Supported decision making

Developing communication skills

National Institute for Care in Excellence (NICE) guidelines on decision-making and mental capacity (2018) recommend that service providers and commissioners should provide training that includes “required communication skills” (Recommendation 1.1.1).  

The following example considers different communication difficulties for people living with dementia: 

Content of communication skills training in dementia care (Eggenberger et al., 2013). 

Verbal skills  

Before physical care:  
Announce single activities 
Use one-step instructions, no usage of multiple instructions  
Delay physical assistance until after verbal prompt  

At an early stage of illness trajectory:
Avoid arguing, accept different perceptions of time and reality 
Use of choice questions versus open-ended questions 
Suggest words when person is struggling for a specific word  

At a moderate to late stage of illness trajectory  
Use names and nouns 
Use the person’s name 
Use simple sentences 
Repeat and rephrase sentences  

General skills  
Use positive and biographical statements 
Identify personal communication styles and preferences 
Identify and do not use elder speak (diminutives, pronoun substitutions)  

Nonverbal and emotional skills  

Recognize unusual communicative attempts  
Recognize micro-behavioural changes (eye movement, lifting the corner of the mouth, tears, etc.) as attempts to communicate  
View behaviour that challenges as an attempt to communicate unmet needs  

Reflect your own nonverbal behaviour  
Make eye contact 
Give enough time 
Avoid high-pitch voice 
Listen actively 
Recognize and answer to emotions 
Notice and validate person with dementia’s effects  
Use emotional tone 
Show empathy  

Knowledge on communication issues  

Know about changes in communication with older people in general (hearing and visual impairment)  
Know about different types of communication breakdown  
Be aware of and reflect on nursing home communication barriers (lack of time, lack of opportunity, task-focused and ignoring communication, elder speak)  
Correct misconceptions about communication with people with dementia.  
Learn about basic concepts of communication with people with dementia such as person-centred care  
Maximize your own skills to maximize communication potential