Special care dentistry - role of the carer and patient's perspectives

Question 1

Forms of support

Answer 1

• Advocacy services
• Paid formal carers
• Paid informal carers
• Volunteers

Question 2

Communication

Answer 2

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

Question 3

Models of communication

Answer 3

Linear
Interactive
Transactional

Question 4

Linear communication

Answer 4

Uni-directional transfer of a message

No feedback

Question 5

Interactive communication

Answer 5

2 way exchange of information includes feedback, context and noise

Question 6

Transactional communication

Answer 6

Simultaneous communication whereby a message is created between 2 or more people

Question 7

Communication misconceptions

Answer 7

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

Question 8

Communication context

Answer 8

• Psychological
• Relational
• Environmental
• Situational
• Cultural

Question 9

The importance of effective communication

Answer 9

WHO(1978)
all people have a right to play an active part
in decision-making regarding their
healthcare and services offered to them

Question 10

Implications for decision-making

Answer 10

• 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

Question 11

Reasons for limited

communication opportunities

Answer 11

• 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

Question 12

Healthcare context

Answer 12

• 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

Question 13

Support and decision-making

Answer 13

• 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

Question 14

Communication aids

Answer 14

• 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

Question 15

Makaton

Answer 15

• Children and adults with a broad range of communication needs
• Interactors of all kinds
• Educational and service providers

Question 16

Advantages of photos, pictures and symbols

Answer 16

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.

Question 17

Pictures can help people

Answer 17

1. Get their message across
2. Make choices: Many people find it hard to make choices in their head.
   Having pictures to look at helps

Question 18

Advantages of symbols

Answer 18

• 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

Question 19

People who may regularly use symbols

Answer 19

• 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

Question 20

Limitations of pictures photos and symbols

Answer 20

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

Question 21

Carers

Answer 21

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

Question 22

Carer needs

Answer 22

• 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

Question 23

Professional-carer partnerships

Answer 23

• 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.

Question 24

Learning points when working with carers

Answer 24

• Carer’s own agendas
• Frustrating for supported person
• Inaccuracies
• Presumptions about carer competence and
understanding
• Multiple carer roles leads to role conflict

Question 25

Advice from carers to dentists

Answer 25

• 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