Around one-quarter of hospital beds are occupied by people with dementia, many of whom have problems communicating and often don’t understand the requests being asked of them. Doctors, nurses and other health workers rely heavily on the cooperation of patients for many routine tasks which lie at the heart of the care they provide - everything from doing a physical examination to taking medication.
Following a study on what was successful and what was less effective when skilled staff talked to people living with dementia, funded by the National Institute of Health Research (NIHR) , the new training was developed by academics in the university’s School of Health Sciences. This included using actors to take the part of people with dementia, so healthcare professionals could practice and get feedback.
The study showed their knowledge and confidence in communicating with patients with dementia had improved and the participants showed changes in communication behaviour. They were using their new skills in practice a month later. In a paper published in the journal PLOS ONE , the experts involved in the VOICE study also identified a possible conflict between effective communication appearing ’bossy’ or controlling.
Tricks of the trade
Professor Rowan Harwood, who led the study, said: “There is little research on the basic skills like communication that professionals use every day. If a patient misinterprets what you say they may seem difficult or uncooperative. Some people are naturally goods at this, but can’t always say exactly what they do that works. We identified some of these ‘tricks of the trade’, and were able to pass them on to doctors, nurses and therapists. We showed that the training worked, and were struck by how much even experienced professionals appreciated the new knowledge."
There is quite a lot of advice on how to speak to people with dementia available, usually in the form of ’10 Top Tips’. However little is based on evidence and there is no previous research on dementia communications skills training in hospitals or related to the training of doctors.
To develop the training course, the researchers analysed video of conversations between experienced healthcare professionals speaking to hospital patients with dementia to identify successful communications strategies and language. Two areas of communication caused particular problems. Making requests and ending the conversation. Requests were often refused. Things that helped included making requests direct and simple, speaking with a high level of authority, and trying to make the task sound easier. To end a conversation satisfactorily the healthcare professional had to make it clear this was happening, to make an explicit arrangement rather than more commonly used phrases like ‘see you soon’, and making sure that body language matched the words used.
The training course was developed involving input from carers of people living with dementia, communication and educational experts, experts at working with actors in education and clinicians experienced in the care of people with dementia. The resulting course focused on learning through simulated exercises in which actors trained in issues around dementia communication took on the roles of patients.
The course was run six times between January and May 2017 and was attended by 44 healthcare professionals, including doctors, nurses, and therapists.
Compassionate and person-centred
To evaluate the success of the training, the researchers undertook a study of the healthcare professionals’ confidence, knowledge and use of the communication skills before and after the course via questionnaire. They were also videoed during a role play exercise before and after training in a scenario where they either had to persuade a ’patient’ to get out of bed or to drink some water as though they were dealing with a real patient. These videos were rated by researchers, and people with dementia and their family carers to see if the way they did it changed.
The researchers followed up with participants one month after the second day of the course. Participants said they remembered the skills they were taught, were using them in their work and found the skills were helpful in their role. Analysis of the videos highlighted a tension: the healthcare professionals could appear more controlling, bossy and dominating.
Professor Harwood added: “We explicitly warned that it was important to be compassionate and person-centred, but would argue that misunderstanding often leads to conflict or argument, and benefits no-one.”
The researchers say, the process of experiential learning means that one month may not have been long enough for the participants to demonstrate all the new communication skills on the course.
The research, which was sponsored by Nottinghamshire Healthcare NHS Trust and the Institute of Mental Health , also involved experts from the School of Sociology and Social Policy and the Division of Psychiatry and Psychology at the university; Trent Simulation Centre and the Department of Healthcare of the Older Person at Nottingham University Hospitals NHS Trust ; the Simulated Patients Workshop Team in Leicestershire; and the Division of Psychology and Language Sciences at University College London.