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Lecture

NUR1 220 Lecture Notes - Hearing Aid, Dementia, Eye Contact


Department
Nursing
Course Code
NUR1 220
Professor
Sonya Laszlo

Page:
of 3
Responding to Special Needs
Strategies with Hearing Changes
- Use patient’s name
- Hearing abilities of both ears
o Speak to one side if it’s better
- Speak distinctly but in a normal voice
- Don’t speak too fast
- Lower if high pitched
- Gestures and facial expressions should be used
- Help adjust hearing aids
- Don’t talk with hands in from of mouth/ with food/with gum in
the mouth
- Decreases background noises
- Get feedback
Vision:
- Have eyeglasses in place
- Id yourself by name/ initial conversation
- Stand in front of the client and use head movements
- Explain all written info
o Ask for feedback
- Provide appropriate lighting and other visual aids
- Remove hazards
- Transporting a client = tell client and describe where you are
going and verbally describe landmarks
Assessing functional ability:
- By explaining and clarifying values, make choices and take
action = they get a better understanding of the client
- Give client responsibility for choices and goal setting in health
care
- Help client link principles of coping in the past = individual care
- Promote independence
o Choice about their bedtime
o Respecting choices in food selection
o Chair risers
o Safety modifications
o Include them in decision-making
Acting as the Client’s Advocate
- Introducing the need for external supports without first
building rapport and helping the client establish a sense of
his/her personal strengths
o It is counterproductive
o Therefore you must reframe
- NB: Freedom and protection
o Storytelling = learn about their early life and important
relationships
Blocks to Communication
- Offers problems by communication mistakes:
o Offering cliché reassurances
Instead: I have some time, would you like to talk?
o Offering advice
Instead: explore options
o Answering your own question/not waiting for an
answer
Remember: they are still cognitively intact
o Giving excess praise/reprimands
Doesn’t allow the older adult to ask
questions/raise concerns about their treatment
Instead: ask if they have further concerns
Don’t reprimand /scold
o Depending against a complaint
Discover the underlying meaning of the
comment
o Using parenting approaches/behaviour
Demeaning
Answering for them
Communication Strategies in Long-Term Care Settings
- Loneliness
- Someone to listen to them
- Affect self-esteem
- Conversation
- Continuity of care with one caregiver
o This increases relationships
Dealing with Memories and Reminiscences
- This is a review of their life
- Reconcile conflicts and atone
o Enter it with client and find relevance
- Reminiscing increase self-esteem mood, morale, and
socialization
o Remembers they were valued
- Suggestion:
o Asking exploring questions
o Use the memory as a bridge to other info.
- Find a cue for a question within frequently heard stories
- Practice ways to tell the person that have heard the story before
Group Activities
- Social support
- Restore hope
- Re-establish sense of personal worth
- Therapeutic
Role Modeling
- Professional documentation should clearly state that the client
was given the opportunity to object to the disclosure
Communication strategies with the cognitively impaired Adult
- Clients in very early stages of dementia have enough cognition
to participate in legal decisions regarding their health care and
finances that they may not later be able to execute
- Some have moderately severe communication deficits retain all
of their intellectual abilities
- Some can communicate effectively, but processing info, learning
and responding = dysfunctional
- Some = seem normal later find the deficit
Apraxia:
- Loss of the ability to take purposeful action even when the
muscles, senses and vocabulary seem intact.
o May seem uncooperative/obstinate
- Giving them time
o Allow them time for processing info reduce anxiety
and improves performance
Reminiscence:
- Communication flows more freely and retention of messages
o It is in this way the reminiscing makes communication
stronger
- Nurse can advocate the learning about the dementia client and
needs expressed as past occurrences and can translate them
into requirements for care
Repetition and Instructions:
- Address by name
o Focuses the patient
- Restate ideas
- Speak in simple sentences/repeat phrases
o Directions given one at a time
- Reinforce self-esteem
Use of Touch
- Eye contact and touch = focus
- Determine level on intimacy
- Hierarchy of places on body
- Least touched = men with cognitive impairment
- Thigh and face = personal parts
o They are selected when touching older adults
o Must establish rapport first
Use of Multiple Modalities:
- Helping a dementia client groom and dress stiffening =
automatic neurological response and due to
resistance/rejection
o Nurse can be more sensitive
- Distraction for disruptive behaviour
Catastrophic reactions:
- With memory loss = lack cognitive ability to develop
alternatives = they have what appears to be temper tantrums in
response to real/perceived frustration
o Tantrums = catastrophic reactions
- Disorganized responses
o Use distraction tell them to forget it.
- Direct confrontation and an appeal for more civilized behaviour
= can lead to escalation
- There are warning signs
o Restlessness
o Refusals
o Uncooperativeness