Transcript Communication and Validation Strategies for Residents with

Communication and Validation
Strategies for
Residents with Dementia
Presented by HomeCare Rehab
and Nursing LLC
Communication
Overview of Abilities
– Common problem is an increase in verbal
conflicts as ability to communicate decreases;
word finding problems and losing the thread
of a story.
– Decrease in ability to censor self leads to
more blunt, direct, and socially inappropriate
comments.
– Argue to protect pride, act defensive and less
cooperative; refuse often.
– Reading to follow directions is not reliable.
Copyright © 2003
Communication
Strategies
– Get inside visual field (2-4 feet in front).
– Keep verbal directions clear and simple; avoid
“conservational speech” while guiding patient
through a task.
– Allow time to respond before asking question
again- ask again exactly the same way.
– Limit choices and open ended questions:
Don’t ask: “What do you want for breakfast?”
Ask: “Would you like cereal or pancakes?”
Copyright © 2003
Communication
Strategies
– DO NOT EVER ARGUE!
– Memory books may be effective with training if
the resident values it.
– Can learn schedule of activities if caregivers
consistently remind them to use it.
– Communication board may be effective to
make choices- no more than 2 to 4 options.
– Don’t hang a sign to improve safety or
orientation.
Copyright © 2003
Communication
Overview of Abilities
– Can name familiar items, can state own
name, can say “you and I” appropriately.
– Can speak in short phrases.
– Talks to self frequently.
– Repeats self, asks questions over and over.
– Phrases may have meaning only to the
patient.
Copyright © 2003
Communication
•
•
•
•
•
Strategies
Get in visual field before speaking or touching
(14 inches in front).
Avoid asking questions that require more than
yes or no.
Show a positive response to all communication
attempts.
Stop what you are doing and make eye contact.
Lower the pitch of your voice.
Copyright © 2003
Communication
•
•
•
•
Strategies
Use distraction to answer repetitive questions
once you have determined there are no other
needs. Reassure often.
Responds best to demonstrated commands.
Assume that the person understands everything
you are saying- don’t talk about them, talk to
them.
Scolding or lecturing is highly inappropriate and
ineffective.
Copyright © 2003
Communication
•
•
•
•
•
Overview of Abilities
May speak incoherently but sing a full song
without errors.
Uses one or two random words to communicate.
Able to say “no”.
May be able to identify body parts when
touched.
Uses gestures to communicate until very late
stages (claps, points, waves).
Copyright © 2003
Communication
•
•
•
•
Strategies
Keep cues limited to 2 or 3.
Get in visual field (less than 12 inches
directly in front of patient).
Use all senses to engage patient’s
attention.
Lower your voice.
Copyright © 2003
Validation
What is validation?
1. Letting the patient know that you accept
and respect their feelings.
2. Standing in their shoes- empathy.
3. Making them feel important and
intelligent.
Copyright © 2003
Validation
1.
2.
3.
4.
How do we validate a patient?
Match the intensity of their emotions with your
response.
Do not lie or belittle, let them know you hear
them.
Do not try to orient a confused or frustrated
patient.
Take opportunity to redirect them if they offerdon’t come up with an unrelated distraction.
Yes: “It sounds like your father was very caring.”
No: “Your father is dead. Did you see the weather outside?”
Copyright © 2003
Communication
1.
2.
3.
4.
5.
Absolute No No’s
No parenting, disciplining, scolding.
No baby talk.
No arguing.
No negative body language (disgust,
frustration, boredom, impatience).
No talking about patients in front of
patients.
Copyright © 2003
Communication and Validation
Strategies for
Residents with Dementia
Presented by Sue Paul, OTR/L
Communication
Overview of Abilities
– Common problem is an increase in verbal
conflicts as ability to communicate decreases;
word finding problems and losing the thread
of a story.
– Decrease in ability to censor self leads to
more blunt, direct, and socially inappropriate
comments.
– Argue to protect pride, act defensive and less
cooperative; refuse often.
– Reading to follow directions is not reliable.
Copyright © 2003
Communication
Strategies
– Get inside visual field (2-4 feet in front).
– Keep verbal directions clear and simple; avoid
“conservational speech” while guiding patient
through a task.
– Allow time to respond before asking question
again- ask again exactly the same way.
– Limit choices and open ended questions:
Don’t ask: “What do you want for breakfast?”
Ask: “Would you like cereal or pancakes?”
Copyright © 2003
Communication
Strategies
– DO NOT EVER ARGUE!
– Memory books may be effective with training if
the resident values it.
– Can learn schedule of activities if caregivers
consistently remind them to use it.
– Communication board may be effective to
make choices- no more than 2 to 4 options.
– Don’t hang a sign to improve safety or
orientation.
Copyright © 2003
Communication
Overview of Abilities
– Can name familiar items, can state own
name, can say “you and I” appropriately.
– Can speak in short phrases.
– Talks to self frequently.
– Repeats self, asks questions over and over.
– Phrases may have meaning only to the
patient.
Copyright © 2003
Communication
•
•
•
•
•
Strategies
Get in visual field before speaking or touching
(14 inches in front).
Avoid asking questions that require more than
yes or no.
Show a positive response to all communication
attempts.
Stop what you are doing and make eye contact.
Lower the pitch of your voice.
Copyright © 2003
Communication
•
•
•
•
Strategies
Use distraction to answer repetitive questions
once you have determined there are no other
needs. Reassure often.
Responds best to demonstrated commands.
Assume that the person understands everything
you are saying- don’t talk about them, talk to
them.
Scolding or lecturing is highly inappropriate and
ineffective.
Copyright © 2003
Communication
•
•
•
•
•
Overview of Abilities
May speak incoherently but sing a full song
without errors.
Uses one or two random words to communicate.
Able to say “no”.
May be able to identify body parts when
touched.
Uses gestures to communicate until very late
stages (claps, points, waves).
Copyright © 2003
Communication
•
•
•
•
Strategies
Keep cues limited to 2 or 3.
Get in visual field (less than 12 inches
directly in front of patient).
Use all senses to engage patient’s
attention.
Lower your voice.
Copyright © 2003
Validation
What is validation?
1. Letting the patient know that you accept
and respect their feelings.
2. Standing in their shoes- empathy.
3. Making them feel important and
intelligent.
Copyright © 2003
Validation
1.
2.
3.
4.
How do we validate a patient?
Match the intensity of their emotions with your
response.
Do not lie or belittle, let them know you hear
them.
Do not try to orient a confused or frustrated
patient.
Take opportunity to redirect them if they offerdon’t come up with an unrelated distraction.
Yes: “It sounds like your father was very caring.”
No: “Your father is dead. Did you see the weather outside?”
Copyright © 2003
Communication
Overview of Abilities
– Common problem is an increase in verbal
conflicts as ability to communicate decreases;
word finding problems and losing the thread
of a story.
– Decrease in ability to censor self leads to
more blunt, direct, and socially inappropriate
comments.
– Argue to protect pride, act defensive and less
cooperative; refuse often.
– Reading to follow directions is not reliable.
Copyright © 2003
Communication
Strategies
– Get inside visual field (2-4 feet in front).
– Keep verbal directions clear and simple; avoid
“conservational speech” while guiding patient
through a task.
– Allow time to respond before asking question
again- ask again exactly the same way.
– Limit choices and open ended questions:
Don’t ask: “What do you want for breakfast?”
Ask: “Would you like cereal or pancakes?”
Copyright © 2003
Communication
Strategies
– DO NOT EVER ARGUE!
– Memory books may be effective with training if
the resident values it.
– Can learn schedule of activities if caregivers
consistently remind them to use it.
– Communication board may be effective to
make choices- no more than 2 to 4 options.
– Don’t hang a sign to improve safety or
orientation.
Copyright © 2003
Communication
Overview of Abilities
– Can name familiar items, can state own
name, can say “you and I” appropriately.
– Can speak in short phrases.
– Talks to self frequently.
– Repeats self, asks questions over and over.
– Phrases may have meaning only to the
patient.
Copyright © 2003
Communication
•
•
•
•
•
Strategies
Get in visual field before speaking or touching
(14 inches in front).
Avoid asking questions that require more than
yes or no.
Show a positive response to all communication
attempts.
Stop what you are doing and make eye contact.
Lower the pitch of your voice.
Copyright © 2003
Communication
•
•
•
•
Strategies
Use distraction to answer repetitive questions
once you have determined there are no other
needs. Reassure often.
Responds best to demonstrated commands.
Assume that the person understands everything
you are saying- don’t talk about them, talk to
them.
Scolding or lecturing is highly inappropriate and
ineffective.
Copyright © 2003
Communication
•
•
•
•
•
Overview of Abilities
May speak incoherently but sing a full song
without errors.
Uses one or two random words to communicate.
Able to say “no”.
May be able to identify body parts when
touched.
Uses gestures to communicate until very late
stages (claps, points, waves).
Copyright © 2003
Communication
•
•
•
•
Strategies
Keep cues limited to 2 or 3.
Get in visual field (less than 12 inches
directly in front of patient).
Use all senses to engage patient’s
attention.
Lower your voice.
Copyright © 2003
Validation
What is validation?
1. Letting the patient know that you accept
and respect their feelings.
2. Standing in their shoes- empathy.
3. Making them feel important and
intelligent.
Copyright © 2003
Validation
1.
2.
3.
4.
How do we validate a patient?
Match the intensity of their emotions with your
response.
Do not lie or belittle, let them know you hear
them.
Do not try to orient a confused or frustrated
patient.
Take opportunity to redirect them if they offerdon’t come up with an unrelated distraction.
Yes: “It sounds like your father was very caring.”
No: “Your father is dead. Did you see the weather outside?”
Copyright © 2003
Communication
1.
2.
3.
4.
5.
Absolute No No’s
No parenting, disciplining, scolding.
No baby talk.
No arguing.
No negative body language (disgust,
frustration, boredom, impatience).
No talking about patients in front of
patients.
Copyright © 2003