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[email protected]Understanding Communication in Persons with Dementia PICOT
The number of older people living with dementia is increasing every day and this requires healthcare systems to prepare adequately to deliver special care. Dementia is a condition that impairs an individual’s cognition leading to symptoms of memory loss, communication difficulties, personality changes, and problems with thinking (Livingston et al., 2020). During care delivery, communication issues make it difficult for providers to understand what type of care to deliver and how to effectively pass the required message without triggering distress (Carpenter et al., 2022). This discussion focuses on understanding communication with persons living with dementia and interventions to address the observed communication challenge.
PICOT Question
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Among elderly patients aged 65 and older living with dementia (P), how effective is staff training (I) compared to no training (C) in improving understanding communication in persons with dementia (O) within six weeks?
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PICOT Problem
Communicating medical interventions and receiving proper feedback is a difficult task for all aging adults. Effective communication among these individuals is always affected by emotions, health literacy, and cognitive impairment among many others (Røsvik & Rokstad, 2020). Dementia is among the chronic conditions that affect an individual’s ability to understand information and communicate properly. For example, hearing loss is among the frequently observed challenges for the elderly meaning that providers may have to shout to pass information (Nguyen et al., 2019). At the same time, shouting may be distressing to these individuals leaving inexperienced nurses with limited options to convey information.
People living with dementia are vulnerable and the constant need for attention makes providers feel ill-equipped to care for and effectively communicate with them. Individuals with dementia are often acutely unwell and complications of pain or delirium may contribute to difficulties in care delivery (Machiels et al., 2017). Problems with communication are observed to cause prolonged hospitalization, higher readmission rates, and even death. The affected individuals may have issues with memory, reasoning, recognition, and decision-making. Severe cases may render the individual unable to construct sentences making the passage of information difficult (Harwood et al., 2018). Interventions like teach-back that can be used to improve understanding of information for other groups minimally elicit responses in dementia patients. To effectively improve understanding of communication, nurses must be well-trained on proper ways to communicate with these patients, choice of words, and other aspects like tone which influence how information is perceived.
Nursing Intervention
The proposed intervention to address the challenge of communication among dementia patients is education and training. Preparing nurses to meet the care needs of the aging population requires careful planning (Harwood et al., 2018). All nurses must be prepared to deal with communication difficulties that come with dementia and how to engage their patients during care delivery. According to evidence-based research, nurses in acute care hospitals lack the knowledge, skills, and confidence to care for people with dementia (Morris et al., 2018). It is observed that most providers undervalue and estimate the skills required to effectively pass information and plan appropriate care for the elderly living with dementia. The proposed intervention will focus on communication competencies like slow communication, limiting utterances to one proposition, and using simple language (Naughton et al., 2018). Identifying solutions to the communication challenge and incorporating the solutions into communication skills training can help to improve the knowledge, confidence, and communication behaviors of nurses.
Summary
Establishing positive and meaningful communication with dementia patients is a problem for nurses and other healthcare providers. Communicating and interacting with these patients becomes challenging because of cognitive impairment and other changes that occur among the elderly. An intervention to improve understanding of communication with dementia patients is required to help nurses deliver good care that can improve outcomes of this special population.
References
Carpenter, C. R., Leggett, J., Bellolio, F., Betz, M., Carnahan, R. M., Carr, D., … & Weintraub, S. (2022). Emergency department communication in persons living with dementia and care partners: A scoping review. Journal of the American Medical Directors Association, 23(8), 1313-e15.
https://doi.org/10.1016/j.jamda.2022.02.024
Harwood, R. H., O’Brien, R., Goldberg, S. E., Allwood, R., Pilnick, A., Beeke, S., … & Schneider, J. (2018). A staff training intervention to improve communication between people living with dementia and health-care professionals in hospital: The VOICE mixed-methods development and evaluation study. Health Services and Delivery Research, 6(41). http://hdl.handle.net/20.500.12904/7990
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., Orgeta, V., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet (London, England), 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
Machiels, M., Metzelthin, S. F., Hamers, J. P., & Zwakhalen, S. M. (2017). Interventions to improve communication between people with dementia and nursing staff during daily nursing care: A systematic review. International Journal of Nursing Studies, 66, 37-46.
https://doi.org/10.1016/j.ijnurstu.2016.11.017
Morris, L., Horne, M., McEvoy, P., & Williamson, T. (2018). Communication training interventions for family and professional carers of people living with dementia: A systematic review of effectiveness, acceptability and conceptual basis. Aging & Mental Health, 22(7), 863–880.
https://doi.org/10.1080/13607863.2017.1399343
Naughton, C., Beard, C., Tzouvara, V., Pegram, A., Verity, R., Eley, R., & Hingley, D. (2018). A feasibility study of dementia communication training based on the VERA framework for pre-registration nurses: Part II impact on student experience. Nurse Education Today, 63, 87-93.
https://www.doi.org/10.1016/J.NEDT.2018.01.024
Nguyen, H., Terry, D., Phan, H., Vickers, J., & McInerney, F. (2019). Communication training and its effects on carer and care‐receiver outcomes in dementia settings: A systematic review. Journal of Clinical Nursing, 28(7-8), 1050-1069. https://doi.org/10.1111/jocn.14697
Røsvik, J., & Rokstad, A. M. M. (2020). What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature. BMC Health Services Research, 20(1), 1-20. https://www.doi.org/10.1186/S12913-020-05618-3
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