Special care dentistry - role of the carer and patient's perspectives Flashcards
Forms of support
- Advocacy services
- Paid formal carers
- Paid informal carers
- Volunteers
Communication
A continuous transactional process involving
participants operating within specific contexts
whereby they create a relationship by sending
and receiving messages via channels, many of
which are distorted by noise
Models of communication
Linear
Interactive
Transactional
Linear communication
Uni-directional transfer of a message
No feedback
Interactive communication
2 way exchange of information includes feedback, context and noise
Transactional communication
Simultaneous communication whereby a message is created between 2 or more people
Communication misconceptions
• Meanings are in words • More communication is better • Communication solves all problems • Communication is simple • Effective Communication is a natural ability
Communication context
- Psychological
- Relational
- Environmental
- Situational
- Cultural
The importance of effective communication
WHO(1978)
all people have a right to play an active part
in decision-making regarding their
healthcare and services offered to them
Implications for decision-making
• Difficult to achieve because of poor
communication skills
• Lack of opportunities for decision-making
• Society displays incompetence in lacking
the requisite communication skills to
interact meaningfully with people with
communication impairments
Reasons for limited
communication opportunities
• Limited range of interactions, lack of communication partners
• Oral/muscular impairments, sensory impairment, memory deficit, or language delay
• Delays in speech, language and communication performance
• Illness
• Limited language use and speech intelligibility
• Difficulty of establishing 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
Healthcare context
• Healthcare professionals display incompetence because they lack the requisite communication skills to meaningfully interact with people with communication
impairments. This reduces their opportunities for
decision-making.
• Healthcare professionals display competence and
possess or employ the requisite communication skills to ensure meaningful transactions with people with communication impairments, thereby enhancing their
opportunities for decision-making
Support and decision-making
• Some people may need support with their choices and decisions
• 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
Communication aids
• Produce ‘accessible’ consent and information sheets or DVDs
explaining. People can take these away and review before
making a decision on what to do
• Picture Banks produced by CHANGE -
www.changepeople.co.uk . These can be inserted into large print Word documents to produce ‘easy read’ versions. A guide to making easy read documents is also available as a free download from the CHANGE website
• Talking Mats® or Photosymbols®
• Picture Exchange Communication Systems
• Think about your own communication skills and address them
• GET CREATIVE
Makaton
- Children and adults with a broad range of communication needs
- Interactors of all kinds
- Educational and service providers
Advantages of photos, pictures and symbols
Can help people to:
• Understand Information; many 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 need
• Some people do not communicate verbally.
• Some people‘s speech can be hard to understand
• One benefit of using pictures is that they are permanent. Once you stop
speaking or signing you rely on the person’s memory.
Pictures can help people
- Get their message across
- Make choices: Many people find it hard to make choices in their head.
Having pictures to look at helps
Advantages of symbols
• Communication -
making a symbol communication book can help people make choices.
• Independence and participation - symbols aid understanding which can increase involvement,
choice and confidence.
• Literacy and learning -
symbol software encourage users to “write” by selecting symbols from a predetermined set in a grid.
• Creativity and self expression - writing letters and stories and expressing your own opinions.
• Access to information -
all of us need accessible information and this should be presented in such a way that the reader can understand and use
People who may regularly use symbols
• People learning English as a second language
• People with memory difficulties, dementia, or co
gnitive impairments
• People with dyslexia, dyspraxia or spatial/time/
organisational difficulties
• People who are deaf or hearing impaired
• Young children who have not yet started to read
• People with Autistic Spectrum Disorders
• People with learning disabilities/difficulties
Limitations of pictures photos and symbols
only a 2 dimensional representation
of an object or idea. Not all people will take a meaning from a picture, photo, or symbol
• Some people with profound communication impairments do not
use pictures and symbols at all. Using an object, like a cup or a toothbrush, can help to explain what you’re saying.
• Many pictures and symbols look lik`e what they represent - others are more abstract. If you can’t easily tell what a picture represents other people will struggle too, and will need help
• Remember that many people won’t be able to read the word underneath
Carers
Onus 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 health care decision – making. Enablement can take many forms but it is only in forming
partnerships between services, supporters, and individuals in receipt of support that successful healthcare decision making can occur
Carer needs
• May be unable to work, work less, and have to give up work, or take early retirement
• May be under a high level of stress: carer burn- out
• May feel under or devalued
• May have to delay or avoid marriage or having children
• Social life may change and they may be isolated
• May have a profound effect in terms of personal,
financial and social consequences for the supporter
Professional-carer partnerships
• Sensitive listening – listening to supporter
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 a direct impact on how
the patient is enabled
• Enabling questions – using probing questions that are non-confrontational prompts care givers to talk about their needs, clarify their
meanings, and come up with solutions to care
rather than have a practitioner suggest them.
Learning points when working with carers
• Carer’s own agendas
• Frustrating for supported person
• Inaccuracies
• Presumptions about carer competence and
understanding
• Multiple carer roles leads to role conflict
Advice from carers to dentists
• Talk to carers about any likely reactions the
patient may have to the examination (the carer
will usually know)
• Get to know the patient and how they like things
to be done
• Be prepared for (un)likely reactions
• Don’t 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 for if things don’t go as expected.
• Allow the carer to be present if necessary – it
might avoid any bad reactions if the patient is
stressed by what is happening
