Dementia Communication Techniques: Part 1 Or CONNECT with the Positive Physical Approach Melanie Bunn, RN, MS, GNP Geriatric Grand Challenge Institute: Dementia Care Duke University School of Nursing March, 2013

Objective Demonstrate & discuss how non-verbal communication techniques (PPA) improve interactions with people with dementia 2

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 9

Positive Physical Approach Come from the FRONT Make sure they are aware of you, before you get close or touch (knock, call out) OPEN PALM Adult greeting, movement directs to face, offers safe point of contact NOT too FAST One second - one step OR let them come to you

Positive Physical Approach NOT in FRONT Use supportive stance NOT confrontational Provides visual and physical ‘out’ for the person Establish HAND contact Greet 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 hand Reduces stress Provides control Take a SEAT, SQUAT or KNEEL Sit down or get down to the person’s level Reduce intimidation without invading space

CONNECT with the Positive Physical Approach CONNECT CCome from the front OOpen palm NNot too fast NNot in front EEstablish hand contact CChange to hand under hand TTake a seat/squat/kneel 13

So, how do non-verbal communication techniques improve interactions with people with dementia? 14

Teaching Dementia Communication Techniques: Experiential Education Melanie Bunn, RN, MS, GNP Geriatric Grand Challenge Institute: Dementia Care Duke University School of Nursing March, 2013

So… WHAT did I teach? & HOW did you learn? 16

Objective Describe the experiential learning approach & how it promotes change in caregiver behavior 17

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 19

Experiencing Start by DOING SOMETHING ! Participating Practicing Physically trying 20

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? 21

Processing Patterns – Discussion of why – Describe relationships “Why do you think that happened?” “How would this impact outcomes?” 22

Generalizing Relate experience to theories “Teaching” – Underlying expertise and knowledge – Examples from experience – Case examples 23

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?” 24

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? 25

Do Something Try IT out… Figure IT Out!? Have Learners what happened Ask learners to THINK OUT what it means… Another Way of looking at the Experiential Learning Cycle 26

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 28

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 29

Making a change (Howell, 1982) Unconscious incompetence Conscious incompetence Conscious competence Unconscious competence 30

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!!! 31

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” 32

Making a Change UICICCUC 33

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) 34

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!!! 35