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Dementia Communication Techniques: Part 1 Or CONNECT with the Positive Physical Approach . Melanie Bunn, RN, MS, GNP m elanie.bunn@yahoo.com Geriatric Grand Challenge Institute: Dementia Care Duke University School of Nursing March, 2013.

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dementia communication techniques part 1 or connect with the positive physical approach

Dementia Communication Techniques: Part 1OrCONNECT with the Positive Physical Approach

Melanie Bunn, RN, MS, GNP

melanie.bunn@yahoo.com

Geriatric Grand Challenge Institute: Dementia Care

Duke University School of Nursing

March, 2013

slide2

ObjectiveDemonstrate &discuss how non-verbal communication techniques (PPA) improve interactions with people with dementia

critical questions
Critical Questions…
  • Is it hard to “help”?
  • Is it hard to be “helped”?
  • So, sometimes, our helping isn’t helpful!!!
so which t do you choose
So…Which “T” do you choose???

Do you want to TANGLE or TANGO???

if you want to
If you want to…

Tangle:

Tango:

Go with the flow

Help at the level of the person’s loss

Listen with your eyes, ears, heart and spirit

Simplify, don’t baby-fy

Build a caregiving team

Take time away, physically, emotionally & spiritually

  • Argue
  • Take over too quickly/try to help too much
  • Ignore what the person says or does
  • Treat the person like a child
  • Do it all by yourself
  • Don’t take any time for yourself
tangle or tango
Tangle or Tango
  • When you tangle:
    • You think about the differences
    • You help too much or not enough
    • You interpret responses as “resistant to personal care”, “aggressive”, “mean” or “manipulative”
  • When you tango:
    • You realize they’re just like us
    • With the lid off
the 3 truths
The 3 Truths

1. People with dementia are doing the best they can

2. Their care partners are doing the best they can

3. Caregiving is difficult…

for the person doing AND the person receiving the care

So…it’s all about the relationship!!!

what would we like the person with dementia to do when we approach
Try to get away?

Try to stop us?

Cling to the chair?

Refuse help?

Get intimidated?

Freeze?

Be afraid?

Try to strike or hit?

Attend

Respond

Participate

What would we like the person with dementia to do when we approach?
positive physical approach
Positive Physical Approach
  • Come from the FRONT

Make sure they are aware of you, before you get close or touch (knock, call out)

  • OPEN PALM

Adult greeting, movement directs to face, offers safe point of contact

  • NOT too FAST

One second - one step OR let them come to you

positive physical approach1
Positive Physical Approach
  • NOT in FRONT

Use supportive stance NOT confrontational

Provides visual and physical ‘out’ for the person

  • Establish HAND contact

Greet the person as a ‘friend’ rather than as a ‘threat’

Provides safety for you from striking out

Prevents wandering or leaving

positive physical approach2
Positive Physical Approach
  • CHANGE to hand UNDER hand

Reduces stress

Provides control

  • Take a SEAT, SQUAT or KNEEL

Sit down or get down to the person’s level

Reduce intimidation without invading space

connect with the positive physical approach
CONNECT with thePositive Physical Approach

CONNECT

C Come from the front

O Open palm

N Not too fast

N Not in front

E Establish hand contact

C Change to hand under hand

T Take a seat/squat/kneel

so how do non verbal communication techniques improve interactions with people with dementia

So, how do non-verbal communication techniques improve interactions with people with dementia?

teaching dementia communication techniques experiential education

Teaching Dementia Communication Techniques:Experiential Education

Melanie Bunn, RN, MS, GNP

melanie.bunn@yahoo.com

Geriatric Grand Challenge Institute: Dementia Care

Duke University School of Nursing

March, 2013

ppa connect debrief
PPA/CONNECT debrief
  • What happened in the previous exercise?
  • How did you respond to the exercise?
  • Why do you think you had that response?
  • How do you think others you work with might respond to this type of exercise?
  • Do you think you can use this approach?
slide19

Experiential Learning Cycle

(developed from work by David A. Kolb)

Experiencing

Applying

Publishing

Generalizing

Processing

experiencing
Experiencing

Start by

DOING SOMETHING!

Participating

Practicing

Physically trying

publishing
Publishing

Share reactions and observations

  • Talking
  • Thinking
  • Describing how, what

“What happened?”

“How did you respond?”

“How did that feel for you?”

“What was easy/hard?

processing
Processing

Patterns

  • Discussion of why
  • Describe relationships

“Why do you think that happened?”

“How would this impact outcomes?”

generalizing
Generalizing
  • Relate experience to theories
  • “Teaching”
    • Underlying expertise and knowledge
    • Examples from experience
    • Case examples
applying
Applying

Plan for changes to practice

  • Reflecting on how the information can be applied in clinical environment
  • Connecting what you know with what you do

“How will you change your behavior/ practice?”

processing questions
Processing Questions
  • What happened?
  • How did you feel?
  • Do you think others might have similar responses?
  • How does this relate to what you know?
  • How can this change your practice?
slide26

Another Way of looking at the Experiential Learning Cycle

Do Something

Have Learners SHARE @ what happened

Try IT out…

Ask learners to THINK OUT LOUD @ what it means…

Figure IT Out!?

homework
Homework

First: Develop some comfort and skill

  • 3 times with a control (family, co-worker)
    • Ask for feedback
    • Evaluate yourself
  • 3 times with a person with dementia who isn’t distressed
  • 3 times with a person with dementia who is a bit distressed
homework1
Homework

Then: Share what you’ve learned

  • Teach it to 3 people
  • Could be family members of people with dementia, co-workers
  • Can do individually or in a group
  • But you must!!!

teach it the way you learned it

making a change howell 1982
Making a change (Howell, 1982)
  • Unconscious incompetence
  • Conscious incompetence
  • Conscious competence
  • Unconscious competence
incompetence howell 1982
INCOMPETENCE (Howell, 1982)
  • Unconscious
    • Unaware of needed change in behavior
    • “I’m fine.”
  • Conscious
    • Aware of needed behavior change
    • “I’m not fine…I need to change!”
    • Often get overwhelmed at how much/how difficult change might be
    • Not failure…practice!!!
competence howell 1982
COMPETENCE (Howell, 1982)
  • Conscious
    • Careful about what you do and how you do it
    • “I can do it if…”
  • Unconscious
    • Brain rewired
    • Body rewired
    • Not aware of doing correct behavior
    • “I’m fine, now let me show you”
making it work
Making it work
  • Probably takes about 5-6 weeks to move from UI to UC
  • You need to get to the level of competence before you try to teach
  • You develop competence by practicing
  • For this homework, some of you are dealing with 2 processes, the practice skill (PPA) and the teaching skill (ELC)
final words
Final words
  • You are adult learners so…
  • Feel free to modify to meet YOUR needs!!!
  • If you are truly skilled at PPA,

try it with people who are different, (sensory impairments, Parkinson’s disease, asleep).

  • If you are a truly skilled teacher,

teach someone else to teach.

  • Make it work for YOU!!!