Strategies Of Communication In Caring For People With Dementia

Literature Review

In Australia, 353,800 people have dementia, a neurodegenerative disease, that impairs cognitive ability, and 70% of them live in residential facilities (Renehan, Goeman, & Koch, 2017). Australian Institute of Health and Welfare (2011) reported that nurses face communication difficulties in caring for people with dementia. My placement at Canberra Hospital was on an aged-care rehabilitation in which almost 40% patients had dementia. I noticed the nurses having difficulty in understanding patients’ needs and establishing rapport. Therefore, patients exhibited difficult behaviours refusing medications and personal hygiene. The incident encouraged me to think why the person-centred communication is important when dealing with people with Alzheimer’s.  Effective communication is one of the approaches to improve quality of life and well-being of the residents. This study aims to compare strategies of communication in caring for people with dementia.

Best Practice	Level of Evidence and Type of Study	Citation in CDU APA 6th format
Communication between the residents with dementia and nurses Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper	Level 1: Systematic review	Machiels, Metzelthin, Hamers and Zwakhalen (2017)
Non-pharmacological interventions in communication	Level 1: Systematic review	Konno, Kang and Makimoto (2014)
Communication strategies	Level 4: Cohort study	Savundranayagam and Lee (2017)

Machiels et al. (2017) are well-known researchers interested in improving communications between nurses and people with dementia in residential care. They aim to research how nurses’ communication level can be improved, and positively influence the people’ behaviours. Data were extracted from six systematic reviews, written in English, German and Dutch, selected from 3815 journals, was synthesised and described as per Cochrane Systematic Review Guidelines. This study examined verbal and non-verbal communication strategies used by nurses when interacting with people with dementia. The finding suggested that communication strategies are effective to implement personalised care plan and address residents’ concerns.     

Konno et al. (2014), well-known scholars, researched on the resistance-to-care behaviour of people with dementia in a residential facility. This study aims to explore how music therapy and nurse education reduces challenging behaviours of the people. This systematic review synthesised data were extracted from three randomised controlled trial and sixteen quasi-experimental journals. This review analysed the articles that researched on people with dementia aged over 55 and their resistance-to-care behaviour. The finding indicated that dementia-specific trained nurses are able to decrease the behaviours using non-pharmacological interventions such as music therapy. The authors concluded that education, experience and intensive training are essential for the nurses to deescalate the challenging behavioural and provide culturally appropriate and individualised care.     

Savundranayagam and Lee (2017), renowned academics, studied on three types of nurses’ communication strategies used in dementia care. The study explores how effective repair strategies, completing action by oneself and ignoring resident strategies impact on delivering nursing care and behavioural changes of the residents. The study included 109 nursing staff, aged from 20 to 67 years and requested to complete a questionnaire on communication difficulty about people with dementia. The results suggested that nurses with effective repair skills find the higher job satisfaction whereas the nurses who used ignoring residents and do-the task-themselves strategies blame the residents as challenging and demanding and have poor job satisfaction. The authors sum up that nurses’ efficient communication skills promote individualised care to the residents and increases job satisfaction.  

The articles selected that best compare the strategies of communication in caring for people with dementia were systematic reviews (Machiels et al., 2017, Konno et al., 2014) and a cohort study (Savundranayagam & Lee, 2017).

Methodology

Using a systematic review (Level 1 evidence), Machiels et al. (2017) reviewed six Randomised Controlled Trials (RCTs) on the improvement of communication level of nurses, of which two studies measured verbal and non-verbal communication and four studies either appraised only verbal or non- verbal; tape-recording or questionnaires. Data were assessed and analysed per Cochrane Handbook for Systematic Review, yet, the methodological quality assessment shows high risk of bias. Twisk et al. (2018) asserted that randomised controlled trial is the best way to examine the effects of new interventions. The review based on six full-text articles selected out of 3815. Strict inclusion criteria and specific study designs produce the desired outcome (Davis, 2016). Machiels et al. (2017) recommend that nurses must use simple and clear sentences, and actively listen when talking to them because these communication strategies positively impact on their behaviours. Schröder and Knebel (2010) suggested that nurses must actively listen, understand their cognitive status and check hearing aids before talking to people with dementia. Machiels et al. (2017) reported determining the efficacy of communication is challenging, predominantly people with impaired cognition. Similarly, Hooper et al.  (2013) emphasised that people with dementia have communication and comprehension deficits. Thus, it is difficult to measure the effectiveness of communication strategies.

 Konno et al. (2014) conducted a systematic review based on the results of three RCTs and sixteen quasi-experimental studies on non-pharmacological interventions, including music therapy, bathing and strength-based approaches, to reduce the resistance-to-care behaviour. After rigorously checked their relevancy and quality, nineteen articles were chosen out of 1262 (Konno et al., 2014). Konno et al. (2014) particularly emphasised on reducing challenging behaviours using the abovementioned interventions. The study shows that music therapy and bathing interventions significantly decrease the people with dementia’s resistance behaviours in comparison with the ability-focused approach (Konno et al., 2014). The review strictly followed the Joanna Briggs Institute (JBI) guidelines the systematic review (Konno et al., 2014). JBI has set international standards for evidence-based research, and EBP considered as the gold standard (Hou et al., 2017). Konno et al. (2014) asserted that nurses’ education and training must be incorporated into the dementia care to reduce the care resistance. This review only focused on three specific times including bathing, mealtime and morning, but did not mention their activities during the afternoon and evening.   

Savundranayagam and Lee (2017) conducted a cohort study by including 109 nursing staff who completed questionnaires on dementia-related communication difficulties, communication strategies and role demand. The data were analysed and evaluated by using 7-point Likert-type scale, and LISREL 8.8 that is a model to examine multiple factors and their outcomes (Savundranayagam & Lee, 2017). The study focused on effective repair, task-oriented and ignoring strategies to communicate to people with dementia (Savundranayagam & Lee, 2017). One specific objective was to directly compare the effectiveness of communication techniques, by collecting data through interviews with the nurses and interpreting it to identify the usefulness of their communication approaches and level of job satisfaction (Savundranayagam & Lee, 2017). The authors concluded that the nurses who used the repair strategies had most job satisfaction and enabled to establish reciprocity with the residents. Savundranayagam and Lee (2017) claimed that exploring the direct relationship between communication, strategy, role demand and job satisfaction is the first research of its kind. Savundranayagam and Lee (2017) further elaborated that nurses with dementia-specific training are more capable of handling the residents’ behaviours.

Results

 The three articles emphasised that communication is vital to provide nursing care to the people, understand their preferences and maintain professional relations which can only be improved through communication skills training. However, the authors could not pinpoint any exact communication interventions that could resolve the care resistance and reduce communication gap between the nurses and residents.

Dementia population is significantly increasing, and most of them live in residential care (Hopper et al., 2013). As dementia impairs cognitive ability, people with dementia are most likely at risk of being misunderstood that triggers refusal-to-care (Hopper et al., 2013). Because of this, nurses working in dementia-specific care must have verbal and non-verbal communication strategies to deliver person-centred care to the people. Thus, Konno et al. (2017) emphasised that music therapy can be an approach to reduce the resistance-to-care behaviour in persons with dementia. But, not all the nurses working in residential care are competent to play music. That is why Machiels et al. (2017) emphasised that nurses’ education and training to improve their communication competency. Furthermore, healthcare providers must create a supportive environment for nurses to enhance communication skills(Thein & Hollister, 2016).

Likewise, Smythe, Jenkins, Galant-Miecznikowska, Bentham and Oyebode (2017) claimed that training and education to nurses promote their interaction efficiency and person-centred care and decreases burnout. Next, Savundranayagam and Lee (2017) asserted that improved communication efficiency increased job satisfaction and nurses’ relation to people with dementia. But, Griffiths (2017) argued the nurses do not have time to translate theories of EBP into practice due to the staff shortage (Brower, 2017). Therefore, the nursing homes should have adequate staff and provide education for promoting evidence-based care. All the three journal articles do not mention about ethnic communities and people from Culturally and Linguistically Diverse (CALD). As, Australia is a multicultural country with a sustained history of migration (Collins, 2013).  Migrants are at risk of developing dementia, losing their acquired languages that make harder for nurses to understand their needs (Söderman & Rosendahl, 2016). Furthermore, the articles do not include the nurses who are from CALD backgrounds. Because nurses who are from CALD, may not understand the local culture, dialect and slang (Allan & Westwood, 2016). However, there are some limitations of the articles; they are still relevant to nurses working in dementia care.

References:

Allan, H. T., & Westwood, S. (2016). English language skills requirements for internationally educated nurses working in the care industry: Barriers to UK registration or institutionalised discrimination? International Journal of Nursing Studies, 54, 1-4. doi.org/10.1016/j.ijnurstu.2014.12.006

Australian Institute of Health & Welfare. (2011). Over half of aged care residents have dementia. AIHW media releases. Retrieved from https://www.aihw.gov.au/news-media/media-releases/2011/2011-may/over-half-of-aged-care-residents-have-dementia

Brower, E. J. (2017). Origins of evidence-based practice and what it means for nurses. International Journal of Childbirth Education, 32(2), 14-18. Retrieved from https://ezproxy.cdu.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,uid&db=rzh&AN=123698139&site=ehost-live 

Collins, J. (2013). Multiculturalism and immigrant integration in Australia. Canadian Ethnic Studies, 45(3), 133-149. Retrieved from https://ezproxy.cdu.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,uid&db=sih&AN=92705464&site=ehost-live

Davis, D. (2016). A practical overview of how to conduct a systematic review. Nursing Standard, 31(12), 60. Retrieved from https://cdu-edu-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_proquest1855429741&context=PC&vid=61CDU&search_scope=default_scope&tab=default_tab&lang=en_US 

Griffiths, J. (2017). Person-centred communication for emotional support in district nursing: SAGE and THYME model. British Journal of Community Nursing, 22(12), 593-597. doi:10.12968/bjcn.2017.22.12.593

Hopper, T., Bourgeois, M., Pimentel, J., Qualls, D. C., Hickey, E., Frymark, T., & Schooling, T. (2013). An evidence-based systematic review on cognitive interventions for individuals with dementia. American Journal of Speech-Language Pathology,22 (1), 126. Retrieved from https://cdu-edu-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_ericEJ1005167&context=PC&vid=61CDU&search_scope=default_scope&tab=default_tab&lang=en_US  

Hou, Y., Tian, J., Zhang, J., Yun, R., Zhang, Z., Chen, K. H., …  Wang, B. (2017). Quality of meta-analysis in nursing fields: An exploration based on the JBI guidelines. PloS one, 12(5). doi.org/10.1371/journal.pone.0177648

Konno, R., Kang, H. S., & Makimoto, K. (2014). A best-evidence review of intervention studies for minimizing resistance-to-care behaviours for older adults with dementia in nursing homes. Journal of Advanced Nursing, 70(10), 2167-2180. doi:10.1111/jan.12432

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, 6637-46. doi: 10.1016/j.ijnurstu.2016.11.017

Ramos?Morcillo, A. J., Fernández?Salazar, S., Ruzafa?Martínez, M., & Del?Pino?Casado, R. (2015). Effectiveness of a brief, basic evidence?based practice course for clinical nurses. Worldviews on Evidence-Based Nursing, 12(4), 199-207. doi:10.1111/wvn.12103

Renehan, E., Goeman, D., & Koch, S. (2017). Development of an optimised key worker framework for people with dementia, their family and caring unit living in the community. BMC Health Services Research, 17(1), 1-16. Retrieved from https://cdu-edu-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_proquest1925247637&context=PC&vid=61CDU&search_scope=default_scope&tab=default_tab&lang=en_US

Savundranayagam, M. Y., & Lee, C. (2017). Roles of communication problems and communication strategies on resident-related role demand and role satisfaction. American Journal of Alzheimer’s Disease & Other Dementias, 32(2), 116-122. doi:10.1177/1533317517689876

Schröder, J., & Knebel, M. (2010). Dementia and communication. Alzheimer’s & Dementia, 6(4), S331. Retrieved from https://cdu-edu-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_crossref10.1016/j.jalz.2010.05.1107&context=PC&vid=61CDU&search_scope=default_scope&tab=default_tab&lang=en_US 

Smythe, A., Jenkins, C., Galant-Miecznikowska, M., Bentham, P., & Oyebode, J. (2017). A qualitative study investigating training requirements of nurses working with people with dementia in nursing homes. Nurse education today, 50,119-123.  doi.org/10.1016/j.nedt.2016.12.015

Söderman, M., & Rosendahl, S. P. (2016). 17 Caring for ethnic older people living with dementia – Experiences of nursing staff. Journal of Cross-Cultural Gerontology, 31(3), 311-326. doi:10.1007/s10823-016-9293-1

Thein H. Z., & Hollister, L. (2016). Effectiveness of the rural trauma team development course for educating nurses and other healthcare providers at rural community hospitals. Journal of Trauma Nursing, 23(1), 13-22. doi:10.1097/JTN.0000000000000176

Twisk, J., Bosman, L., Hoekstra, T., Rijnhart, J., Welten, M. & Heymans, M. (2018). Different ways to estimate treatment effects in randomised controlled trials. Contemporary Clinical Trials Communications, 10, 80-85. Retrieved from https://cdu-edu-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_sciversesciencedirect_elsevierS2451-8654(17)30184-9&context=PC&vid=61CDU&search_scope=default_scope&tab=default_tab&lang=en_US