Communication With the Cognitively Impaired and Elderly

Transcription

1 + Communication With the Cognitively Impaired and Elderly For the Certified Nursing Assistant, Home Health Aide, and Patient Care Assistant This self-administered tutorial is equal to One Hour of CNA/HHA Inservice Passing grade on exam is 75% Florida Board of Nursing Course # Written by Susan J.G. Davis, RN, BSN, BBA, MS/HAS FPECA Approved Alzheimer s Disease or Related Disorders Trainer, Approval #NH This tutorial is the copyrighted property of Totally Free Inservices. Florida Board of Nursing Education Provider # Reproduction or translation of any part of this tutorial without prior written permission is prohibited. For questions or written permission to copy, contact Susan JG Davis at susan_davis@bellsouth.net.

2 Communication with the Cognitively Impaired and Elderly for the CNA/HHA/PCA OBJECTIVES At the completion of this tutorial students will be able to: 1. Define communication. 2. Discuss reasons why people may feel uncomfortable with a cognitively impaired or elderly patient. 3. Describe non-verbal communication body language. 4. Discuss what equal and un-equal communication actions mean. 5. List 3 differences between personal and professional relationships. DEFINITIONS 1. Communication is an act or instance of transmitting information. It is also a verbal or written message or a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior. 2. Cognitive Impairment is the state of not being oriented to person, place, and time. Most individuals know who they are, but not necessarily where they are or what day or date it is. 3. Emotional Involvement is the feeling with which a message is sent and the feeling with which it is received. These are not necessarily the same feelings by both people, especially if the message was sent with strong emotions. 4. Feedback: is checking to see that the message you intended was received that way. You do this by asking questions and watching non-verbal expressions. 5. Negative Language is language using phrases that expresses to the receiver what cannot be done, stresses negative feelings, or negative actions. 6. Non-Verbal Communication is a message sent by posture, facial expression, or signals that the sender of the message may or may not be aware they are sending. 7. Receiver of the Message the person(s) hearing the message. It may or may not be heard exactly the same way it was sent. 8. Relationships are neutral, negative, or positive bonds established by communication and shared experiences with another or a group. 9. Verbal Communication is speaking a message or idea in the language that the person understands.

3 INTRODUCTION How do you feel about a guest in your home coming to visit you, then not paying attention to you? Or listening to you impatiently? You probably feel pretty uncomfortable. When we are in a patient s apartment or room, we are a guest in their space or their home. Your mother probably told you to mind your manners when you were at someone s house, if you wanted to be invited back. Part of being a professional in health care is to be able to make our patients feel comfortable around us, especially when we are performing some intimate care for her/him. This tutorial will focus on: what communication is, both verbal and non-verbal, ways to involve your patient in healthy communication, ways to develop a positive and professional relationship with your patient, how communication establishes a relationship, ways to communicate with the cognitively impaired, ways to communicate with the person with a hearing loss, acceptable topics to maintain your professional standing, and identifying times when no communication at all is preferred. COMMUNICATION Communication is an act or instance of transmitting information. It is also a verbal or written message or a process by which information is exchanged between individuals through a common system of symbols, signs, or behaviors. It is also the transferring of a message or expression from one person to another in a language both understand. It can be spoken/verbal, written, or non-verbal, as long as an idea goes from one person to another person. This sounds simple, but people can interpret the same statement in many different ways depending on their own feelings and experiences, so the message sent may not be the same one received. This is especially true of the cognitively impaired patient. The sender of the message needs to be clear. For example, a single sentence can be received many different ways, depending on how the person hearing the message interprets it or misinterprets it. The language we use and the emotion with which we speak can make the message become unclear. To be clear requires patience and understanding of the types of communication techniques. Communicating with the person with a Hearing Loss Good communication techniques are essential in talking with a person with hearing loss. Hearing loss only multiplies the difficulties in transmitting information both

4 ways if the person is also cognitively impaired. Some of the techniques to use when dealing with the person with hearing loss are: Start with the general topic of the conversation, so the person is aware of the topic. It helps them to orient themselves and focus on the topic. Face the person. Do not speak with your back or side turned to them and do not speak from another room. Do not speak over other noises: the TV, the radio, or music all distract the person with both a hearing loss and cognitive impairment. Say the person s name, especially if they seem distracted. It brings them back into the conversation. Speak clearly, slowly (not rapidly), distinctly, and in the person s primary language. Do not use slang words and if the person appears to misunderstand or not understand, use different words to say the same thing. Your position is important if the person hears better in one ear than the other. Place yourself on the good ear side of the person. Keep your hands away from your face. It is very distracting to both the cognitively impaired person and the hearing impaired person. If you have any written communication or documentation that supports or helps the person understand your instructions or directions, use that in addition to the verbal communication. Pay attention to the listener. Remember, everyone has a harder time understating, focusing on, and relaying to a topic when they are tired or ill. Allow the cognitively and hearing impaired person to speak, interrupt you, and ask questions when they think of them. The cognitively impaired person usually has such a short attention span, they may forget the question, if you tell them not to interrupt you. Verbal Communication Verbal communication is getting the message across through the use of words. Words are used to get and give information, to entertain, to share experiences, to distract and to change the subject. Positive language skills are a powerful tool, not only in the health care professions, but in all aspects of your life. The way you express yourself will affect every aspect of your life, either positively or negatively. Effective communication between staff and patients includes: Pace your verbal speed to the speed at which your patients speak. Allow time for talking, not just talking during a procedure.

5 Express an interest in what is being said. Maintain eye contact, if possible. Stay at a person s eye level or below when talking and stay within their line of sight Match what you say (body language) to your words. Speak clearly and loudly enough to be heard. Don t shout. Ask for a response or feedback. If communication is not occurring, ask questions in a calm, non-judgmental tone. Listen and be patient. Don t interrupt or try to finish your patient s sentences when they pause to find a word. Keep words concise and sentences short. Avoid criticizing, concentrate on and acknowledge positive actions. Barriers to Effective Communication or Ineffective Communication include: Talking all of the time, not waiting to listen to them. Standing over a person while they re sitting or lying down. Avoiding eye contact. Seeming too busy to take time to listen. Example: If you ask them a question, then turn the water on for their bath, your action could be taken as not paying attention to their answer. Making judgments or jumping to conclusions when the patient is talking. Changing the subject and not acknowledging what was said if it made you uncomfortable. Giving false or inappropriate reassurances. Giving your own opinion without being asked. Hurting a person s feelings, even unintentionally. Many patients have not only speech and/or hearing impairments which interfere with good communication, but are cognitively impaired. Some basic principles that you can follow that will help you to become better able to communicate with patients are: Announce yourself as you walk into a room and walk slowly towards the patient. Call the patient by her/his name. Face the patient when speaking. Speak slowly and clearly in short sentences. Do NOT SHOUT or whisper. Do NOT speak to the patient as though she/he were a child. Avoid baby talk. Repeat information if necessary. Be patient and sensitive to the feelings expressed by the patient. Allow the patients to write, or you can write a message, if this is how the patient can communicate more effectively. Use words the patient understands. Have the patient repeat the message in her/his own words if you are not sure that they understand you. Sit down in the patient s room to show them you have the time for them.

6 PROFESSIONAL AND PERSONAL RELATIONSHIPS Your patients need care provided by you in a friendly, professional manner. Sometimes, when patients are sharing stories of their lives, or seem to be friendly to you, you may want to share stories of your own life to make them feel better and not so alone in their situation. Remember, in a professional relationship, the focus is on the patient s needs, not your own. Many aides say they just want to be friendly with their patients, especially if the patient asks about their personal life. If you need to answer about your personal life, keep the answer brief, don t go into details and try to turn the question around to focus back on the patient. Differences Between Personal and Professional Relationship Subject Personal Relationship Professional Relationship Time You may choose how much or how little time you want to spend. Time spent is determined by patient wishes and the agreed upon hours per shift. Motive You and your friend BOTH want to keep the relationship going. You are responsible to keep your assigned shift and duties to that patient for pay. Money No one will pay you for friendship. You are paid for your job functions in End of Relationship Place There is no discharge date for personal relationships. They can last a lifetime. Anywhere, anytime, any distance. It does not matter. caring for a patient. Your shift will end or the patient may discharge you or your agency from service. Takes place where the patient (or whoever pays for the service) says the job is. In the home, skilled nursing facility, assisted living, or hospital. Training There is no training for friendship. You need to be trained to do a professional job. Remember, the goal of your professional relationship with the patient is for their care, safety, and to help them to live independently. Maintaining their social skills, their health, and enhancing their quality of life is important. Patients Who are Cognitively Impaired need extra time with communication needs. They frequently have at least short term memory loss and may be unable to communicate at all. If they are not able to talk at all, they may exhibit negative behaviors when they are: hungry, in pain, or need the bathroom. These negative behaviors may be pacing, going through drawers and taking our clothes/objects, yelling out, striking out, randomly moving in bed, or knocking objects off a table or off their bed. For these patients, it is very important to decrease their negative behavior by speaking calmly to them. Do not try to obviously restrain them, but let them wander/walk as needed, keep them safe, without holding them down, and keep repeating that they are safe. Do not say, NO to them, as this only increases their anxiety. Distract them with

7 something you know they like by saying some phrases or questions like: Let me help you. Show me where you re going. Do you want something to drink? Are you in pain? Help them by asking questions that have Yes and No answers, so they do not have to think too hard. It decreases their confusion. CONCLUSION We all communicate daily, sometimes verbally and sometimes non-verbally. If you remember Mazlow s hierarchy from school, we all have physical needs (food, water, and air), safety and security needs, social needs to feel loved and accepted, selfesteem needs with approval and recognition from others, and self-actualization needs. When all of the other needs are fulfilled, self-actualization occurs when people are successful in fulfilling their goals in life and have received recognition of these dreams and goals. This is enhanced by communication. The more successful the communicator, the more successful the person in achieving their goals. Our patients who are cognitively impaired have a harder time than others trying to communicate their basic needs to us. Most of our older patients have fulfilled their goals and now want to maintain a social and healthy life style. We can help them do this by not only doing our job function, but by communicating the respect and professional caring they should expect from us. When we act in a professional manner, we can be friendly without being friends. They can expect a professional level of caring and assistance in the daily living functions they no longer can do for themselves. References Booher Consultants Communicating with People with Hearing Loss, UCSF Medical Center. Retrieved 2015 from Slate, M.K. Communication with Cognitively Impaired Patients. Published September Retrieved April 2015 from Click link below to take the quiz: