Special care dentistry - role of the carer AND PT'S PERSPECTIVES (2 lectures)

Question 1

List the forms of support

Answer 1

Advocacy services
Paid formal carers
Paid informal carers
Volunteers

Question 2

Define 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

What are the models of communication?

Answer 3

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 4

What are the misconceptions of communication?

Answer 4

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

Question 5

Communication context?

Answer 5

Psychological
Relational
Environmental
Situational
Cultural

Question 6

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 requisite communication skills to interact meaningfully with people with communication impairments

Question 7

Reasons for limited communication opportunities?

Answer 7

Limited range of interactions, lack of communication partners
Oral/muscular impairments, sensory impairment, memory deficit or language delay
Delays in speech, language, communication performance
Illness
Limited language use and speech intelligibility
Difficulty establishing rapport
Overestimation of individual understanding of verbal language or failure to interpret non-verbal behaviour
Reliance on others = impoverished communication

Question 8

What are healthcare workers lacking?

Answer 8

They lack the requisite communication skills to meaningfully interact with people with communication impairments = reduces opportunities for decision making

Question 9

How do healthcare professionals display competence?

Answer 9

Possess or employ the requisite communication skills to ensure meaningful transactions with people with communication impairments = enhances their opportunities for decision making

Question 10

How to support someone to make a decision?

Answer 10

Explain the consequences or outcomes of a particular choice or decision
Increasing the existing knowledge of a person to facilitate a choice or decision

Question 11

Examples of communication aids?

Answer 11

Information sheets or DVDs explaining - pt can review before making a decision
Picture banks
Photosymbols
Picture exchange communication systems
Address your own communication skills

Question 12

What is makaton?

Answer 12

Helps children and adults with a broad range of communication needs
Interactors of all kinds
Educational and service providers

Question 13

Advantages of photos, pictures and symbols?

Answer 13

Understand info - for those who do not read or find it hard to understand when you explain things
Help get message across
Some people do not communicate verbally
Speech can be hard to understand
Pictures are permanent

Can help people:

• Get their message across
• Make choices - especially if find it hard to make in head

Question 14

Advantages of symbols?

Answer 14

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 15

People who regularly use symbols?

Answer 15

People learning English as their 2nd language
People with memory difficulties, dementia or cognitive impairments
People with dyslexia, dyspraxia or spatial/time/organisational difficulties
Deaf or hearing impaired
Young children who don’t read yet
Autism
Learning difficulties/difficulties

Question 16

Limitations of photos, pictures and symbols?

Answer 16

2D image representation of an object or idea
Profound communication impairments - do not use pictures or symbols. Use an object to help explain what you’re saying
May not be able to tell what a picture represents
Some may not be able to read word underneath

Question 17

What do carers do?

Answer 17

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 18

Carer needs?

Answer 18

• 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 19

Professional-carer partnerships requires sensitive listening and enabling questions - define both

Answer 19

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 20

What are the learning points when working with carers?

Answer 20

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

Question 21

How to work with pts with a carer?

Answer 21

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