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Communication Difficulties : Assessment And Interventions

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Question:

Discuss about the Communication Difficulties : Assessment and Interventions.
 
 

Answer:

Introduction:

As Philip Lusk is a 69 year old Italian patient with behavioral and psychological symptoms of dementia, he has minimum English language knowledge to communicate his needs. Due to this limitation and clinical presentation of dementia, he is often aggressive and agitated. Appropriate psychosocial intervention is important to decrease his aggressiveness and agitation.

Date

Nursing outcomes

Nursing Interventions

Person responsible

8/05/2017

Decrease agitation in Philip due to language deficits and difficulty in understanding verbal messages.

Verbal communication

·       Try to anticipate what Philip is trying to say and response to his thoughts and feeling.

·       Avoid any form of questioning beyond Philip’s communication abilities.

·       Adapt patient’s level of communication by assessing the level of language deficits  in Philip.

·       Compensate for English language deficit in patient by means of asking direct question so that Philip can give only yes or no response. Secondly, to give verbal instruction short and simple sentences should be used so that he easily understands the message. This form of instruction can be given in the form of gestures. This would help because Philip Lusk can respond to body language and non-verbal cues (Zembrzuski, 2017). 

·       Any superfluous information should be avoided and one step instruction should be given to patients.

·       As Philip is disturbed by people’s tone of voice, moderate vocal tone will be used to calm patients down. Loudness in voice will be avoided and appropriate touch should be used as a way to interact and make eye contact with patient (Dougherty, 2015). However, non-verbal gestures like touch and contact with patients should be done in a professional manner so that ethical dilemma in care do not arise (Youell et al., 2016).

·       Communication should be facilitated in Philip by assessing their difficulty in finding the correct words to express. In such case, it is necessary to identify the key thoughts and ideas by non-verbal gestures of patient (Cabrera et al., 2015).

 

Enrolled Nurse

8/05/2017

As Philips has difficulty in understanding simple task, reducing his aggressiveness by means of non-verbal communication is important.

 

Non-verbal communication

·       As Enrolled Nurse (EN) have the duty to assess patient’s response to health care interventions, appropriate non-verbal communication and body language is needed for care of Philip, who has difficulty in communication.

·       According to the scope of practice of EN, they use a variety of communication methods to engage appropriately with patients (Standards for practice: enrolled nurses, 2017). In Philip’s case, non-verbal means of communication will help to increase trust and rapport with patients.  Non-verbal message is a natural language that easily helps to broadcast true feelings of patients (Lykkeslet et al., 2014).

·       As Philip particularly has difficulty in emoting his concerns due to language deficits and behavioral and psychological symptoms of dementia, it is necessary to respond to emotion of Philip instead of depending of his verbal complains.

·       To reduce agitation in patients due to lack of understanding of task and language, it is necessary to assess unmet needs of patients. For example, misperception, hunger, thirst, pain or toileting needs might also be the reason for frustration in patients.

·       While conveying certain instruction to patient, Philips reaction will be assessed such as if he interprets the message or gives blank expression.  In case of blank expression, gesture will be used repeatedly to communicate with patient.

·       It is very important to respond to Philip emotions first and assure them about improving their health condition in order to establish a therapeutic relationship.

·       On days, when Philip is having serious problem in communicating, the conversation period with be lessened to avoid bothering patients (Kales et al., 2014).

·       Dignity is also an important requirement in caring for dementia patients. Diginity in care of Philip must be maintained by evaluating moral perspective of each nursing action.

·       Dignity can also be maintained by analyzing the best interest of patient and not forcing him any activities that he may not prefer to do (Johnston et al., 2015).

.

 

Enrolled Nurse and other nursing and care staffs

10/07/2017

Provide appropriate environment to Philip to reduce agitation and aggressiveness during care.

Environment

·       Reduce client’s agitation by providing stress free environment and not bothering Philips with things he does not want to do. Make sure that environment around Philip does not trigger aggressive reaction and all such triggers should be kept away.

·       As dementia patients have memory problem, family member’s should always be encouraged to identify themselves to Philip while visiting to avoid agitation and embarrassment in patient.

·       Aggressive behavior is seen in patients due to inappropriate environment. Therefore, any background noise or conversation in front of Philip should be avoided.

·       As dementia patients have impaired judgment levels, all unsafe objects within the close proximity of Philip should be avoided. Secondly, sensory-perceptual functioning is also impaired in patients with dementia. In such case, good lighting should be provided so as to maintain normal function in patients. This would help in providing a therapeutic environment for the recovery of patients.

·       To avoid additional distress and confusion in dementia patients, provide familiar environments to them as far as possible.

·       Assess for fall risk due to symptoms of dementia and engage in greater care at all times.

·       To assist patient in the management of agitation, appropriate dose of PRN medication and side effects needs to be considered. In case of Philip, use of Risperidone may lead to side effects such as dizziness, fever, headache, vomiting and constipation. Hence, side effects need to be closely monitored in order to cease or reduce the dose of medication at appropriate time.

·       As Philip is an old patient with dementia, range of potential side effect is high for him. Philips may also gain weight, so hi weight and blood pressure should be monitored regularly (Kales et al., 2015).

·       While considering environmentally safe conditions for Philip, it is necessary to maintain hygiene and personal care of Philip. This can be done by promptly identifying toileting needs, physical aids and diet consumed by patient (Johnston et al., 2015).

EN and care staffs

 

Reference

Cabrera, E., Sutcliffe, C., Verbeek, H., Saks, K., Soto-Martin, M., Meyer, G., ... & RightTimePlaceCare Consortium. (2015). Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. European Geriatric Medicine, 6(2), 134-150.

Dougherty, J. (2015). Effective communication strategies to help patients and caregivers cope with moderate-to-severe Alzheimer’s disease. The Journal of clinical psychiatry, 76(3), 9-9.

Johnston, B., Lawton, S., McCaw, C., Law, E., Murray, J., Gibb, J., ... & Rodriguez, C. (2015). Living well with dementia: enhancing dignity and quality of life, using a novel intervention, Dignity Therapy. International journal of older people nursing.

Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2014). Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society, 62(4), 762-769.

Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2015). State of the art review: assessment and management of behavioral and psychological symptoms of dementia. The BMJ, 350.

Lykkeslet, E., Gjengedal, E., Skrondal, T., & Storjord, M. B. (2014). Sensory stimulation-a way of creating mutual relations in dementia care. International journal of qualitative studies on health and well-being, 9.

Standards for practice: enrolled nurses. (2017).  [online] Available at: https://file:///C:/Users/admin/Downloads/Nursing-and-Midwifery-Board---Standards-for-Practice---Enrolled-Nurses.PDF [Accessed 8 May 2017].

Youell, J., Callaghan, J. E., & Buchanan, K. (2016). ‘I don't know if you want to know this’: carers’ understandings of intimacy in long-term relationships when one partner has dementia. Ageing and Society, 36(05), 946-967.

Zembrzuski, C. (2017). Communication Difficulties: Assessment and Interventions in Hospitalized Older Adults with Dementia. [online] Available at: https://consultgeri.org/try-this/dementia/issue-d7.pdf [Accessed 8 May 2017].

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