of the patient by validating feelings. Assess the patient for unmet needs (hunger, thirst, toileting needs, pain, etc.)
Anticipate the patients needs and read their nonverbal communication.
Additional Tips
Approach the patient from the front.
When speaking face the patient.
The patient should be given time to process information and to respond
Let the patients complete their thoughts
Use a steady voice
If the patient makes a mistake do not correct them
Do not pressure the patient to respond
To establish another avenue of communication, use tough to help concentration and offer reassurance and encouragement.
Jootun, D. McGhee, G. (2011).Effective communication with people who have dementia. Nursing Standard. Volume 25(25), 40-47

Lewis, S. Dirksen, S. Heitkemper, M. & Bucher, L. (2013). Nursing Management: Delirium, Alzheimer's Disease, and Other Dementias. Medical-surgical nursing in Canada: Assessment and management of clinical problems (3rd Canadian ed., pp. 1740-1751). Toronto: Elsevier Canada

Miller, C. (2008). Communication Difficulties in Hospitalized Older Adults with Dementia. AJN. Volume 108(3)

(Jootun & McGhee, 2011)
(Jootun & McGhee, 2011)
(Miller, 2008)
To successfully connect and engage with patients, it is fundamental for nurses to to skilled communicators. The ability to adjust communication strategies to fit the needs of patients with dementia is key to improve their outcomes. These out comes include enhancing the patient's activity of daily living, stabilization of cognition, emotional well-being, and preventing behavior that that affects functioning (Lewis et al., 2013).
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