The purpose of this program is to prepare Nursing Assistants to effectively and safely communicate with cognitively impaired residents.
Nursing Assistants (NA) have a difficult, but rewarding job, especially in long term care. The CNA can be in a nursing home, a hospital or in home care. CNAs are the "front line" workers, giving direct patient care. Because CNAs have such a close, personal relationship with their patients, they form LASTING relationships with both the patient and the family.
Working with cognitively impaired patients take a special kind of person; a person with patience, kindness and understanding. It is not always easy to work with someone who is agitated, angry or aggressive. The key to working safely is to learn to communicate effectively, knowing what your residents need/want before they can start "acting out."
CNAs assist residents to do basic Activities of Daily Living (ADLs): helping with bathing, dressing, brushing their hair, mouth care and eating. When agitated behaviors start, CNAs must learn to control the situation, and keep the resident safe, using verbal or non-verbal cues. CNAs communicate with many different people during their work hours, including the supervisor, charge nurse, co-workers, physicians, families and residents.
(Aarti R 2009 Four types of communication)Communication is the exchange of information in the form of messages, symbols, thoughts, signs and opinions (Aarti, 2009). There are many different types of communication, but there are only a few that are effective when working with dementia residents.
Verbal communication is the most common form to use. It involves the use of words or sounds, spoken or written (Alvare, Fuzy, & Rymer, 2009). It is important to remember to speak to everyone with kindness, compassion and respect. Do not yell or speak loudly. Use short sentences so the resident can follow directions easily. When working with dementia residents, it is the most important part of daily care. Speaking slowly, clearly and face-to-face is the best way to communicate with dementia residents. Eye contact is very important. The tone of your voice can have an effect on the resident.
Non-verbal communication is the way we communicate without using words (Alvare, Fuzy, & Rymer, 2009). Body language is easy to understand. Anger is very simple to display and hard to control. When assisting a resident, be careful how you stand, hold your arms and keep your facial expressions as neutral as you can. If you stand with your arms crossed you show anger. If you have a frown on your face, you show anger. If you are standing with your hands on your hips, it shows anger. Always be aware of your body language.
Always approach a dementia resident from the front. If you happen to start talking or if you touch them without them seeing you, they become startled, and may try to hit you. Be respectful, and think about the reaction you may cause with your behavior. Identify yourself before speaking, and use the resident's name. This will help spark their memory.
Dementia is a general term that refers to a serious loss of mental abilities such as thinking, remembering, reasoning and communicating (Alvare, Fuzy, & Rymer, 2009). Alzheimer's is a progressive form of dementia that cannot be reversed. It eventually affects brain functions, erasing memory, communication skills, movement and behaviors. Alzheimer's residents lose their ability to chew and swallow food. As residents journey through the stages of Alzheimer's disease, they become completely dependent on their caregivers. CNAs have to be able to be patient and compassionate while giving care to this special population, and remember that they cannot respond like a normal adult. As the disease gets worse, the response of the dementia patient becomes more like an infant. They do not understand what you are saying and cannot communicate what they mean to you. The dementia patient is confused and easily frightened. As dementia gets worse, the resident does not respond with normal social behavior.
It is very important to know the different stages of Alzheimer's disease to be better able to care for the residents. Not all residents have the same signs at the same stage in the disease. One resident may be able to play a musical instrument, but not be able to carry on a conversation. Another may be able to read, but not be able to feed him/herself. The following chart shows how the resident changes in each stage of Alzheimer's disease (Alvare, Fuzy, & Rymer, 2009).
|Stage 1 Symptoms||Stage 2 Symptoms||Stage 3 Symptoms|
|Short term memory loss||May forget family/friends||Total disorientation|
|Inability to concentrate||Difficulty finding right words/following directions||Apathy/total dependence|
|Irritability/rude behavior||Restlessness/wandering||Confined to bed/chair|
|Carelessness in personal habits||Incontinence at times||Total incontinence|
|Poor judgment||Lack of impulse control||Inability to speak, except for grunting, screaming|
|Sleeps, but gets night/days confused||Sleep problems||Increased sleep problems|
|Feeds self||May need cueing to feed self||Difficulty swallowing, high risk for choking|
The NA needs to pay attention to each stage so communication can continue. In stage 1, the resident may be irritable or make rude comments. You must not take anything the resident says personally. If your feelings get hurt, the resident will notice, and continue the rude behavior. In stage 2, lack of impulse control can make giving care very difficult. Good communication skills involve good listening skills. Look at the resident, see what their body language is, and respond calmly and quietly. Do not overreact to impulsive behavior. As the stages progress, sleep habits do change. If the resident is having trouble sleeping, use short "rest" periods during the day, and keep the resident busy with activities while awake. It is easier to let the resident sleep whenever he/she wants to, but remember, if they sleep during the day, they will not sleep at night.
Sundowning is a special and difficult behavior. It is when the resident gets confused at the end of the day. The cause is unknown, but fatigue may play be a factor. A few tips to reduce sundown symptoms include soothing music, keeping the lights on and having familiar items in the resident's room.
Communication is difficult, but if safe approaches are used, the resident will respond better and with less agitation. Always approach the resident from the front, not from the back. Sit or stand right in front of the resident to maintain eye contact. Keep the environment quiet, not only to reduce agitation, but to allow the resident to better hear and understand what is being said. Turn off the television and radio. If the resident is in a noisy area, take the resident to a quiet area. Give the resident time to respond to you. Speak in a calm and gentle tone using short sentences. Do not use "baby talk" as this may agitate the resident. Use simple words they can understand. Only discuss one topic at a time. Speak in your normal tone of voice, do not shout or yell. Never contradict the resident, as that is a sure way to get into trouble. Arguing only makes the bad behavior worse.
When assisting with ADLs, go slowly and do not expect the resident to agree with all aspects of care. Do not ask the resident if he/she wants a shower, but say "It is time for your shower now." If the resident refuses, do not argue.
Remember to be aware of your body language as it speaks volumes. If you stand in front of the resident with your arms crossed in front of you, the resident may think you are angry. If you have a frown on your face the resident will respond in kind.
The following are some tips from the Alzheimer's Association on how to talk to dementia residents in a safe and efficient manner (Alzheimer's Association, 2009):
If these simple tips are followed, communication with a dementia resident will be easier.
One of the most common mistakes in communicating with the elderly/dementia residents is speaking loudly, or talking "baby talk." The way many people speak to the elderly sounds a lot like baby talk, using words of endearment such as honey, sweetie and dearie (Williams, 2008). It is best to avoiding using those terms of endearment. Always treat your residents with respect. Never talk down to them.
Caring and communicating with dementia residents can be rewarding, but challenging. NAs work closely with dementia residents, and with patients in the home setting. It is imperative that patience, kindness and understanding be displayed. Learning to talk effectively with dementia residents makes the NA's job easier and safer. Remembering to approach persons from the front, speaking softly, using simple words and phrases will make your work more pleasant, with less resistance from your resident.
Aarti, R. (2009). Four types of communication. Retrieved November 30, 2009, from (Visit Source).
Alvare, S, Fuzy, J., & Rymer, S. (2009). Nursing assistant care. Albuquerque. Hartman Publishing, Inc.
Alzheimer's Association (2009). Communication. Retrieved December 3, 2009 from (Visit Source).
Williams, K. (2008). How to talk to those with dementia so they can hear you. Retrieved December 3, 2009 from (Visit Source).