I returned to work this week having had two weeks off (and relax), which were lovely, and have been busy organising the launch of the carers’ drop-in support sessions.
On my travels around the wards, I overhear amy conversations between professionals and patients, and I am always interested to hear how staff communicate with individuals with dementia.
Medics clearly document in every entry in the notes a diagnosis. This doesn’t always seem to then translate into their interactions! Other staff members know their patients are confused and disorientated, but continue to try and debate with them on their terms, rather than on the terms of the individual.
Key communication tips that I try to share:
- Engagement – make a connection with the person. Before you even start speaking, ensure the person is aware of your presence, be on their level so that eye contact can be made. Smile! Use their name. Minimise other noises and distractions. Touch their hand if appropriate to bring the person back to you
- Questions, questions – keep them simple! Don’t give the person too much information in one go, they won’t retain it. Even in chosing their menu, I overhear people being given four or five options in a hurried manner. Guess what? They pick the last option because they can’t remember the others. Which can then cause problems at mealtimes, because a. they can’t remember what they ordered, and b. they may not actually like the last option chosen, so arguments ensue – “I don’t like this, nurse.” “But that’s what you ordered!”, etc. I think menus should come with pictures, but that’s another topic altogether…
- It’s the same with decision-making – keep them simple. If in any doubt about someone’s ability to make a decision or understand what is being asked, the process of capacity assessment and Best Interest decision making come into play (again, a whole other topic!)
- Just walk away! – you really do need to pick your battles, and sometimes you need to walk away to save the person stress and upset, and return a little later/send in a fresh face/use a different approach. This isn’t always possible on a ward, however I think we need to be more accomodating in the way we work – why can’t we try to give someone their tablets at a different time? Why can’t Bill (random name) have a shave in the evening? Not everything will fit in exactly when we plan. Engaging in an argument with someone with dementia really is a waste of energy, and only causes you both to become upset, angry or distressed. Unless it is something which is putting the person at risk, go back to it later.
- It’s real to them – their reality will not always coincide with ours. Rather than debating the facts of the matter, address the emotions – are they upset? Angry? Happy? Engage with those feelings and share them (yet another topic which I could talk about for hours!). Validation rather than orientation lets the person know you’re hearing how they feel, which will make them feel safe.
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