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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
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0 Introduction
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1 Reflecting on values and bias within mental capacity decision-making
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2 The history and current context of mental capacity legislation and policy
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3 The concept of mental capacity
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4 Best interests
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5 Supported decision making
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6 Deprivation of liberty: human rights
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7 MCA in clinical decisions for care and treatment
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8 MCA and the Office of the Public Guardian (OPG) role
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9 Conclusion