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Navigating the Divide :. How to Communicate Effectively with Dementia Patients. Objectives. Understand the behaviors associated with dementia and their causes Identify techniques to manage such behaviors Identify unspoken cues by dementia and Alzheimer’s disease patients

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navigating the divide

Navigating the Divide:

How to Communicate Effectively

with Dementia Patients

  • Understand the behaviors associated with dementia and their causes
  • Identify techniques to manage such behaviors
  • Identify unspoken cues by dementia and Alzheimer’s disease patients
  • Provide techniques to help engage patients suffering from dementia and Alzheimer’s disease
the divide
The Divide
  • Gaps in cognition make it unable to communicate
  • Meaningful connections
  • Quality of life
  • Burnout

The Disorders of Loss

definition and criterion
Definition and Criterion
  • Dementia is characterized by loss
    • Loss of ability to understand spoken or written language
    • Loss of ability to identify or remember objects
    • Loss of ability to perform motor activities
    • Loss of ability to think abstractly
  • These manifest as a loss of autonomy, control and oneself.

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

common causes of dementia
Common Causes of dementia
  • Over 70 types of dementia
  • Often comorbid or “mixed”
  • Alzheimer’s Disease
  • Vascular Dementia
  • LewyBody Dementia
  • Frontotemporal Degeneration
  • Hydrocephalus
basics of alzheimer s
Basics of Alzheimer’s
  • Understanding the disease
  • Progressive
  • Degenerative
  • Ultimately fatal
barriers to communication
Barriers to Communication

As a Result of Dementia and Related Diseases

methods of management
Methods of Management


Joining Patient’s Reality

  • Short term memory is effect them
  • Honest with patients
  • Relive painful trauma
  • Death
  • Patients physically cannot retain information
  • Follow along with what the patient believes is true
dementia s role in behavior
Dementia’s role in behavior
  • Keep in mind how far reaching the grasp of dementia can be
  • What if our brains couldn’t complete the command or message
  • What would happen if you couldn’t recognize what normal functions of the body feel like
    • Urination
    • Hunger
    • Pain
  • Imagine the anxiety and behavior you would exhibit if you didn’t know that these feelings could be resolved
recognizing barriers to communication
Recognizing Barriers to Communication
  • Identify underlying causes
  • Question
  • Overcome
  • Assess
  • Repeat if necessary
behavior as a barrier
Behavior as a Barrier
  • As the ability to communicate wanes, behavior is the main way patients can communicate
  • Problem Behavior Vs. Nuisance Behavior
  • Must choose which behaviors are necessary to manage
  • Some may not need management
  • “Pick your battles”
behavior barriers
Behavior Barriers
  • Nuisance behavior – Behaviors which do not put the patient or staff at risk; these may just be behaviors which are odd or socially unacceptable.
    • Singing
    • Repetitive speech
    • “Babies”
    • Word Salad
behavior barriers1
Behavior Barriers
  • Problem behaviors – Behaviors that could result in emotional or physical harm to the patient or staff.
    • Delusions
    • Hallucinations
    • Wandering
    • Sexual Inappropriateness
    • Lack of Interest in Cleanliness
question the behavior
Question the behavior
  • Discern if the behavior is in fact needing to be managed

Singing may be a nuisance behavior at 3pm, but it may be a problem behavior at 3am

  • If it needs managed, what could the behavior mean
    • Consider what the client is not saying
    • Are there non verbal cues
    • Is this a common behavior
    • Is the patient more disoriented than normal
overcome the behavior
Overcome the Behavior
  • Use cues from the client’s history to redirect to another activity
    • Not wanting to bathe
  • Overstimulation
    • Modify the environment or remove items that could be causing an issue
    • Notify other staff if you remove or replace something
    • Simplify a task
    • Questions
      • Open ended
      • Closed ended
engage the patient
Engage the patient
  • Assure the patient that they are safe
  • Use a reassuring touch
    • Which is commensurate with relationship
  • Tell them what you plan to do
  • Have confidence in your ability to manage the situation
  • Use cues from your relationship with them to let them know you have had contact previously
  • These will help to find the root cause of the problem, which may then be addressed
what are they not saying
What are they not saying
  • Use nonverbal cues to read into what the patient is unable to tell you
    • Pacing- worried, anticipating someone’s arrival
    • Aggression- frustration at loss of control
    • Wandering- confusion to place
    • Sexual Inappropriateness- confusion to person
reassess the patient
Reassess the patient
  • After the root of the behavior is found and tended to, the patient needs to be reassessed
  • Is the behavior still occurring?
  • If it is, look for an additional meaning
    • Physical
    • Emotional
not one size fits all
Not One Size Fits All
  • There is no one universal answer
  • One solution may work, until it doesn’t any longer
  • Not every behavior will be resolved
  • Regain perspective
ideas f rom family
Ideas From Family
  • Memory people
  • Give time to answer
  • Listen
  • Be patient
  • Respect patients as people
    • Still have intelligence
tremendous opportunity
Tremendous Opportunity
  • It all comes down to perspective
  • You are my sunshine