COMMUNICATION

1. COMMUNICATION Speech Pathology Department

2. Modes of Communication • Expressive communication • Verbal speech • Writing • Signs, gestures • Body language • Receptive communication • Listening • Reading • Watching

3. Keep in Mind… • Use meaningful gestures and facial expressions liberally • 58% of messages are communicated through non-verbal language • 35% through tone of voice • 7% by actual words • Convey a calm reassuring encouraging attitude at all times • Keep a positive attitude with your patient and their family

4. ESTABLISH • Establish some type of communication system – speech dept plays a key role in this • Have them blink, squeeze your hand, etc. • Always have one response • Generally best to have them respond to any “yes” question • For example: “Blink your eyes if you are in pain.” • If they do not blink then you know they are not in pain, if they do then you know they are in pain.

5. SIMPLIFY • Handle only one idea at a time • Use short sentences, with simple common words • Do not speak to the patient as if they are a child • If the patient is hard of hearing, do not shout/yell at them • Decrease the noise level with permission • Speak more slowly, but naturally

6. CLUE THEM IN • Be sure to have your patient’s attention • Use gestures & pointing where possible • Facial cues/body language can also help them • Repeat & reword if the patient is having difficulty with message • Probability of a message distortion is high with our patients

7. CONFIRM • Repeat what you think they said to clarify • “You have pain”. “Your arm hurts”. “It hurts more today than yesterday”. • If they say yes to a question, ask the opposite to ensure they have consistent yes/no response • If they say yes to both questions then you know they are not answering consistently

8. Keep in Mind… • The patient may need extra time to understand & respond to your questions • Be patient, unhurried, and accepting of their speech attempts. • Do not stress if you are having difficulty communicating with a patient – ask another co-worker for assistance • If you do not understand say “I’m sorry, I don’t understand you, but please try again”

9. Keep in Mind… • Don’t leave abruptly when attempts fail • Pat them on the arm and reassure them that it is your problem not understanding them…..not their fault • Decrease noise & activity levels- be sure to ask permission first

10. RESPECT • Treat your patients as intelligent individuals • Include them in the conversations • Do not talk as though they are not there – even if they have a diagnosis of comatose • Always knock on their door before you enter and greet your patient • Do not call them nicknames such as “Granny” or “Honey” • Avoid responding to sensitive questions from the family in front of the patient • Always tell the patient that you are talking to their family member and ask for permission • “Is it OK if I tell your daughter how you slept last night?”

11. Types of communication we may use here: • Verbal speech • Low tech systems • Letter boards • Picture boards • Speaking valves • High tech systems • Computers • Sign language, gestures • Writing

12. EMPOWERMENT • Empower your patients by allowing them to communicate • If they have a special device to communicate allow them to use it when communicating • For example: if they have a speaking valve, have it placed so they can communicate their needs with you more effectively • If they have a letter board – USE IT

13. REMEMBER! • The patient’s frustration level is ten times what yours is when they have something to communicate • Always go get someone else if you are unable to understand what someone is trying to tell you

14. INTERPRETER RESOURCES • We subscribe to the AT&T Language Line Services • A list of interpreter resources are posted at each nurse’s station and in the ED • We update the list annually

15. ORAL CARE

16. Why is Oral Care Important? Oral Care is important for the following reasons: • To Provide a Clean Oral Cavity • Decrease Dry Mouth • Decrease Risk of Gum Disease • Decrease Risk of Aspiration Pneumonia • Help Prevent Heart Disease

17. Outcomes of Oral Care: • Decreases aspiration pneumonia • Increases oral movement of food • Increases alertness • Prepares the patient for the meal by increasing taste, sensation, salivation • Increases the desire to eat • Increases oral awareness of food • Improves overall quality of life • Improves chewing, swallowing and speaking

18. Materials Needed • toothbrush • toothbrush cover/cap • toothpaste • mouth wash • oral care kit/container for storage • water • emesis basin • suction available for residents unable to rinse their mouth independently *ask the nursing coordinators where the materials are located on each wing

19. How To Perform Oral Care • Toothbrushes: • Use a toothbrush with a small head and soft bristles • Replace every 3 months or after an infection • Toothpaste: • Use pea-size amount of toothpaste • DO NOT use toothpaste for residents who cannot swallow, rinse/spit properly, or have impaired cognition. If any of these are a factor, follow these steps: • Resident should be at 90’. • Keep chin in neutral position during oral care. • Dip toothbrush in water or fluoride and tap toothbrush on side of container to remove excess liquid. • Use oral swab or clean washcloth if patient/resident has difficulty spitting out excess liquids. • Use suction catheter to remove liquids from mouth if the patient is at high risk of aspiration, cannot spit out the excess liquids, and/or NPO.

20. How to Perform Oral CareContinued • Denture care: • Plaque and tartar form on dentures just as they form on natural teeth. • Brush dentures (as you would natural teeth) at least twice daily. • Remove dentures daily for at least three hours to allow gums to rest (usually over night) • Use a separate toothbrush for any natural teeth. • Ask the resident to remove their dentures (assist if they cannot):

21. How to Perform Oral CareContinued • Cleaning dentures • Wear gloves • Rinse with cold water to remove food – hot water can warp dentures. • Scrub dentures using a denture brush and denture paste. Never use abrasive cleansers or scouring powders. • Thoroughly brush all surfaces especially those that touch the gums. Rinse well with cold water. • At bedtime, place dentures in labeled denture cup with approved denture cleanser. • Careful to use denture tablets for soaking dentures with residents with dementia – ingestion of tablets/solution is serious.

22. Oral Care Schedule • Oral Care should be completed • At least 2 times every day • i.e. before/after each shift change • i.e. For residents with swallowing difficulties, it is beneficial to perform oral care before each meal to decrease amount of bacteria in mouth prior to eating, in case the patient were to aspirate any food during the meal. • AND as needed throughout the day • i.e. visible signs of oral care needed between brushing

23. Keep in mind… • We must also consider our patients oral care beliefs and respect their decision to refuse oral care. • We should provide the patient with information regarding the benefits of oral care and good oral hygiene.

24. Candida (yeast)