Article

Resident Reactions to Person-Centered Communication by Long-Term Care Staff

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Abstract

Long-term care staff caregivers who are person centered incorporate the life history, preferences, and feelings of residents with dementia during care interactions. Communication is essential for person-centered care. However, little is known about residents' verbal reactions when staff use person-centered communication. Accordingly, this study investigated the impact of person-centered communication and missed opportunities for such communication by staff on resident reactions. Conversations (N = 46) between staff-resident dyads were audio-recorded during routine care tasks over 12 weeks. Staff utterances were coded for person-centered communication and missed opportunities. Resident utterances were coded for positive reactions, such as cooperation, and negative reactions, such as distress. Linear regression analyses revealed that the more staff used person-centered communication, the more likely that residents reacted positively. Additionally, the more missed opportunities in a conversation, the more likely that the residents reacted negatively. Conversation illustrations elaborate on the quantitative findings and implications for staff training are discussed.

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... These central attributes of a person-centred philosophy are fundamentally integrated in day-to-day communication and interactions between care providers and residents (Kitwood, 1997). Research shows that LTC residents react more positively (Savundranayagam et al., 2016), experience enhanced mood and affect (McGilton, Sidiani, Boscart, Guruge, & Brown, 2012) and report higher levels of well-being (Custers et al., 2011) when care providers demonstrate effective relational behaviours during interactions. ...
... Relational PCDC elements. The relational elements of PCDC were evaluated using a measurement approach described in the empirical literature (Savundranayagam, 2014;Savundranayagam & Moore-Nielsen, 2015;Savundranayagam et al., 2016). Aligning with Kitwood's four indicators of positive person work relevant to PCDC (Kitwood, 1997), this coding scheme identifies the presence of recognition, negotiation, validation, and facilitation/collaboration within care provider interactions with LTC residents during care activities. ...
... For reliability testing of the relational PCDC coding system, agreement analysis of two trained researchers was reported to be 91% for recognition, 92% for negotiation, 85% for validation, and 84% for facilitation/collaboration (Savundranayagam, 2014;Savundranayagam & Moore-Nielsen, 2015;Savundranayagam et al., 2016). Details of the linguistic and relational coding system, and steps taken to address rigor of coding in this study are outlined in the supplemental materials. ...
Article
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Objective To pilot test a novel communication intervention incorporating a video-feedback component on the person-centred dementia communication skills of long-term care aides. Methods Effectiveness was assessed using a single group pre-test/post-test design. 11 care aide-resident dyads participated in the study. Objective outcomes included provider statements demonstrating linguistic (i.e., reciprocity, clarity/coherence, and continuity categories) and relational elements of person-centred dementia communication, measured via video-recorded observations of usual care interactions. Subjective outcomes of care aide communication confidence/competence, satisfaction with the resident relationship, relationship closeness, and self-reflection at work were measured using self-report questionnaires. Results In respect to observed person-centred dementia communication skills, there was an increase in the use of linguistic statements in the reciprocity and continuity categories, as well as total linguistic statements overall. Relational statements and overall person-centred dementia communication (i.e., linguistic plus relational strategies) increased. Care aide-reported communication confidence and competence, relationship closeness with the resident, and self-reflection at work also increased after the communication intervention. Discussion The communication intervention showed promise as an effective approach to enhance person-centred dementia communication behaviours in care aides. These results support undertaking a larger trial to examine the intervention’s effectiveness more fulsomely.
... Furthermore, these communication impairments affect the communication partners of individuals with dementia (Small and Perry 2012). Dementia-related communication disorders therefore impact the quality of life of individuals with dementia as well as their communication partners (Savundranayagam et al. 2016). ...
... Human interactions are the primary medium for the establishment and maintenance of personhood; a 'standing or status bestowed on one human being, by another, in the context of relationship and social being' (Kitwood 1997: 8). Interpersonal interactions are therefore essential for the enactment of person-centred care (Savundranayagam et al. 2016). Examining naturally occurring conversation could assist further development of facilitative strategies that promote person-centred care and which are 'empirically grounded in the experiences of people with dementia and their family members' (Kindell et al. 2017: 2-3). ...
... Thus, the framework of 'personhood' (Kitwood 1997), which is integral to the implementation of person-centred care, assists in translating these findings into clinical practice. Personhood is promoted through positive interpersonal interactions that recognize an individual's residual abilities and unique preferences (Savundranayagam et al. 2016). ...
Article
Background: Language and memory impairments affect everyday interactions between individuals with dementia and their communication partners. Impaired topic management, which compromises individuals' construction of relevant, meaningful discourse, is commonly reported amongst individuals with dementia. Currently, limited empirical evidence describes the sequential patterns of behaviour comprising topic-management practices in everyday conversation between individuals with dementia and their communication partners. Aims: To describe the sequential patterns of behaviour relating to the manifestation of topic-management impairments and facilitative behaviours in everyday interactions between individuals with dementia and their familiar communication partners (FCPs). Methods & procedures: Three 20-min conversations between individuals with moderate to severe dementia and their FCPs were recorded. Conversation Analysis was used to examine sequences in which topic-management appeared to be impaired. Outcomes & results: Conversational behaviours that reflected a difficulty in contributing on-topic talk were pervasive in the talk of the three individuals with dementia. FCPs responded to these conversational difficulties by using two categories of facilitative behaviours. The first involved responding to an individual with dementia's explicit repair-initiation by performing repair. In the second category, explicit repair-initiation was absent; instead, the distance of the conversational difficulty from the prior topic-shifting turn mediated the form and outcome of the FCPs' facilitative behaviours. Each category successfully facilitated the individual with dementia to contribute on-topic talk. Conclusions & implications: The findings contribute to a growing understanding of topic-management abilities in everyday interactions involving individuals with dementia. Individuals with dementia took a proactive role in eliciting topic-management support. The FCPs responded with turns that facilitated the individuals with dementia to talk on-topic. Clinically, the results support and extend the current topic-management recommendations available in communication partner training programmes, and promote conversations which attend to the personhood of the individual with dementia.
... Storytelling and life story work have also been suggested as useful conversational approaches to help the person express their experiences, retain their sense of self, as well as develop and maintain relationships (McKeown et al., 2015). Furthermore, personcentered communications wherein staff consider the person's values and embrace a respectful attitude have also been observed to increase conversations and positive reactions in residents with dementia (Savundranayagam et al., 2016). ...
... Although some studies have recruited people living with dementia (e.g. Savundranayagam et al., 2016), only observations of their behavioral responses to communication strategies were made; therefore their experiences and perspectives of communication remains unclear. Historically, people with dementia have been excluded from research as they were assumed to be incapable of participating due to cognitive declines (Cottrell and Schultz, 1993). ...
... Such connectivity could facilitate person-centered care; if others are continually attuning to the person's needs; necessary adaptations could be detected and employed quicker (Acton et al., 2007). Such behaviors and beliefs are features within person-centered communications and have been observed to elicit positive responses in people with dementia (Downs and Bowers, 2014;Savundranayagam et al., 2016). ...
Article
Background Many strategies have been recommended to support caregivers in communicating with people who live with dementia. However, less is known about what makes communication a good and meaningful experience from the perspective of people with dementia. Understanding this may enhance the person with dementia's sense of connectedness, strengthen their relationships, and facilitate person-centered care. The current review aimed to evaluate research that examined experiences of communication in people living with dementia. Studies that examined reports provided by people with dementia, healthcare professionals, and family caregivers were included. Methods A mixed-methods systematic review was conducted using PsychINFO, MEDLINE, and EMBASE databases. Results After applying the eligibility criteria, 15 studies were included. Although eight of these recruited people with dementia, only one focused on their perspectives of communication experiences and the remaining studies focused on the perspectives of family caregivers and healthcare professionals. These studies either explored experiences without suggestions of communication methods, “open exploration,” or through examining experiences of strategies, “exploration of strategies.” A significant theme was around communication difficulties that affected interpersonal relationships and activities of daily living. Conversely, personhood strategies and a strong underlying relationship were believed to facilitate communication. The one study that examined the perspectives of people with dementia emphasized the importance of retaining valued relationships and feeling respected during communication. Conclusions The need to involve people with dementia in research, particularly around their experiences of communication, is evident. Such research would be imperative for facilitating person-centered care, strengthening social relationships, and informing training programs.
... According to Savundranayagam, Sibalija & Scotchemer [27] the framework of PCC reinforces the importance of the affinity between the team and the resident, for it is possible to establish a plan of care for older adults while maintaining their personality, especially for those with dementia, and contributing to their quality of life, with the selection of healthcare professionals in LTCFs being extremely important considering the preferences of the residents and the proximity between the resident and the professional. ...
... A high prevalence was identified for certain issues discussed consistent with PCC: residents' needs, strategies to improve the care provided, and construction of care plans. Thus, the team's attention to residents' quality of life during meetings is prominent, since the points mentioned assume a concern with the individualities of the residents, all of which is crucial for the PCC framework [27] . ...
Article
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Objective: This study aims to discuss the caregiving practices developed by Long-term Care Facilities (LTCFs) during the COVID-19 pandemic and analyze the daily care practices in long-term institutions for older adults in Brazil, all in light of the PCC framework. Methods: This is a mixed methods study in which data were collected through interviews with managers from 10 LTCFs. The qualitative discussion was carried out through the PCC framework divided into 5 categories: leisure, accommodation, food, hygiene and comfort, and clinical care. The quantitative data collected were analyzed in a descriptive way, being discussed in the light of the literature. Results: Analyzed LTCFs are unaware of our present difficulties in the implementation of PCC, with a greater presence of the traditional biomedical model being recognized. Given the vulnerabilities that the LTCFs present, PCC is an important alternative for LTCFs to promote the quality of life and autonomy of residents. Deconstructing the vision of LTCFs as a last resort of care and investing in the quality of care is an urgent and essential imperative for dignified and comprehensive care. Conclusions: This study highlights the need for a change in culture and understanding of the LTCFs not only as a place to provide healthcare, but also as a residents’ home that fosters their autonomy, and feeling of belonging. Thus, it is essential to ensure that healthcare teams in LTCFs know about PCC and that further studies investigate the impact on the costs of PCC for institutionalized older adults.
... In responding to what PWD has said, the listener uses an indirect or direct repair strategy. In the indirect strategy, the listener provides additional descriptive informa-tion through paraphrasing PWD's intended purpose, while in the direct strategy, the listener points out PWD's errors (i.e., word-finding difficulties, misunderstanding), interjects corrective feedback, and infringes on the personhood of PWD by punishing their verbal behavior [25]. In conversation with PWD, if the other individual explains verbally while also illustrating the explanation through body language, the PWD can understand well [26]. ...
... A positive and respectful attitude toward PWD influences the closeness of relationships between PWD and caregivers [31,51]. Acknowledging their perspective makes them feel comfortable and lowers their level of anxiety [25,49]. Making use of their personal information in conversation helps PWD feel that they enable them to retain consciousness of their self-identity [42, 49,52]. ...
Article
Purpose: This paper aimed to clarify the meaning of personhood communication with persons with dementia, by identifying its attributes.Methods: Walker and Avant’s concept analysis method was employed. A literature review was performed using salient medical and health databases such as PubMed, Embase, and CINAHL between 1988 to June 2020. The literature review employed keywords such as “personhood”, “communication”, and “dementia”.Results: Personhood communication with persons with dementia is defined as providing social interaction based on their residual capacities, with adjustments being made in light of their remaining communication abilities, attentiveness to their emotions and respect for their individuality being shown, and decision-making rights being maintained.Conclusion: At the core of personhood communication is respect for persons with dementia and the goal of enabling them to be valid members of society. Further research is needed on the development of educational programs that impart the attributes of personhood communication with persons with dementia.
... Second, as introduced in Section 1.2, it can be expected that PwD react more sensitive to controlling tones of voice because the nonverbal relationship channel remains relatively preserved and becomes more important in the course of dementia when compared to the verbal content channel (Ellis & Astell, 2017;Kuemmel et al., 2014). Furthermore, the beneficial effect of person-centered tones of voice has been indicated by positive associations between person-centered communication styles and residents' cooperation during care activities (Savundranayagam et al., 2016). ...
... Second, individuals with cognitive disorders might react more sensitive to controlling tones of voice because the nonverbal communication pathway becomes more important in the course of dementia when compared to the verbal pathway (Kuemmel et al., 2014). The positive effect of person-centered tones of voice has also been indicated by studies showing positive associations between personcentered communication and residents' cooperation during care (Savundranayagam et al., 2016). This corroborates the general assumption that person-centered communication plays a key role in the care of older adults with dementia-related disorders by affirming personhood (Buron, 2008), whereas controlling communication may threaten it . ...
Thesis
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Objective: Acute care hospital settings represent a challenging environment for vulnerable older patients such as those with dementia. In particular, ageist behavior as reflected in so-called elderspeak communication has been considered as a crucial factor contributing to neuropsychiatric symptoms, suboptimal medical decision making, and poorer treatment outcomes in patients with dementia. Despite its linkage with negative health outcomes, the bulk of previous research on elderspeak has been conducted in nursing home settings and did not simultaneously consider multiple contextual conditions. Following a contextually-driven framework, the present dissertation concentrated on everyday care interactions between older patients and nurses (micro-level) in two German acute hospital settings differing in patient characteristics and geriatric expertise (macro-level). Paper 1 focused on the communication behavior of cognitively impaired (CI) versus cognitively unimpaired (CU) older inpatients. Paper 2 investigated nurses’ emotional tone toward older inpatients with a particular focus on the role of the acute hospital setting and patients’ cognitive impairment. Paper 3 examined the role of proximal (cognitive and functional impairment) and distal contextual factors (acute hospital setting, psychogeriatric knowledge, and evaluative age stereotypes) in predicting the occurrence of elderspeak. Method: Data of all three papers were based on a cross-sectional study focusing on elderspeak in an acute internal medicine ward (n = 36 beds, mean length of stay = 4.9 days) and an acute geriatric ward (n = 35 beds; mean length of stay = 16.5 days). A total of 106 older patients participated in the study. Patients were between 66 and 96 years old (M ± SD Years = 83.08 ± 6.19). Half of the patients (49%) were severely cognitively impaired (M ± SD 6CIT = 10.80 ± 8.60) and 56% were female. In total, 34 registered nurses took part in the study. Nurses were between 22 and 59 years old (M ± SD Years = 38.93 ± 12.30). The majority of nurses were female (79%). Based on a mixed methods design, three types of data sources were used: (a) audio-recordings during the morning (49%) or evening care (51%), (b) patient data from the medical information system, and (c) standardized interviews with patients and nurses. The first paper was based on a psychometric study validating a tool to assess communication behavior in dementia (CODEM) for use in CI patients in the acute care hospital setting. Patients were observed by trained research assistants during a standardized interview situation and rated afterward. In the second paper, an emotional tone rating procedure was performed to differentiate between a person-centered and a controlling tone of nurses’ voice toward older inpatients (Cronbach’s α = .98 for both subscales). A total number of 92 audio-recorded clips were evaluated by 12 naïve raters (M ± SD Age = 32.75 ± 9.33 years) based on their impressions of nurses’ vocal qualities. The third paper was driven by psycholinguistic analysis using manual coding (κ = .85–.97) and computer-assisted procedures for extracting likely harmful (diminutives, collective pronoun substitutions, tag questions) and hybrid features of elderspeak (sentence fragments, mean length of utterances, speech rate, type-token ratio, complex units). Results: The first paper demonstrated that CODEM is a reliable and valid tool to examine the communication behavior of CI patients in the acute care hospital setting. CI patients significantly differed from CU patients in terms of an overall lower frequency of communication behavior as well as a higher occurrence of nonverbal when compared to verbal communication behavior. The second paper revealed that the emotional tone of nurses’ voice toward older patients was perceived as largely person-centered and not so much as control-centered. Finally, the third paper provided further evidence on the existence of likely harmful diminutives (61%), collective pronouns substitutions (70%), and tag questions (97%). An important finding of Paper 2 and 3 was that functional impairment more strongly contributed to controlling tones of nurses’ voice and elderspeak than cognitive impairment and acute hospital setting. Whereas a low percentage of older patients reported perceived age discrimination (2%), more than one third of older patients (36%) endorsed at least one type of ageist event during their hospital stay. Overall, nurses’ views on aging were largely negative. Conclusions: A large interindividual variability of communication resources and deficits has been demonstrated in acutely ill older inpatients. Furthermore, key features of elderspeak have been identified at the verbal and nonverbal communication level. Taken together, the present dissertation provides initial evidence for the occurrence of ageism and elderspeak in acute care hospital settings. Furthermore, it extends previous elderspeak research by discovering the dominant role of functional impairment that may be more strongly involved in the process of negative stereotype activation than cognitive impairment. The present work also provides a unique, multi-level, and interdisciplinary measurement approach for examining ageism in naturally occurring interactions. Such an ecologically valid approach may inform future studies and help to systematically combat ageism in high-risk groups. Finally, the current outbreak of ageism underpins that evidence-based interventions are urgently needed to overcome ageism and to establish a new narrative on aging in the public discourse.
... 8). The notion of personhood is significant in dementia care because the condition can be viewed through the lens of loss, with a focus on the diminishing cognitive abilities of the individual (Savundranayagam, Sibalija, & Scotchmer, 2016). Normative brain functions, especially memory, are highly valued in society (Post, 2006), given that cognition enables functions such as informed choice, decision-making, rationality, and responsible action (Dewing, 2008). ...
... Communication barriers, therefore, have negative effects on the quality of life of PwD, the quality of care provided, and the relationship between formal caregivers and PwD (Eggenberger, Heimerl, & Bennett, 2013). Consequently, it is imperative that formal caregivers possess appropriate and suitable communication skills to interact effectively with PwD (Savundranayagam et al., 2016). ...
Chapter
Persons with dementia experience profound changes in their ability to communicate. The trajectory associated with the condition results in a wide variety of communicative impairments. Communication difficulties hinder the opportunity for social interaction and impede individuals with dementia from expressing needs in a clear and effective manner, consequentially complicating the caregiving experience. However, persons with dementia are capable of communicating when caregivers account for their unique needs. Thus, this chapter examines the use of person-centered communication among formal caregivers of persons with dementia, particularly within the long-term care context. It begins with an overview of dementia, with emphasis on the consequences of communication impairment for individuals with dementia. The chapter then shifts to the concept of personhood, and the ways in which person-centered care can preserve the personhood of persons with dementia. Next, person-centered communication in dementia care is highlighted, with emphasis from theoretical contributions and an overview of methods to measure person-centered communication. We end with a discussion of the effects of person-centered communication on persons with dementia and their formal caregivers.
... Third, the focus on "I matter" highlights the importance of the dyadic relationship between PSWs and persons with dementia. Specifically, person-centered communication from formal caregivers results in positive reactions by persons with dementia which, in turn, can strengthen dyadic relationships (Savundranayagam, Sibalija, & Scotchmer, 2016). The final component is focusing on abilities, social history, and preferences of persons with dementia. ...
... The overwhelming focus was on task completion versus person-centered care. A person-centered approach enables tasks to be completed with less resistance and more cooperation (Savundranayagam et al., 2016). ...
Article
Objectives: This study assessed the feasibility of Be EPIC, a dementia-focused, person-centered communication intervention for personal support workers (PSWs). Be EPIC’s foci includes the environment, person-centered communication, client relationships, and clients’ abilities, social history and preferences. Methods: Feasibility was assessed using semi-structured interviews and focus groups with PSWs. We used a phenomenological approach to assess: acceptability, implementation, practicality, demand, and limited efficacy. Results: The theme supporting the criterion of acceptability was helpful/relevant training. Themes supporting implementation included realistic simulations, interactive training, and positive learning experience at the adult-day center. The theme supporting practicality was support to attend training. Demand for Be EPIC revealed two themes: participants’ personal motivation and barriers to applying newly learned knowledge and skills. The theme reflecting limited efficacy was applying newly learned knowledge and skills with home care clients. Four themes emerged that mapped onto Be EPIC’s foci. Conclusions: The findings support Be EPIC’s feasibility and highlight the need to address structural barriers from employers and government to ensure the delivery of person-centered dementia care. Clinical Implications: The findings highlight the need for and positive impact of person-centered communication training on home care workers, especially the value of learning by doing, reflective practice, and peer support.
... This communication dynamic exists between residents and staff despite aged care staff acknowledgement that effective resident-staff communication is critical to staff ability to develop positive relationships with residents and provide high quality, efficient, individualised care (Bennett, Ward, Scarinci, & Waite, 2014;Forsgren, Skott, Hartelius, & Saldert, 2016;Savundranayagam, Sibalija, & Scotchmer, 2016). ...
... "She would like someone to prompt/ remind her about activities that might be of interest" (R18 (Savundranayagam, Ryan, Anas, & Orange, 2007;Savundranayagam et al., 2016). ...
Article
Background and aim: Irrespective of age, communication is a tool of expression and a key daily activity meeting the human need for social interaction and connection. The introduction of consumer-directed care (CDC) emphasises the importance of communication to provide consumers with the opportunity to exercise choice over the care they receive. As consumer-directed care progresses, it is hypothesised that the feasibility of shared decision-making and care planning in residential aged care will be largely determined by the communication opportunities afforded to the residents. Therefore, the aim of this study was to explore resident perceptions of the opportunities they have to communicate, including the opportunity to express their care preferences and contribute opinions about their care. Design: A qualitative inductive design was adopted. Methods: An individual interview format was used to gather the perspectives of 102 residents. Data were analysed using qualitative content analysis to generate themes illustrating patterns in participant views. Findings: Overall, residents desired increased involvement in their care planning and increased opportunity for more meaningful communication and social opportunities. Residents described the negative impact of the communication difficulties they face on their communication and the need for support and activities to be tailored to residents' individual communication needs. Conclusions: To facilitate resident participation in CDC and meet resident desire for increased social communication, further investment in resources to support resident-staff communication and accommodate residents' individual communication needs is required. Implications for practice: By highlighting communication as a stand-alone activity and a priority of residents, the findings of this study raise the profile of communication and demonstrate the need for explicit allocation of care time and specialist services to support resident-staff communication and social communication in residential aged care. Such support must be tailored to meet residents' individual communication needs and be coupled with increased staff training in providing communication support. Without facilitating resident communication and increasing the opportunity to communicate, shared decision-making and care planning in residential aged care consistent with person-centred and consumer-directed models of care will be limited.
... Rather, he suggests that it is through the informed intervention of others, creating a supportive social environment, that the person with dementia can realize and demonstrate other dimensions of well-being, even into more advanced stages of the condition. While Kitwood, who died in 1998, was criticized for a lack of direct evidence for his claims (e.g., Baldwin & Capstick, 2007), recent research provides supportive evidence for his basic premise (Brooker, 2012, Savundranayagam, Sibalija, & Scotchmer, 2016. For example, residents in long-term care settings responded positively to person-centered communication by cooperating with nursing staff and self-disclosing about their life histories, personal experiences, and desires (Savundranayagam et al., 2016). ...
... While Kitwood, who died in 1998, was criticized for a lack of direct evidence for his claims (e.g., Baldwin & Capstick, 2007), recent research provides supportive evidence for his basic premise (Brooker, 2012, Savundranayagam, Sibalija, & Scotchmer, 2016. For example, residents in long-term care settings responded positively to person-centered communication by cooperating with nursing staff and self-disclosing about their life histories, personal experiences, and desires (Savundranayagam et al., 2016). Additionally, persons with more severe dementia showed the capacity to seek meaning in their circumstances or to exploit opportunities for creative work (e.g., Basting, 2009). ...
Chapter
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This chapter brings together innovative uses of multimedia tools to explore narratives of people living with dementia. The three projects described here share an understanding of the role of narrative-based reminiscing in fostering resilience, particularly as applied to people with dementia. This collective work focuses on supporting people living with dementia, their families, and their communities to sustain resilience and promote well-being. We begin with a discussion of the conceptual foundations underpinning this research.
... 5 The benefits of person-centered care are well studied and suggest improved resident outcomes. [7][8][9] Person-centered care emphasizes that individuals maintain their identity despite cognitive impairment. Nurse aides are tasked with providing person-centered care for residents with dementia by implementing environmental approaches, such as redirection, during daily routines to meet patient needs and bring unique perspectives on caring. ...
... In line with other experimental and qualitative studies examining CNA perspectives, thematic analysis of data from this study revealed the importance of empathy and positive work relationships to job satisfaction. [7][8][9][10][11][12] Incorporating these aspects into training programs for CNAs is critical since it may help reduce CNA turnover. ...
... Changing the culture of nursing homes (NHs) away from their institutional roots to person-centered care is the predominant trend but remains a challenge in today's long-term care settings (Miller, Lepore, Lima, Shield, & Tyler, 2014;Miller, Looze, et al., 2014;Savundranayagam, Sibalija, & Scotchmer, 2016). Communication plays a critical role in person-centered care because it is essential for understanding and responding to the individual's needs in the caregiving process (Savundranayagam et al., 2016). ...
... Changing the culture of nursing homes (NHs) away from their institutional roots to person-centered care is the predominant trend but remains a challenge in today's long-term care settings (Miller, Lepore, Lima, Shield, & Tyler, 2014;Miller, Looze, et al., 2014;Savundranayagam, Sibalija, & Scotchmer, 2016). Communication plays a critical role in person-centered care because it is essential for understanding and responding to the individual's needs in the caregiving process (Savundranayagam et al., 2016). Communication that recognizes and affirms the individual is a key aspect of person-centered care (Buron, 2008). ...
Article
Person-centered communication recognizes the individual as a person and responds to the individual’s feelings, preferences, and needs. This secondary analysis tested four interdisciplinary strategies to measure changes in person-centered communication used by nursing home staff following an intervention. Thirty-nine nursing assistants were recruited from 11 nursing homes and participated in the three-session Changing Talk communication training. Video recordings were collected at baseline, immediately postintervention, and at 3-month follow-up. Staff communication was analyzed using behavioral, psycholinguistic, and emotional tone coding of elderspeak communication and content analysis of communication topics. Sign rank test was used to compare postintervention changes for each measure of communication. Postintervention improvements in communication occurred for each measure; however, the changes were statistically significant only for behavioral and psycholinguistic measures. Methods and results for each communication measure were compared. Implications for future research and use of measures of person-centered communication as a tool to improve care are discussed.
... A person-centered approach to care is emphasized for use in longterm care settings (Savundranayagam, 2014) since it denotes high quality care for persons living with dementia (Passalacqua and Harwood, 2012). Communication is essential in the provision of person-centered care (Passalacqua and Harwood, 2012;Savundranayagam, 2014;Savundranayagam et al., 2016). Furthermore, part of realizing personcentered care is embracing the role of nonverbal communication in interactions with older adults (Hubbard et al., 2002). ...
Article
Background Many people living with dementia experience challenges comprehending language and benefit from nonverbal communication supports. Little published empirical evidence exists for care partners regarding supportive strategies for nonverbal communication with people living with dementia. This study aimed to conduct a scoping review of nonverbal strategies for care partners which have been observed to support communication with people living with dementia. Methods Current best practices for scoping research guided this review. CINAHL, PsycInfo, Scopus, and Pubmed databases were searched December 8, 2020. Empirical studies that examined the supportiveness of nonverbal communication strategies used by care partners of people living with dementia were eligible. All publication dates were included. Eligible studies were published in English in peer-reviewed journals. Studies were screened first by title and abstract, and subsequently by full-text review. Data charting was conducted using an evidence summary table, which was subsequently used for analysis. Results were presented in the form of a written summary. Results Sixteen studies were included in the final review. Six categories of supportive nonverbal communication strategies were identified: eye contact, gestures, facial expression, touch, close proximity, and frontal orientation. Studies observed six outcomes which indicated that these nonverbal strategies were supportive for communication with people living with dementia; however, person-centered outcomes were limited. Conclusions The review identified supportive nonverbal communication strategies used by care partners with people living with dementia in the current literature. Disagreement exists in the literature regarding which outcomes define supportive nonverbal communication with people living with dementia. This in combination with the benefits of person-centered approaches to care with people living with dementia presents a critical need to delineate which nonverbal communication strategies are person-centred in future research. Tweetable abstract. Six supportive nonverbal communication strategies identified by scoping literature review, but there is disagreement in how the literature defines “supportive” @marie_y_s @EmmaBender19.
... As for the residents, several communication characteristics are often assessed. Verbal features include sharing personal information about themselves, contributing to conversations, and using intelligible utterances (Cohen-Mansfield et al., 2014;Savundranayagam et al., 2016). Non-verbal features include positive affect, eye contact and smile toward the nursing aide, engagement in activities, and responsiveness to social contacts (Cohen-Mansfield et al., 2014). ...
Article
Objectives This study examined the emotional availability of nursing aide-resident with dementia dyads in a long-term care-facility. Emotional availability refers to the nursing aide’s sensitivity toward the resident, structuring their interactions in a non-intrusive and non-hostile manner and the resident’s responsiveness to and involvement of the nursing aide. The study evaluated the reciprocity in the emotional availability of nursing aides and the residents and examined whether emotional availability varies with the level of difficulty of taking care of the residents and with the context of the interaction. Method The study was conducted in three wards in one long-term care-facility. Twenty nursing aides and 40 residents took part in the study. Each nursing aide was videotaped during feeding, structured and unstructured interactions, with two residents, one that was nominated by the head nurse as difficult to take care of and one that was nominated as easy to take care of. The interactions were coded using the emotional availability scales. Results Linear mixed-effect model analyses indicated that higher emotional availability of nursing aides was related to higher emotional availability of the residents. Nursing aides’ emotional availability did not vary between “difficult” and “easy” residents or across the three interaction contexts. “Difficult” residents involved their nursing aides less than “easy” residents. Discussion The study documented the reciprocal nature of the interaction between nursing aides and residents with dementia. It suggests that nursing aides have an important role in promoting residents’ responsiveness and involvement.
... Discussed more fulsomely below, the central attributes of a person-centred care philosophy, namely relationship, individualism, holism, respect and empowerment, are ideally integrated into the care milieu through day-to-day communication and interactions between providers and residents when providers demonstrate effective relational (personcentred) behaviours during interactions. Conversely, it has been suggested that missed opportunities for person-centred communication in long-term care homes undermine provider-resident communication and relationships and can result in negative responses from residents, including resistiveness to care and distress (Savundranayagam et al., 2016). ...
Article
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The intricacy and impact of human communication has long captured the attention of philosophers, scholars and practitioners. Within the realm of care and service provision, efforts to maximize outcomes through optimal person-provider communication have drawn research and clinical focus to this area for several decades. With the dawning of the person-centred care movement within healthcare, and in particular long-term care home and dementia care settings, improvement in care providers’ use of person-centred communication strategies and enhancement of relationships between residents, their families and care providers are desired outcomes. Thus, several person-centred care and communication theoretical perspectives have been employed to ground study in this field. However, a comprehensive theoretical position to underpin person-centred communication in dementia and older adult research does not exist to our knowledge. To offer expansion to the theoretical work in this emerging field, a Person-Centred Communication Enhancement Model for long-term care and dementia care is proposed, as well as rationale for its development. This discussion will also provide an overview and critique of the extant philosophies, theories, frameworks and models that have been utilized in the study of person-centred communication within the context of long-term care and dementia care.
... Approach : Approach concerns a combination of verbal and non-verbal skills ("how you say it") and consists of three subthemes: communication style, adapting to individual and flexibility . Person-centred communication, a style characterized by recognition, negotiation, facilitation and validation, and styles characterized by consideration and relational behaviours predict positive resident reactions and are therefore beneficial to communication ( Edberg et al., 1995 ;McGilton et al., 2012 ;Savundranayagam et al., 2016 ). Styles characterized by infantilizing speech and controlling emotional tone (elderspeak) or by controlling a task without including the resident influence communication negatively Strandroos and Antelius, 2017 ). ...
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Background Communication between nursing staff and people with dementia can be challenging. According to the literature, communication is seen as a process of social- and/or informational exchange between a sender and a receiver in a context. Factors related to these elements determine the quality of communication. Insight into the factors involved in the communication process between nursing staff and people with dementia is limited and a comprehensive model of communication in dementia care is lacking. Objectives To identify and visualize factors associated with communication between nursing staff and people with dementia. Design A scoping review of scientific literature. Data Sources Scientific articles were retrieved from the bibliographic databases of PubMed, CINAHL and PsycINFO. Review Methods The reviewing process was directed by the Joanna Briggs guidelines for scoping reviews. Full-text articles describing the communication process between nursing staff and people with dementia were eligible for inclusion. A data extraction form was used to identify factors associated with communication. Following a directed content analysis approach, factors were categorized in one of three categories: nursing staff; people with dementia; or context. Each category was thematically analysed to identify themes and subthemes. Results were visualized into a communication model. Results The review included 31 articles; in total, 115 factors were extracted. Thematic analysis of nursing staff factors (n = 78) showed that communication is associated with professional characteristics, individual experiences, verbal- and non-verbal communication skills, communication approach and values. Factors attributed to people with dementia (n = 22) concerned client characteristics, functional status, behaviour, verbal communication skills and values. Contextual factors (n = 15) related to organization of care, time and situation. Based on these results, the Contac-d model was constructed. Conclusions The Contac-d model gives a comprehensive overview of factors involved in the communication process between nursing staff and people with dementia, providing insight in potential starting points for communication improvement, e.g. respect for needs, identity and privacy of people with dementia, a flexible and adapted communication approach and matching language. Additionally, results suggest that an appealing location, longer duration of the interaction, and music in the surrounding may improve communication in certain situations. However, it was not feasible based on current literature to recommend what works to improve communication in which situations. Future studies should study factors and their interrelatedness in specific care situations. Authors further believe that more attention should be paid to strengths and capabilities of people with dementia and to non-modifiable factors that influence communication.
... With a growing NH population suffering from chronic progressive illnesses and evolving patterns of comorbidities, EOL communication has an even more critical role to enable HCPs to gather information about the resident's wishes for care at the EOL and organise the care plan accordingly (6). When communication takes place and makes HCPs aware of a resident's preferences, a natural death with controlled symptoms reflecting the individual's preferences is more likely (2). ...
Article
Background With a growing nursing home population suffering from chronic progressive illnesses and evolving patterns of comorbidities, end‐of‐life communication takes on a critical role to enable healthcare professionals to gather information about the resident’s wishes for care at the end‐of‐life and organise the care plan accordingly. Aim To explore nurses’ perspective about the process by which end‐of‐life communication impacts on the goal of end‐of‐life care in nursing home residents. Design A qualitative descriptive research design based on thematic analysis was performed. Fourteen nurses involved in the care of residents during their last week of life were recruited across 13 Italian nursing homes and accounted for 34 semi‐structured interviews. A combined approach of analysis that incorporated a data‐driven inductive approach and a theory‐driven one was adopted. Results Twelve themes described how end‐of‐life communication may contribute to adjust the care plan in nursing home according to the nurses’ perspective. Five antecedents (i.e. life crisis or transitions, patient‐centered environment, arising the question of possible dying, quality of relationships and culture of care) influenced the establishment and quality of communication, and five attributes depicted the characteristics and potential mechanisms of end‐of‐life communication (i.e. healthcare professional‐resident and healthcare professional‐family carers communication, knowledge of family carers’ preferences, knowledge of residents’ preferences, family carers and residents understanding, and shared decision‐making), while curative‐oriented and palliative‐oriented care goals emerged as consequences. Conclusion This study provides insight into the nursing perspective of end‐of‐life communication between healthcare professionals and bereaved family carers of nursing home residents. Several factors influenced the occurrence and quality of end‐of‐life communication, which contributed to the transition towards palliative‐oriented care by using and improving knowledge about family cares’ and resident’s preferences for end‐of‐life care, promoting family carers and residents understanding about prognosis and treatments available, and fostering shared decision‐making.
... Residents, particularly those with dementia, may lack the ability to verbally or non-verbally communicate their needs which may cause them agitation (McGilton et al., 2017). There may be missed opportunities for staff to enhance social interactions with residents and engage in person-centred communication (Savundranayagam, 2014;Savundranayagam, Sibalija, & Scotchmer, 2016). Involving residents in their care and decision-making can foster a personcentred approach to care, yet it was not clear from our study how staff determined the residents' capacity for making decisions. ...
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Aim The aim of this study was to explore shared decision‐making among residents, their families and staff to determine relevant strategies to support shared decision‐making in long‐term care (LTC). Background Meaningful engagement of long‐term care home (LTCH) residents and their families in care decisions is key in the provision of quality of care. Shared decision‐making is an interprofessional approach to increasing resident and family engagement in care decisions which can lead to higher quality decisions, more relevant care interventions and greater resident, family, and staff satisfaction. Despite these advantages, shared decision‐making has not been widely implemented in practice in LTC. Methods The study took place in one LTCH in Toronto, Ontario, Canada. A qualitative descriptive design was used to explore how residents, family members and staff described how they collaborate when making decisions concerning resident care, and their perceptions of facilitators and challenges to a collaborative approach to decision‐making. Individual interviews were conducted with nine participants: residents, families and staff. Data were analysed using content and thematic analysis. Findings Four main themes that described resident, family and staff perspectives of shared decision‐making were as follows: (a) oral communication pathways for information sharing; (b) supporting resident decision‐making autonomy; (c) relational aspects of care facilitate shared decision‐making; and (d) lack of effective communication creates barriers to shared decision‐making. Conclusion As the demand for LTC continues to increase, it is crucial that healthcare providers engage in collaborative, relational practices that foster high‐quality resident care. While a relational approach to care can facilitate shared decision‐making, there are opportunities to further cultivate shared decision‐making in LTCHs through more effective communication and collaboration. Implications for practice Understanding how information is shared and decisions are made can facilitate shared decision‐making in LTCHs. The strategies identified from this study could be further co‐developed and implemented in LTCHs.
... PCCommunication is felt to be a necessary operational component of quality person-centred dementia care (Brooker, 2007;Downs & Collins, 2015;Kitwood, 1997). The importance of PCCommunication has been supported by evidence that indicates LTC residents react more positively (Savundranayagam, Sibalija, & Scotchmer, 2016), experience enhanced mood and affect (McGilton, Sidani, Boscart, Guruge, & Brown, 2012), and report higher levels of well-being (Custers, Kuin, Risken-Walraven, & Westerhof, 2011) when health care providers demonstrated effective relational behaviours during interactions. ...
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Aim: A discussion of the use of video feedback as an effective and feasible method to promote person-centred communication approaches within dementia care and long-term care. Background: Effective strategies to integrate person-centred approaches into health care settings have attracted global attention and research in the past two decades. Video feedback has emerged as technique to enhance reflective learning and person-centred practice change in some care settings; however, it has not been tested in the context of person-centred dementia communication in long-term care. Design: Discussion paper. Data sources: Articles dating from 1995 to 2018 retrieved via searches of the SCOPUS, CINAHL, MEDLINE and Cochrane Systematic Review databases. Implications for nursing: Inclusion of video feedback in a person-centred dementia communication intervention for nurses and other health care providers may effectively fill a gap evident in the literature. This intervention can offer feedback of enhanced quality and enduring impact on behaviour change relative to traditional training. Conclusion: A critical review of empirical and theoretical evidence supports video feedback as a potential means to enhance person-centred communication within the context of dementia and long-term care. The promising benefits of video feedback present a novel research opportunity to pilot its use to enhance person-centred communication between nurses/health care providers and persons with dementia in long-term care.
... Second, individuals with cognitive disorders might react more sensitive to controlling tones of voice because the nonverbal communication pathway becomes more important in the course of dementia when compared to the verbal pathway (Kuemmel et al. 2014). The positive effect of person-centered tones of voice has also been indicated by studies showing positive associations between person-centered communication and residents' cooperation during care (Savundranayagam et al. 2016). This corroborates the general assumption that person-centered communication plays a key role in the care of older adults with dementia-related disorders by affirming personhood (Buron 2008), whereas controlling communication may threaten it (Williams et al. 2017). ...
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The emotional tone of nurses’ voice toward residents has been characterized as overly controlling and less person-centered. However, it is unclear whether this critical imbalance also applies to acutely ill older patients, who represent a major subgroup in acute hospitals. We therefore examined nurses’ emotional tone in this setting, contrasting care interactions with severely cognitively impaired (CI) versus cognitively unimpaired older patients. Furthermore, we included a general versus a geriatric acute hospital to examine the role of different hospital environments. A mixed-methods design combining audio-recordings with standardized interviews was used. Audio-recorded clips of care interactions between 34 registered nurses (Mage = 38.9 years, SD = 12.3 years) and 92 patients (Mage = 83.4 years, SD = 6.1 years; 50% with CI) were evaluated by 12 naïve raters (Mage = 32.8 years, SD = 9.3 years). Based on their impressions of the vocal qualities, raters judged nurses’ emotional tone by an established procedure which allows to differentiate between a person-centered and a controlling tone (Cronbach’s α = .98 for both subscales). Overall, findings revealed that nurses used rather person-centered tones. However, nurses’ tone was rated as more controlling for CI patients and in the geriatric hospital. When controlling for patients’ functional status, both effects lost significance. To our knowledge, this is the first study that examined nurses’ emotional tone in the acute hospital setting. Findings suggest that overall functional status of older patients may play a more important role for emotional tone in care interactions than CI and setting differences.
... Person-centered care has been regarded as the gold standard for healthcare and has emphasized the importance of providing meaningful activities and a positive social environment where the intrinsic value of people with dementia as unique human beings can be nurtured (Institute of Medicine, 2001;Kaufmann & Engel, 2016;Kitwood, 1997). Studies found positive outcomes of utilizing person-centered approaches for people with dementia, including improved communication and interaction with people with dementia, decreased behavioral symptoms and psychotropic medication use, and enhanced staff's attention to needs of residents with dementia (Chenoweth et al., 2015;Li & Porock, 2014;Savundranayagam, Sibalija, & Scotchmer, 2016). With better understanding about people with dementia, older volunteers in this study took on active advocacy roles voluntarily by talking to others including their friends and church members to correct misunderstanding about people with dementia and giving information about the program to neighbors who may benefit from joining the program. ...
Article
This qualitative study aimed to explore older adults' perspectives on volunteering in an activity-based social program for community-dwelling people with dementia, called Stepping Stones. Semi-structured interviews were individually conducted with eight older adults who had volunteered in Stepping Stones. Interpretative phenomenological analysis was used to analyze interview data. Four themes related to learning experiences of older volunteers in Stepping Stones emerged. These themes include: (a) Self-growth and confidence in working with people with dementia; (b) understanding dementia, people with dementia, and needed support for people with dementia and their families; (c) desire not to develop dementia, while recognizing that anything can happen in old age; and (d) exercising person-centered approaches and taking on advocacy roles. Findings suggest that older volunteers gain feelings of personal growth and confidence in working with people with dementia, better understanding, and enhanced attitudes toward people with dementia through volunteering in an activity-based social program for people with dementia. Older adults will be able to fill the needs of community programs for people with dementia, while experiencing benefits from volunteering and learning in later life. Further research is needed to examine to what extent having previous dementia experiences make their experiences and learning different.
... Attempts have been made to develop instruments for assessing degree of person-centredness in communication [24][25][26]. Savundranayagam and colleagues have developed a scheme for coding frequency of use of person-centred communicative strategies with people with communication difficulties due to dementia [27][28][29]. In this instrument a nursing staff 's use of communicative strategies is quantified without considering the context of the communicative interaction. ...
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Introduction: Thousands of individuals with communication disorders live in long-term residential care. Nursing staff are often their primary communication partners. The positive effects of social interaction and person-centred care have been recognised but there remains a paucity of research on the content and quality of communicative interaction between long-term care staff and residents with aphasia. This mixed method study investigates the discourse in interaction between nursing staff and residents with aphasia. Methods: A routine care activity was explored in 26 video-recordings featuring four enrolled nurses and four elderly persons with severe aphasia. Factors such as goals and roles in the activity were mapped out and a qualitative discourse analysis was performed. Based on the findings a coding scheme was constructed and the amount of time spent in different interactional foci of discourse was explored. Results: From the qualitative findings three broad, but distinct, foci in the nurse-initiated interaction could be distinguished: (1) a focus on getting the task done with minimum interaction; (2) topics related to the task, but not necessary to get the task done; and (3) personal topics related to themes beyond the caring task. The analysis of distribution of time revealed that although most of the interaction was focused on the main care activity, between 3 and 17% of the time was spent in either task-related or non task-related interaction. The distribution varied between dyads and could not be related to the residents' severity of aphasia nor the activity as such. Conclusions: An endeavour to interact socially with the residents with aphasia influences the nurses' foci of interaction. Contextual and personal factors of the residents and nurses need to be considered in clinical work as well as research on how communication may be supported to facilitate social interaction and person-centredness in long-term care of people with aphasia.
... From the first session on, the SLT systematically used the narrative stories of the PwDs and caregivers and their own words for the contents of the ICA and thematic texts. To get the required information from the dyads, the SLT used a combination of languagebased communication strategies (such as affirmations, repetition, yes/no questions and rephrasing) and personcentred communication strategies (such as facilitation of conversation, validation of feelings, recognition of life history), which have been demonstrated to be helpful [27][28][29]. The application of these communication strategies, and the therapeutic abilities that go with it, shows similarities with the philosophy of person-centred (dementia) care, which is based on Rogers' [30] and Kitwood's [31] ideas of involving the life history, values, and personal preferences of a PwD in any intervention process, employing skills such as empathy, sensitivity, and active listening. ...
Article
Objective: To identify the essential elements of a newly developed, practice-based logopaedic intervention, which focuses on communication between persons with dementia (PwDs) and their caregivers. Methods: The intervention of 6 one-hour sessions was conducted and evaluated with 4 PwD-caregiver dyads. Eighteen therapy sessions were video recorded and semi-structured interviews with all dyads and an interview with the speech-language therapist (SLT) were audio recorded. Framework analysis and triangulation were used to analyse the data. Results: Five elements were found, which were systematically applied in the treatment of all dyads: interactive history taking, dynamic assessment, education about consequences of dementia for communicative effectiveness, development and use of two communication tools, and specific didactic strategies of the SLT. Regarding the outcome of the treatment, the dyads valued the focus on the interaction between PwD and caregiver, the usefulness of the received pieces of advice, and the empowering attitude of the SLT, which improved their self-confidence. The SLT added another element for an efficient approach: the ability to deliver treatment in people's home environment. Conclusion: A short pragmatic but consistent approach for communication problems caused by dementia seems promising for improving daily communication and reducing stress and frustration. Further research will explore the feasibility and efficacy of this approach.
... Effective communication can ensure that nursing staff fulfil the needs of older adults and also elicit positive reactions from these patients (Savundranayagam, Sibalija, & Scotchmer, 2016). This has prompted an increasing number of studies into strategies for improving communication with older adults in long-term care facilities, which emphasise the importance of nurses and patients getting to know one another and devoting sufficient time for interactions in order to facilitate communication. ...
Article
Aims and objectives: To explore barriers to ethical nursing practice for older adults in long-term care facilities from the perspectives of nurses in South Korea. Background: The number of older adults admitted to long-term care facilities is increasing rapidly in South Korea. In order to provide this population with quality care, a solid moral foundation should be emphasized to ensure the provision of ethical nursing practices. Barriers to implementing an ethical nursing practice for older adults in long-term care facilities have not been fully explored in previous literature. Design: A qualitative, descriptive design was used to explore barriers to ethical nursing practice as perceived by registered nurses in long-term care facilities in South Korea. Methods: Individual interviews were conducted with 17 registered nurses recruited using purposive (snowball) sampling who care for older adults in long-term care facilities in South Korea. Data were analyzed using qualitative content analysis. Results: Five main themes emerged from the data analysis concerning barriers to the ethical nursing practice of long-term care facilities: emotional distress, treatments restricting freedom of physical activities, difficulty coping with emergencies, difficulty communicating with the older adult patients, and friction between nurses and nursing assistants. Conclusions: This study has identified methods that could be used to improve ethical nursing practices for older adults in long-term care facilities. Because it is difficult to improve the quality of care through education and staffing alone, other factors may also require attention. This article is protected by copyright. All rights reserved.
... Most of the above aspects by Kitwood were also identified by care staff when asked to describe the characteristic of person-centred communication: incorporation of life history, preferences, and the person's feelings (Savundranayagam, Sibalija, & Scotchmer, 2016). The importance of relationships were described in a review conducted by Eriksen et al. (2016) where people living with dementia experienced a change in relations like being disconnected and with a feeling of loss of social function due to reduced cognitive function. ...
Article
Older adults living in long term care (LTC) facilities may experience increased isolation and loneliness. This was compounded with the Coronavirus Disease 2019 (COVID-19) pandemic. Loneliness and isolation increase the risk for physical, psychological, and social decline. This case report discusses the effect of a letter writing initiative on feelings of loneliness and connection in a long-term care resident. Personalized care is the standard in the long-term care setting and letter writing between two people can contribute to personalized meaningful care as evidenced by the example provided. Further research is needed to explore social connection and loneliness and methods to combat these issues with a personalized approach for different populations within LTC facilities.
Article
Purpose This study aimed to develop an ICF core set to profile communicative competence in dyadic communication among adults who use communication devices in Taiwan. Materials and Methods The study was conducted following the release of a manual by the World Health Organisation (WHO) on how to develop the International Classification of Functioning, Disability and Health (ICF) core set in three phases: Preparatory Phase, Phase I, and Phase II. The Preparatory Phase helped collect and sort second-level ICF codes into a candidate list based on different perspectives, including the Systematic Literature Review Phase (i.e., researchers’ perspectives), Empirical Multi-Center Study Phase (i.e., clinical perspectives), Qualitative Study Phase (i.e., perspectives of individuals with a health condition), and Expert Survey Phase (i.e., health professionals’ perspectives). An ICF core set was developed from the candidate list in Phase I through the Delphi technique, and the content validity of this core set was assessed in Phase II. Results Altogether, 94 s-level ICF codes in the candidate list from the Preparatory Phase were included in the three rounds of the Delphi technique for Phase I. Finally, these 94 s-level ICF codes were validated and included in the core set for Phase II, including 28 in Body Functions (b), 0 in Body Structures (s), 42 in Activities and Participation (d), and 24 in Environmental Factors (e). Conclusions The developed ICF core set provides an evaluation tool to profile communicative competence in dyadic communication among adults using communication devices. This core set identifies the gap and future opportunities for further examining the care providers’ roles, together with exploring the environmental facilitators and barriers. The implications concerning rehabilitation, limitations, and the way forward are discussed. • Implications to Rehabilitation • This core set was first developed in the context of Taiwan from the perspectives of adults and professionals who used communication devices to profile communicative competence in dyadic communication. • This core set, which can be utilised across health care disciplines, can serve as the foundation for more holistic evaluation, profiling levels of communicative competence in daily dyadic communication among adults who use communication devices. • Rehabilitation providers may decide, based on this core set, if communication devices should be proposed for adults again in order to minimise the abandonment of subsidised communication devices. • Levels of communicative competence in daily dyadic communication among adults who use communication devices can be profiled through this ICF core set.
Article
The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited from the memory care unit. Delivery, receipt, and enactment of the PPCI were assessed for feasibility. Change in staff outcomes and facility outcomes were examined for preliminary efficacy. The four steps of the PPCI were implemented as intended with 100% staff exposure to education and considerable staff engagement in weekly mentoring sessions. Although there was an improvement in AL environment and policy, no significant changes were observed in staff outcomes. Future testing of the PPCI should include a longer timeline and explore a hybrid model that includes online education and in-person mentoring and coaching of staff to improve care interactions. [Journal of Gerontological Nursing, 48(8), 17-25.].
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This research covers the design of a digital simulation tool, from identification of training needs to analysis of the simulation produced by testers from a demonstration scenario. It is based on the development of a simulation tool for training caregivers in geriatrics in France, as part of a multidisciplinary research and development project known as VirtuAlz and supported by the French National Research Agency. Training needs were identified from a study of the current challenges of communicating with patients with Alzheimer’s disease or other related forms of dementia. There are two parts to the process of designing the simulation environment. First, the design of the simulation scenario builds on what caregivers actually do (from observations and interviews). Second, the design process continues through the analysis of the figurations produced during the simulation by a group of experienced and inexperienced testers. This work offers the potential of promising avenues for the design, which is being produced jointly by simulation specialists and experts from the field of simulation environments for training purposes.KeywordsSimulationTraining designAlzheimer’s diseaseProfessionals healthcareNonverbal communication
Article
Background Little is known about formal caregivers’ lived experiences communicating with persons living with dementia (PLWD) who live in their own homes. Most information comes from research conducted in long-term care settings or home care settings involving family care partners. Yet, there are expected needs and rising demands for formal caregivers to provide support within clients’ homes. Objectives Accordingly, this study aimed to understand the lived experiences of personal support workers (PSWs) regarding their communication with PLWD who live in their own homes. Methods The study was grounded in a hermeneutic phenomenological research approach. Data were collected as part of the Be EPIC project, an evidence-informed, person-centred communication intervention for PSWs caring for PLWD. One, in-depth semi-structured interview was conducted with each of the PSWs (N = 15). Thematic analysis was completed on the interviews. Results Three major themes emerged: (1) Challenged by dementia-related impairments; (2) Valuing communication in care; and (3) Home is a personal space. Findings revealed that PSWs experience difficulties communicating with PLWD because of dementia-related impairments, despite PSWs recognizing the importance of communication when they provide optimal care in the homes of PLWD. This suggests that PSWs view communication as a crucial component of quality care but do not possess the skills necessary to ensure effective interactions. Findings also demonstrated the importance, uniqueness and impact of the personal home space on PSWs’ experiences with communication. Conclusion Overall, findings indicate that PSWs acknowledge the importance of communication as an integral element of providing optimal care, but dementia-related impairments and the intimate, personal home-based care context can hinder successful communication between PSWs and PLWD. The implications of the findings are that additional and targeted education and training are required for PSWs, especially on how dementia-related impairments impact communication within the context of home care based services for PLWD.
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Background Nursing students need experiences providing patient centered care for persons with dementia. Methods Students were provided with a voluntary opportunity to complete an online educational module that focused on caring for persons with dementia. Dementia knowledge was measured with the Alzheimer Dementia and Knowledge Scale and confidence was assessed with the Sense of Competence in Dementia Care Staff Scale. Results Data suggested that students developed an increased confidence in caring for persons with dementia after the education. Key to person centered care, students demonstrated an increased ability to sustain person hood and build relationships. Conclusions The growing complexity and needs of persons with dementia in various practice settings requires a nursing workforce able to apply clinical reasoning and provide person centered care. Further studies are needed exploring the effects of online educational opportunities on learning outcomes and clinical reasoning to build confidence in caring for persons with dementia.
Article
Purpose Interpersonal skills are increasingly important tools in long-term care with older people, especially against the backdrop of loneliness affecting older people and expectations for a person-centred, joined-up approach. However, the term is used as a composite and its definition lacks shape and focus. In existing literature, participants appear to be selected on the basis of specific illnesses rather than age. Better understanding of the features of everyday communication processes associated with person-centred care can lead to improvements in policy and practice. Design/methodology/approach A scoping review examined communication features associated with person-centred care for older adults. This identified the extent and nature of literature. Several databases were searched; after screening and hand-searching, 31 were included. Findings were analysed for patterns and contradictions, against the objectives of person-centred and integrated care. Findings Emotional intelligence and the ability to employ various communication styles are crucial skills of person-centred communication. Such approaches can have positive effects on the well-being of older people. Research limitations/implications Some studies' validity was weakened by methodological designs being founded on value judgements. Practical implications Using personalised greetings alongside verbal and non-verbal prompts to keep residents emotionally connected during personal care is considered good practice. Stimulating feedback from people using services and their relatives is important. Originality/value The role of communication is highlighted in many professional guidance documents on person-centred and integrated care, but the process of implementation is decentralised to individual employers and workers. This paper draws on the findings of contemporary literature, grounded in naturalistic data, with implications for practice and policy.
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Preparing a healthcare workforce able to respond to the growing complexity of health issues facing older adults is a critical issue for interprofessional educators. Students are in need of experiences promoting confidence and skill in communicating with older adults with cognitive issues. Student emotional and cognitive responses to an interprofessional Music and Memory® project in long term care facilities were evaluated. Forty-eight students met with assigned adults weekly to develop personalized music playlists and complete a journal entry. Student participants demonstrated improved interpersonal connections, enhanced professional skills, and increased empathy toward clients. Results are explored within the context of Kolb’s Learning Theory and application of the evaluation outcomes for interprofessional education.
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Nursing students need innovative educational approaches to bridge generational and cultural differences and improve communication skills with patients who are cognitively impaired. An individualized music and memory intervention for older adults with dementia and communication issues was implemented. A review of weekly student journals provided information regarding the use of the approach as an alternative therapy and benefit for students. The usefulness of the music and memory program as an innovative learning tool has widespread applicability to various health care settings.
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The prevalence of individuals living with dementia worldwide is expected to increase exponentially; yet these individuals receive minimal recommended quality of care. Physical therapists are a valuable component of the comprehensive medical care team serving individuals with cognitive impairment. Utilization of evidence-based outcome measures to determine optimal care is critical to improving the effectiveness of care for individuals with cognitive impairment , decreasing the variability in the evaluation process. The purpose of this article is to describe functional outcome tools to assist skilled physical therapists with the evaluation process, essential to enhancing the quality of the individualized plan of care.
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The prevalence of individuals living with dementia worldwide is expected to increase exponentially; yet these individuals receive minimal recommended quality of care. Physical therapists are a valuable component of the comprehensive medical care team serving individuals with cognitive impairment. Utilization of evidence-based outcome measures to determine optimal care is critical to improving the effectiveness of care for individuals with cognitive impairment, decreasing the variability in the evaluation process. The purpose of this article is to describe functional outcome tools to assist skilled physical therapists with the evaluation process, essential to enhancing the quality of the individualized plan of care.
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The older adult population in long-term care is experiencing significant growth, which includes an increased number of minority admissions. An estimated 48% of long-term care patients are admitted with a diagnosis of dementia. Patient-centered, culturally appropriate care is critical in the management of dementia and treatment of associated behavior and psychological symptoms of dementia (BPSD). The use of personalized music playlists has shown promise in the interdisciplinary treatment of BPSD. Regulatory agencies are closely monitoring the management of BPSD. Accurate diagnosis and treatment of BPSD is an increasingly important skill for the provider.
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Background: There are many recommended language-based strategies for effective communication with persons with dementia. What is unknown is whether effective language-based strategies are also person centered. Accordingly, the objective of this study was to examine whether language-based strategies for effective communication with persons with dementia overlapped with the following indicators of person-centered communication: recognition, negotiation, facilitation, and validation. Methods: Conversations (N = 46) between staff-resident dyads were audio-recorded during routine care tasks over 12 weeks. Staff utterances were coded twice, using language-based and person-centered categories. There were 21 language-based categories and 4 person-centered categories. Results: There were 5,800 utterances transcribed: 2,409 without indicators, 1,699 coded as language or person centered, and 1,692 overlapping utterances. For recognition, 26% of utterances were greetings, 21% were affirmations, 13% were questions (yes/no and open-ended), and 15% involved rephrasing. Questions (yes/no, choice, and open-ended) comprised 74% of utterances that were coded as negotiation. A similar pattern was observed for utterances coded as facilitation where 51% of utterances coded as facilitation were yes/no questions, open-ended questions, and choice questions. However, 21% of facilitative utterances were affirmations and 13% involved rephrasing. Finally, 89% of utterances coded as validation were affirmations. Conclusions: The findings identify specific language-based strategies that support person-centered communication. However, between 1 and 4, out of a possible 21 language-based strategies, overlapped with at least 10% of utterances coded as each person-centered indicator. This finding suggests that staff need training to use more diverse language strategies that support personhood of residents with dementia.
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A communication skills intervention was developed based on Dawn Brooker’s four elements of person-centered dementia care: Valuing people, Individualized care, Personal perspectives, and Social environment (VIPS). The aim of this study was to test the feasibility of a series of workshops built around VIPS, intended to increase the person-centered communication, beliefs, and attitudes among paraprofessional dementia caregivers in a long-term care facility. The effect of the intervention on communication strategies, caregiver burnout, and other variables associated with the quality of caregiving was examined using a pre- and post-test design. Details of the intervention design and execution are dis- cussed, as are findings regarding intervention outcomes. The intervention was determined to be highly feasible based on successful implementation, positive caregiver feedback, and promising exploratory analyses of outcome measures. Following the work- shops there was a reduction in caregiver depersonalization of residents and an increase in both empathy and hope for those with dementia. In addition, caregivers reported using more concrete communication strategies known to be effective with those who suffer from dementia. Given this encouraging preliminary evidence, the VIPS communication skills intervention is suggested as a useful tool to improve the quality of dementia care provided by paraprofessional caregivers in long-term care facilities.
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Chapter
The purpose of this chapter is to highlight the communication and language strategies involved in key positive care interactions identified by Kitwood (1997a) as central to affirming personhood of individuals with dementia. We focus upon the enactment of these strategies in the challenging environment of long-term care. In these facilities, residents typically are in the moderate or severe stages of dementia; staff are necessarily task-oriented; and very little knowledge is available about the residents prior to disease onset. Communication features of the positive care interactions are illustrated through transcript selections from recorded conversations in a long-term care facility with one individual in the moderate stage of dementia. As person-centered conversations lead to reciprocity, contributions on the part of the person with dementia are also shown. The real value of the examples of positive care interactions is that they reinforce the position that individuals with dementia, even those who are in the more advanced stages, retain communicative competence and are active contributors to interpersonal relationships. Moreover, the examples serve to debunk the myth that individuals with dementia in long-term care facilities are nonfunctioning, passive communicators.
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The qualitative analysis of naturally occurring discourse in neurogenic communication disorders, specifically in dementia studies, has experienced recent burgeoning interest from wide-ranging disciplines. This multidisciplinarity has been exciting, but has added contextual confusion. This book advances the study of discourse in dementia by systematically exploring and applying different approaches to the same free conversational data sets, collected and transcribed by the authors. The applied methodologies and theories comprise a useful sourcebook for students, researchers, and practitioners alike. © 2006 by Lawrence Erlbaum Associates, Inc. All rights reserved.
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A recent paper by (Temple et al., 1999) investigating the politeness abilities of Alzheimer's sufferers has suggested that the sufferers they worked with were capable of employing politeness strategies towards their interlocutor. Given that politeness, according to (Brown and Levinson, 1987) revolves around face and that attending to another person's face requires the ability to take the other's role or perspective, Temple et al.'s findings would seem to contradict the findings of (Hamilton, 1988) who made the claim that Alzheimer's sufferers are unable to take the role of the other. Our proposal is that a more sophisticated view of politeness is required in identifying what the Alzheimer's patient is capable of. A refinement of the notion of politeness would also allow us to reconcile these two views. This refinement may be usefully achieved through employing the subdivision made by (Janney and Arndt, 1992) who propose that social politeness be distinguished from tact. In this approach, it is tact that involves facework while social politeness is more conventionalized or routinized. The distinction between tact and social politeness allows us to recognise certain politeness behaviours as not involving facework. Applying this distinction to our data, we rnd that our subject does engage in social politeness but, as one would expect from Hamilton's assumptions, she does not appear to be able to attend to the face of her interlocutors with much show of tact. However, in relation to facework, whilst she does not demonstrate much awareness of the need to protect the other's face, she does, in fact, engage with some sophistication in saving her own face. In this paper, we aim to examine not whether Alzheimer's Disease sufferers have the ability to be polite or not but which aspects of politeness remain after other aspects appear to have been lost.
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This article outlines the development of distress reaction training in a large care home charity, provided by directly employed My Home Life Admiral nurses, who are mental health nurses specialising in dementia. Reference is made to the limitations of a person-centred approach to care, and the importance of relationship-centred care, which underpins the My Home Life social movement for quality improvement in care homes. The authors argue that relationship-centred care is a more helpful approach to improve the lived experience and wellbeing of residents, relatives and staff. Potentially, it might also help to address high staff turnover in the care home sector.
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Deterioration of verbal abilities is among the most debilitating consequences of Alzheimer's disease (AD). Recent research suggests that the common responses of conversational partners may contribute to excess verbal deficits in persons with AD in that they function to punish verbal behavior. The purpose of this study was to systematically evaluate two types of listener repair responses, indirect and direct repairs, on the conversational speech of older adults with AD. In an indirect repair, the listener paraphrases the speech of the person with AD. In a direct repair response, the listener interjects with corrective feedback. Three men diagnosed with AD participated in this study. A female confederate was trained in indirect and direct repair responses. An ABAC single subject design was used to evaluate the effects of listener repair responses on the amount, duration, and fluency of the speech of the participants during videotaped conversations with the confederate. The results indicate that the confederate's responses significantly impacted the conversational speech of older adults with AD. Indirect repair responses by the confederate were associated with higher levels of coherent speech for all participants compared to the direct repair and baseline conditions. The results indicate that indirect repair responses may decrease the risk of excess verbal deficits in persons with AD by functioning to reinforce (i.e., increase) speech. The findings have implications for the training of care-givers of persons with AD. Training caregivers in responses that reinforce rather than punish verbal behavior may prevent or reduce excess disability thereby improving the quality of life for persons with AD and their care-givers.
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This study is a critical analysis of the components of a communication skills training program designed to increase the quantity and quality of nursing aides' (N = 126) verbal interactions with residents with dementia (N = 125) during care routines. Training included a didactic in-service, one-on-one, criterion-based training during care interactions, the use of memory books, and a staff management system. Results indicated that this communication skills program significantly improved nursing aides' effective skills (p > .001), effective instructions (p > .01) and manner of communication during care interactions with residents. One-on-one performance training and feedback was required to master and maintain skill use 3 months beyond program termination.
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Assessed nursing care for people with dementia at 6 sites in a psychogeriatric service, using dementia care mapping (DCM). All care settings showed at least a good standard of care, with highest care value scores being achieved by a day hospital and an occupational therapy craft group. Results suggest a role for DCM in quality assurance and staff training. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
A conceptual model and objective scale for measuring resistiveness to care in individuals with advanced dementia of the Alzheimer type (DAT) were empirically generated from the perspective of nursing staff caregivers and through observation of residents with DAT. The resistiveness to care scale (RTC-DAT) was judged to have content validity and reduced to 13 items. Quantifiable scoring procedures and methods for rating videotapes and conducting clinical observations were developed. The RTC-DAT was tested with 68 subjects at three sites. The RTC has a range of 0–156. Initial testing provided reliability estimates of .82–.87 for internal consistency and good to excellent kappas. Criterion-related validity with observed discomfort and construct validity by factor analysis support the RTC-DAT. Measurement issues and recommendations for use in research are discussed. © 1999 John Wiley & Sons, Inc. Res Nurs Health 22: 27–38, 1999.
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The aim of this study was to identify the communication behaviours and strategies used by socially skilled geriatric nurse aides working with residents in long term care facilities. Communication skills are recognized as tools for establishing relationships and accomplishing care related tasks. A small but growing research literature exists within gerontology around geriatric nurse aide/resident communication. The present study was intended to contribute to this literature. This study used an exploratory qualitative design involving personal interviews with geriatric nurse aides. Interviewers carried out 90-minute interviews with 16 nurse aides who worked at an assisted living facility or a nursing home. Of interest was the extent to which established systems for coding interactions could be used to code nurse aide/resident interactions, or whether new categories would emerge. The novel finding that all of the aides used a communication strategy that could be characterized as 'giving positive regard', defined as acknowledging the resident, treating the resident with respect. The category of 'giving positive regard' included specific behaviours which can be included as content in communication skill training programs.
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The Shewan Spontaneous Language Analysis (SSLA) system is designed to describe and quantify aphasic subjects' connected language using a picture description task. The 12 SSLA variables measure the three components of the linguistic system and additional general parameters of verbal output. Intrajudge, interjudge, and test-retest reliability are within acceptable psychometric standards. The SSLA correlates significantly with clinical judgments of the severity of connected language impairment. The system differentiates aphasic from normal performance, using both clinical and statistical methods. SSLA performance data for a group of aphasic subjects and a group of normal controls will be presented.
Article
Nurse-patient cooperation during morning care in two wards for the care of severely demented patients (107 observations) were analyzed by using a hermeneutic-phenomenological approach. Nurse-patient cooperation was found to be characterized by their acting in mutuality or unilaterality and in or out of pace with each other. When acting iri pace and mutuality, the nurse and patient turned to each other as persons as well as to the task. This theme related to confirming nurse actions and actions that provided opportunities for the patient to participate. When acting out of pace and unilaterality, cooperation was mainly task oriented and related to acts of resistance, the use of force, loss of attention or turning to others, or the patient wanted to escape. The findings were interpreted within the contexts of power, empowerment, and powerlessness and may serve as indicators of low- or high-quality nurse-patient cooperation during morning care provided for demented patients.
Article
A conceptual model and objective scale for measuring resistiveness to care in individuals with advanced dementia of the Alzheimer type (DAT) were empirically generated from the perspective of nursing staff caregivers and through observation of residents with DAT. The resistiveness to care scale (RTC-DAT) was judged to have content validity and reduced to 13 items. Quantifiable scoring procedures and methods for rating videotapes and conducting clinical observations were developed. The RTC-DAT was tested with 68 subjects at three sites. The RTC has a range of 0-156. Initial testing provided reliability estimates of .82-.87 for internal consistency and good to excellent kappas. Criterion-related validity with observed discomfort and construct validity by factor analysis support the RTC-DAT. Measurement issues and recommendations for use in research are discussed.
Article
To evaluate the efficacy of two nonpharmacological techniques in reducing agitation, aggression, and discomfort in nursing home residents with dementia. The techniques evaluated were person-centered showering and the towel bath (a person-centered, in-bed bag-bath with no-rinse soap). A randomized, controlled trial, with a usual-care control group and two experimental groups, with crossover. Nine skilled nursing facilities in Oregon and six in North Carolina. Seventy-three residents with agitation during bathing (69 completed the trial) and 37 nursing assistants who bathed them. Agitation and aggression were measured using the Care Recipient Behavior Assessment; discomfort was measured using a modification of the Discomfort Scale for Dementia of the Alzheimer Type. Raters who were blinded to subject status coded both from videotaped baths. Secondary measures of effect included bath duration, bath completeness, skin condition, and skin microbial flora. All measures of agitation and aggression declined significantly in both treatment groups but not in the control group, with aggressive incidents declining 53% in the person-centered shower group (P<.001) and 60% in the towel-bath group (P<.001). Discomfort scores also declined significantly in both intervention groups (P<.001) but not in the control group. The two interventions did not differ in agitation/aggression reduction, but discomfort was less with the towel bath (P=.003). Average bath duration increased significantly (by a mean of 3.3 minutes) with person-centered showering but not with the towel bath. Neither intervention resulted in fewer body parts being bathed; both improved skin condition; and neither increased colonization with potentially pathogenic bacteria, corynebacteria, or Candida albicans. Person-centered showering and the towel bath constitute safe, effective methods of reducing agitation, aggression, and discomfort during bathing of persons with dementia.
Article
After a brief introduction to Dementia of the Alzheimer's Type (DAT), its behavioral diagnostic symptom complex and a summary of communicative implications, we present data from two conversations involving participants with and without DAT. We discuss the concept of "order" in conversation, and the central importance of interactional monitoring. Conversational success and problems in interactions with persons with DAT are seen as emergent from situationally embedded conversations in the presence of cognitive and linguistic impairments on the part of the person with DAT, and of contextually situated communicative impairment resulting therefrom.
Article
This paper presents an evaluation of a communication enhancement intervention on staff and patients in a complex continuing care facility. The importance of effective communication as a fundamental element of nursing has been emphasized and is regarded as integral to the provision of quality patient care. For people residing in complex continuing care (similar to long-term care facilities), opportunities for socialization occur primarily during interactions or communication with staff, and these interactions have been found to be limited. One way to improve nursing staff communication is through a communication enhancement intervention. Twenty-one nursing staff members (Registered Nurses, Registered Practical Nurses and healthcare aides) working in a complex continuing care environment and 16 patients participated in this study, conducted in the summer of 2003. A repeated measures design was used to evaluate the effects of the communication enhancement intervention on outcomes. Data were collected from patients and nurses at baseline, 5 weeks into the intervention and at 10 weeks after the intervention. Nurse outcome variables included nurses' job satisfaction and their relationships with patients; patient outcome variables included two measures of patient satisfaction with care. Nursing staff felt closer to their patients (F(2,40) = 3.0, P = 0.045) following the intervention and reported higher levels of job satisfaction (F(2,40) = 4.1, P = 0.02). No changes were found in the level of patient satisfaction with care. Our results suggest that nursing staff can feel better about their job and about their patients as they enhance their communication skills. Understanding the barriers to finding time to talk with patients for a few minutes a day, outside of direct hands-on caregiving, requires further exploration.
Article
Resistiveness to care (RTC) by persons with dementia significantly adds to subjective and objective burden for caregivers and may be triggered by environmental factors, including communication. This case study evaluated behavioral responses of a nursing home resident with dementia to nursing staff use of elderspeak communication (infantilizing speech). Four videotaped staff-resident interactions that were previously recorded were coded for staff elderspeak communication and resident RTC. Total elderspeak scores (M = 29.5, SD = 25.74) and RTC scores (M= 8.75, SD = 13.79) were correlated r= 0.93, p = .03. This preliminary single-subject observational study suggests a relationship between staff elderspeak communication and RTC in a nursing home resident with dementia that warrants further investigation. Limitations include the use of a convenient case study sample with inability to control time of day, medications, different care activities, staff characteristics, and other factors. Knowledge about communication in dementia care may inform nursing care practices to overcome behavioral symptoms such as RTC and improve quality of life for individuals with dementia and working conditions for nursing staff.
Article
When caring for people with severe Alzheimer's disease (AD), the concept of the person being central is increasingly advocated in clinical practice and academia as an approach to deliver high-quality care. The aim of person-centred care, which emanates from phenomological perspectives on AD, is to acknowledge the personhood of people with AD in all aspects of their care. It generally includes the recognition that the personality of the person with AD is increasingly concealed rather than lost; personalisation of the person's care and their environment; offering shared decision-making; interpretation of behaviour from the viewpoint of the person; and prioritising the relationship as much as the care tasks. However, questions remain about how to provide, measure, and explore clinical outcomes of person-centred care. In this Review, we summarise the current knowledge about person-centred care for people with severe AD and highlight the areas in need of further research.
Article
Resistiveness to care is common in older adults with dementia. Resistiveness to care disrupts nursing care, increasing costs of care by 30%. Elderspeak (infantilizing communication used by nursing staff) may trigger resistiveness to care in individuals with dementia. Videotaped care episodes (n = 80) of nursing home residents with dementia (n = 20) were coded for type of staff communication (normal talk and elderspeak) and subsequent resident behavior (cooperative or resistive to care). Bayesian statistical analysis tested relationships between staff communication and subsequent resident resistiveness to care. The probability of resistiveness to care varied significantly with communication (Bayes P = .0082). An increased probability of resistiveness to care occurred with elderspeak (.55, 95% CrI, .44-.66), compared with normal talk (.26, 95% CrI, .12-.44). Communication training has been shown to reduce elderspeak and may reduce resistiveness to care in future research.
Dementia Reconsidered: The Person Comes First
  • T Kitwood
Kitwood T. Dementia Reconsidered: The Person Comes First. Bristol, PA: Open University Press; 1997.
Effect of person-centered showering and the towel bath on bathing-associated aggression
  • P D Sloane
  • B Hoeffer
  • M Mitchell
Sloane PD, Hoeffer B, Mitchell M, et al. Effect of person-centered showering and the towel bath on bathing-associated aggression, Positive resident utterances Example
Staff: Don't throw them on the floor. Resident: No. ''Ow, ow, ow!'' agitation, and discomfort in nursing home residents with dementia: A randomized, controlled trial
Distress 29 : expressions of pain, discomfort or anxiety. Staff: Don't throw them on the floor. Resident: No. ''Ow, ow, ow!'' agitation, and discomfort in nursing home residents with dementia: A randomized, controlled trial. J Am Geriatr Soc. 2004;52(11): 1795-1804.