Special care dentistry - patients perspective and role or carer

Question 1

What are the forms of support?

Answer 1

Advocacy services
Paid formal carers
Pain informal carers
volunteers

Question 2

What are models of communication?

Answer 2

Linear, uni-directional transfer of a message - no feedback
Interactive 2 way exchange of information includes feedback context and noise
Transactional - simultaneous communication whereby a message is created between 2 or more people

Question 3

What are the communication misconceptions?

Answer 3

Meanings are in words
More communication is better
communication solves all problems 
Communication is simple 
Effective communication is a natural ability

Question 4

What are the different contexts of communication?

Answer 4

Psychological
Relational 
Environmental 
Situational 
Cultural

Question 5

What is the importance of effective communication according to WHO 1978

Answer 5

All people have a right to play an active part in decision-making regarding their healthcare and services offered to them

Question 6

What are the implications for decision making?

Answer 6

Difficult to achieve because of poor communication skills
Lack of opportunities for decision making
Society displays incompetence in lacking the requiste communications skills to interact meaningfully with people with communication impairments

Question 7

What are the reasons for limited communication opportunities?

Answer 7

Limited range of interactions, lack of communication partners
Oral/muscular impairments, sensory impairments, memory deficit, language delay
Delays in speech, language and communication performance
Illness
Limited language use and speech intelligibility
Difficult to establish rapport
Overestimation of individual understanding of verbal language or failure to interpret non-verbal behaviour as a means of communication
Reliance on others may result in impoverished communication

Question 8

How the healthcare professionals allow for more opportunities in decision making for people with communication impairments?

Answer 8

Healthcare professionals display competence and possess or employ the requisite communication skills to ensure meaningful interaction with people with communication impairments, thereby enhancing their opportunities for decision making

Question 9

How can support be provided to allow decision making?

Answer 9

Explanation about the consequences or outcomes of a particular choice or decision
increasing the existing knowledge of a person to facilitate a choice or decision

Question 10

What are different communication aids?

Answer 10

Accessible consent and information sheet or DVD’s explaining - so people can take these away and review before making a decision
Picture banks produced by CHANGE
Talking mats or photosymbols
Picture exchange communication systems PECS, talking mats
Examples: Makaton, Widgit, picture exchange communication systems

Question 11

What can photos, pictures and symbols help people to do?

Answer 11

Understand info - people with communication impairments do not read and some people find it hard to understand when you explain things
Pictures can help get your message across and help people tell you what they really needs
Some people do not communicate verbally
Some people’s speech can be hard to understand

Question 12

What do pictures help people with communication impairments to do?

Answer 12

Get messages across
Make choices - people find it hard to make choices in their head and having pictures to look at helps
If have a bad memory pictures good because can look at it for as long as need

Question 13

How can symbols help support?

Answer 13

Communication - symbol communication book can help with choices
Independence and participation - aid understanding which can increase involvement, choice and confidence
Literacy and learning - symbol software encourages users to write selecting symbols from a predetermined set in a grid
Creativity and self expression - expressing your own opinions
Access to information

Question 14

Who are the people that may need to use symbols?

Answer 14

People learning english as a second language
People with memory difficulties, dementia, or cognitive impairments
People with dyslexia, dypraxia or spatial
/time /organisational difficulties
People that are deaf or hearing impaired
Young children who have not yet started to read
People with autistic spectrum disorders
People with learning difficulties/disabilities

Question 15

What are the problems with using symbols/pictures?

Answer 15

A picture/photo is only a 2D representation of an object or idea
Not all people will take a meaning from a picture, photo or symbol
Using an object can help explain what you are saying
Many pictures look like what they represent - others more abstract

Question 16

What is the role of the carer?

Answer 16

Responsibility on the supporter of individuals who are facilitated on a daily basis by support services to enable the individual to play an active part in the health care decision making
Enablement can rake many forms but it is only in forming partnerships between services, supporters and individuals in receipt of support that successful healthcare decision making occur

Question 17

What are the different carers needs/how they feel?

Answer 17

May be unable to work, work less or take early retirement
May be under a high level of stress = carer burnout
may feel under or devalued
May have to delay or avoid marriage or having children
Social life may change and they may need to be isolated
may have a profound effect in terms of personal, financial and social consequences for the supporter

Question 18

What are the professional-carer partnerships?

Answer 18

Sensitive listening - listening to supporters needs and using advanced empathy without imposing a point of view can identify where you may be helpful and attending to the needs of the supporter, may have direct impact on how the patient is enabled
Enabling questions - using probing questions that are non-confrontational prompts caregivers to talk about their needs clarify meanings and come up with solutions to care rather than have a practitioner suggest them

Question 19

Learning points when using carers:

Answer 19

Carers own agendas
Frustrating for supported person
Inaccuracies
Presumptions about carer competence and understanding
Multiple carer roles lead to role conflict

Question 20

What is the carer advice to dentists

Answer 20

Talk to carers about any likely reactions the patient may have to the examination
Get to know the patient and how they like things done
Be prepared for likely reactions
Dont be in a hurry to see the next patient - allow more time
Discuss any treatment and procedures thoroughly with carers before embarking on them including a plan of action if things dont go as expected
Allow the carer to be present if necessary - avoid bad reactions if the patient gets stressed