By Julie Willoughby,
Consultant Nurse for Dementia Services,
Royal Wolverhampton Hospitals NHS Trust.
This article, published in the Royal College of Nursing’s Nursing Older People, covers the effective communication skills which are vital for nurses to be able to meet the needs of patients with dementia and improve the quality of their care in acute hospitals. The time spent carrying out personal care, clinical observations and wound dressings etc. provides many valuable opportunities to interact with these vulnerable patients.
Verbal and Non-Verbal Approaches
People with dementia usually retain some ability to communicate, non-verbally if not verbally. As dementia progresses it is not unusual for memory loss, poor comprehension, failing concentration and word-finding difficulties to result in frustration and distress; this limits individuals’ expressive ability, their self-confidence and sense of identity. Efforts should be made to adapt strategies to the needs of the individual. Eye contact and touch, for example, become increasingly important when a patient’s ability to communicate verbally diminishes. Practical strategies to aid communication include:
- Ensuring a conducive environment and an appropriate approach.
- Gaining the person’s attention.
- Use of good listening skills.
- Use of clear, simple speech at the right speed and tone.
- Repeating or rephrasing sentences and avoiding argument or correction.
- Use of non-verbal communication techniques, such as body posture, gestures, facial expression, eye contact and touch.
The aim is for individuals to be able to express themselves and establish a two-way process of engagement.
Effective communication is enhanced by knowledge about the person. Some form of documentation helps to gather such information to inform a person-centred approach and obtain an insight into their viewpoint. At the Royal Wolverhampton Hospitals NHS Trust, the “About Me” document is central to a unique care bundle approach.
The Reach Out Care Bundle
Communication, a safe and orientating environment, plus adequate nutrition and hydration comprise three fundamental elements of the “Reach Out” care bundle. This care bundle has been developed at New Cross Hospital to offer a composite approach to excellence in dementia care.
Behavioural and Psychological Symptoms of Dementia (BPSD)
Behavioural symptoms of dementia, such as restlessness, agitation and aggression, often express an unmet need in relation to - for example - disorientation, physical discomfort, untreated pain, emotional distress, hunger, thirst or a need for the toilet. A person-centred approach to care helps to identify these unmet needs and ensure they are addressed sympathetically. Example strategies include:
- Using the patient’s preferred name may help to gain attention and rapport.
- Raising a familiar topic of conversation may help settle agitation.
- Knowing that a certain word or behaviour expresses the need for the toilet can help avoid the distress and humiliation of incontinence.
- Identification of personal pain indicators can ensure appropriate treatment and reduce the risk of physical deterioration and possible delirium.
The challenges of communicating effectively with a patient with dementia may be informed by remembering the person and the ways in which each individual may have been affected by illness. A person-centred approach helps to engage with the person’s remaining ability to communicate, whether verbally or non-verbally.
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Willoughby, J. (2012). Practice Question. Communicating with cognitively impaired patients: How can I communicate effectively with patients who have dementia in hospital? Nursing Older People, June 2012, Vol.24(5), p.14.