Dementia Communication Techniques: Part 1

Or

CONNECT with the Positive Physical Approach

Melanie Bunn, RN, MS, GNPmelanie.bunn@yahoo.com

Geriatric Grand Challenge Institute: Dementia CareDuke University School of Nursing

March, 2013

Objective

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

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Critical Questions…

• Is it hard to “help”?

• Is it hard to be “helped”?

• So, sometimes, our helping isn’t helpful!!!

Do you want to TANGLE or TANGO???

So…Which “T” do you choose???

If you want to…

Tangle:• 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

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

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

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!!!

How You Start MATTERS!

First you CONNECT!!!

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

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Positive Physical Approach

• Come from the FRONT Make sure they are aware of you, before you get close or touch (knock, call out)

• OPEN PALMAdult greeting, movement directs to face, offers safe point of contact

• NOT too FASTOne second - one step OR let them come to you

Positive Physical Approach

• NOT in FRONTUse supportive stance NOT confrontationalProvides visual and physical ‘out’ for the person

• Establish HAND contactGreet the person as a ‘friend’ rather than as a ‘threat’Provides safety for you from striking out Prevents wandering or leaving

Positive Physical Approach

• CHANGE to hand UNDER handReduces stress Provides control

• Take a SEAT, SQUAT or KNEELSit down or get down to the person’s level Reduce intimidation without invading space

CONNECT with thePositive Physical Approach

CONNECTC Come from the frontO Open palmN Not too fastN Not in frontE Establish hand contact C Change to hand under hand T Take a seat/squat/kneel

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

people with dementia?

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Teaching Dementia Communication Techniques:

Experiential Education

Melanie Bunn, RN, MS, GNPmelanie.bunn@yahoo.com

Geriatric Grand Challenge Institute: Dementia CareDuke University School of Nursing

March, 2013

So…

WHAT did I teach? & HOW did you learn?

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Objective

Describe the experiential learning approach & how it promotes change in caregiver behavior

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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?

Experiential Learning Cycle(developed from work by David A. Kolb)

Experiencing

Publishing

Applying

Processing

Generalizing

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Experiencing

Start by

DOING SOMETHING!

ParticipatingPracticing

Physically trying

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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?

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Processing

Patterns– Discussion of why– Describe relationships

“Why do you think that happened?”

“How would this impact outcomes?”

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Generalizing

• Relate experience to theories

• “Teaching”

– Underlying expertise and knowledge

– Examples from experience

– Case examples

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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?”

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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?

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Do Something

Try IT out…

Figure IT Out!?

Have Learners SHARE @ what

happened

Ask learners to THINK OUT LOUD @ what it means…

Another Way of looking at the Experiential Learning Cycle

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So, how does the experiential learning approach promote change in caregiver behavior?

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

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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

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Making a change (Howell, 1982)

• Unconscious incompetence

• Conscious incompetence

• Conscious competence

• Unconscious competence

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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!!!

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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”

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Making a Change

UI

CI

CC

UC

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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)

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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!!!

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