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Module three Communicating effectively Communicating effectively This module covers: 3.1 Understanding communication 3.2 Communication strategies 3.3 Cultural differences and supporting families 1 Learning outcomes At the end of this session you will be able to: • Define the term communication • Demonstrate the use of a range of communication techniques • Provide support to clients using reality orientation, validation and reminiscence • Identify barriers to communication and strategies to overcome them • State the impact of dementia on carers and describe a range of communication techniques to support families • Provide support and guidance to family members 2 3.1 Understanding communication SENDER (Idea) RECEIVER Verbal & Non-Verbal Verbal & Non-Verbal RECEIVER SENDER (Idea) 3 •Blah Elements of communication • Spoken words 10% • Tone of voice 30% • Body language No, I’m NOT upset! 60% •Blah •Blah •Blah •Blah We tend to believe body language over verbal messages when they don’t match! All behaviour is a form of communication 4 What makes it hard to communicate? People with dementia may … • mumble their words and not make sense • not be able to pronounce words properly • not look at you • stare away with a vacant look in their eyes • not answer your questions • just make awkward sounds • not understand what you are saying • cut across your conversation • look away with distraction from a noise • not follow the theme of the conversation in a logical way • remain quiet all the time How may they be feeling? People with dementia may feel … • miserable because they are in pain • unwell because they are experiencing a change in medication or medication side effects • frustrated because they forget how to speak English and revert to their original language, • worried about experiencing a health problem • anxious by who you remind them of • scared by too much background noise • confused by someone who is speaking too quickly • uncomfortable because the light is too bright or too glary • feeling lost in an unfamiliar environment Barriers to communication SENDER Verbal & Non-Verbal RECEIVER (Idea) Barriers RECEIVER Verbal & Non-Verbal SENDER (Idea) 7 Progressively shrinking vocabulary Vague & less communicative Changes to communication Repetitive words or movements Problems verbalising ideas Problem naming objects, people, events Problem reasoning aloud Great difficulty understanding Can’t self-correct Early Progression Mute Late 8 3. 2 Strategies for effective communication Verbal • Five ‘s’ • Slow • Simple • Specific • Show • Smile • Use familiar words • Reflect • Repeat, Rephrase 9 Strategies for effective communication Non Verbal • • • • • • • • Gain Attention Active listening (ears and eyes) Warm and calm (pleasant) Tone of voice Face to face Facial expressions and gestures Don’t talk above or around the person, or shout Never argue and watch the position of your body 10 Rephrasing and Reflecting • Demonstrates active listening • Control of the conversation stays with the person • Encourages person to expand on their topic • How? • Use key words • Respond to feelings 11 Practical strategies for effective communication • Accepting attitude • Speaking clearly • Body language • Right environment • Right level and words 12 Different strategies and techniques • Reminiscence • Reality orientation • Validation Person centred & relationship focused approach Strategies that can IMPROVE QUALITY OF LIFE! 13 Reminiscence Definition: the process of ‘recalling the past’ Purpose: • to help maintain identity, self esteem and maintain well-being • develop a sense of usefulness, happiness, fulfilment and fun • may assist dealing with old conflicts or difficulties Examples: speaking, thinking or writing about past events 14 Reality Orientation (24hr) Definition: the process of ‘putting in touch with now’ reminding of day, time, relationships and occasions Purpose: • help put people in touch with the present (passive 24 hour approach – patterns, routines) • reduce stress & reassure (not confronting) • gain cooperation, learn or maintain skills (not arguing) Examples: introduction, diaries, labels, calendars, notes 15 Validation Definition: accepting and acknowledging the feelings of the person with dementia Purpose: to enable the person to feel accepted and to encourage expressions of their feelings • ‘entering into the their world’ • putting ourselves in touch with their feelings (empathy) Examples: ‘walking beside them, wherever they happen to be’. Naomi Feil (1992) 16 3.3 Communication, cultural differences and working with families • Australia is culturally diverse • Person-centred care focuses on the uniqueness of each person • Culture is an important component of care • Culture does not just mean people from other countries but differences from growing up in different ways e.g. rural and city, rich and poor 17 People from diverse cultural and linguistic backgrounds Similarities and differences between people: Same Different Unique Culturally sensitive strategies • Don’t stereotype • Learn about the culture - ask! • Respect traditions • Develop links & partnerships • Learn some words • Learn non verbal norms • Use aids • Use interpreters 19 Supporting families • The impact of dementia on families • The impact of placement on families • Strategies for supporting families • The importance of partnerships with family in dementia care Understanding their caring journey 20 Remember… all carers are unique • • • • • • Personal responses to their individual journey Support systems Coping styles Relationships with their person with dementia Health Values and beliefs about caring and using services • Expectations 21 Family Carer – the caring journey Understanding family carers & their stresses EMOTIONAL RESPONSES Coping with painful feelings CARING KNOWLEDGE & SKILLS Understanding dementia & coping with caring role 22 Common carer needs Emotional support Time out & Self care skills Knowledge about dementia and caring Information and practical support 23 Practical application Care workers need to be able to… • Listen first and talk second • Be empathetic – ‘it must be hard when ….’ • Be non-judgemental • Do not jump into defending • Refer on … 24 Partnerships with families Families give us: Families need us to: • Background information to help with problem-solving • Communicate openly and honestly • The words, the routines, the stories, the history, the interests and more • Recognise their expertise • Helpful hints on previous routines for personal care. • Enable them to be involved in care management. • Provide support, information, respite and self care skills 25 Listen to the Music not the words People with dementia seem to retain their ability to sense and remember feelings when they have lost the ability to recall events Work with the feelings 26 Key Messages 1. 2. 3. 4. 5. Watch your body language & tone of your voice Slow, simple, specific, show, smile and go at the person’s pace One message at a time and don’t argue Recognise, respect and include cultural diversity Remember the caring journey is unique for each family. REMEMBER…We cannot change how the person communicates but we can change so they can understand us. 27