Qualified & Practising: The Diary of a Junior Physiotherapist [S1E8] - Dementia Simulation Training Day


by Nikki Anderton
  

 

 

 

 

In this blog series, Nikki takes over to tell us about her experience as a newly qualified physio and to describe the joys, fears and people she meets along the way. She'll also share her tips which might be useful to some of you too!

 


A s healthcare professionals, dementia is an illness we can't ignore. We are all in contact with somebody with dementia, whether it be from a personal experience or a professional one. As the aging population increases due to rising life expectancy, so does the prevalence of dementia. Approximately 85,000 people in the UK live with dementia (Alzheimer’s Society, 2017) and global figures are estimated to triple by 2025 (World Health Organisation, 2012).

The assessment and treatment of patients with dementia has so far been unavoidable in my career both as a student and as a qualified practitioner. Currently, a large proportion of patients on my current caseload either report memory difficulties or, already have a formal dementia diagnosis.

When reflecting back on sessions with a current client with dementia, one of the challenges I have faced with him has been communicating instructions effectively. Asking him to follow what appear to me seemingly simple instructions became a complicated task. For example, explaining the all too familiar sit-to-stand technique; “bring your bottom to the front of the chair, slide both heels further back underneath you, put both hands on the arms of the chair…” appeared to be ineffective ad confusing to someone with processing difficulties. I have found this with many other patients with dementia as well.

It surprises me to think that, aged 26, I am in situations where my communication skills are not always successful. At university, Communication Skills underpinned many of our modules; I wrote numerous essays on the topic and I was scrutinously assessed on my practical communication skills by clinical educators. Yet even now, I find myself in clinical scenarios where I feel like a communication amateur with so much more to learn.

 

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"It surprises me to think that, aged 26, I am in situations where my communication skills are not always successful."

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So when the opportunity of attending a Dementia Simulation Training Day arose, I was keen to get a place. Run by Oxford Brookes University, the day is designed to build dementia awareness among healthcare professionals, helping to develop skills in supporting people with dementia.

The first part of the course required wearing a bodysuit to simulate mobility issues older people face. I had never before truly appreciated the impact of stiff joints, reduced muscle strength and altered vision on mobility. This was simulated through the use of weights around our wrists and ankles, straps around our joints and yellow tinted goggles narrowing your peripheral vision. Attempting a bed transfer whilst restricted into a kyphotic posture with reduced active range of movements in my elbow and knee joints was almost impossible and I lay helplessly on my back, struggling to bridge in order to reposition myself in bed. Ascending the stairs was another eye opening challenge. How many of our patients circumduct their hip in order to compensate for reduced knee flexion? Without realising, I was doing exactly that. My reduced peripheral vision and cervical range of movement meant that I could not see my feet on the steps. Luckily, as my proprioception is intact, I knew where to place my feet without looking at them, however it made me realise how difficult this may be for someone with poor lower limb proprioception as well as poor vision.

 

 

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"Attempting a bed transfer whilst restricted into a kyphotic posture with reduced active range of movements in my elbow and knee joints was almost impossible and I lay helplessly on my back, struggling to bridge in order to reposition myself in bed."

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The second part of the day involved role play, which as always, was daunting. We took it in turns to sub in and out of different scenarios, interacting with an actor playing the part of a person with dementia. This was challenging however group reflection and discussion after each scenario highlighted some key communication learning points;

 

  • Being comfortable with silences in conversation can be powerful. These pauses could be fundamental components of a conversation, allowing the ‘Receiver’ to interpret the message before forming their own response and communicating that back to the ‘Sender”. Furthermore, by delivering short sentences can allow a person with processing difficulties to decode the message you have delivered.
  • In a situation where a patient appears confused and distressed, empathic language and active listening and provide powerful and effective tools to help the person control their emotions. For example, by reflecting back what the patient is saying reaffirms that you are listening and understanding their distress.
  • Reducing the amount of verbal information you give to someone with dementia can help their understanding. Nonverbal communication can be just as powerful as verbal. For example, instead of instructing “put both of your hands on the arms of the chair”, you could illustrate this by through tactile facilitation and placing their hands on the arms of the chair with them. In addition, removing the ‘fluffy’ words in the sentence can be effective. Instead of saying “...and now stand up”, you could just say “stand”. It seemed to me that these short, direct commands may be considered rude? But actually, by taking out the non-relevant words and reducing a complex verbal sentence, helps a person with processing difficulties interpret the message they are receiving.

 

I have since put this into practice and have been surprised at how more efficient my communication has been with a patient with advanced dementia. To give commands rather than explain something in a full sentence doesn’t really come natural to me and I have to really think about what I am about to say. I have also found that often, it is easy to get caught up in repeating the same thing over again, for example, reminding patients that it is safer to push up from the chair as opposed to pull up on the rollator frame. In situations like this, I have since started using tactile and non-verbal prompts instead of verbal instructions as an alternative way of communicating.

 

Other interventions to support those with dementia

As well as developing communication skills, the course also educated us on other ways of supporting people with dementia;  

 

Colour contrast

With age, the ability to differentiate between colours clearly becomes reduced. As a result, the perception of depth and spatial awareness diminishes, especially with lower contrasting colours. The colour red on a light background can ensure that important objects such as a raised toilet seat, a grab rail or a rollator frame stand out to a person with dementia. In 2015, Physiotherapists in Frimley Park Hospital, Surrey trialled red rollator frames with patients with dementia to investigate whether the colour encouraged use however their results appear to remain unpublished.

 

Flooring

Busy floor patterns can appear confusing and shiny flecks can cause a glare and appear unsafe. Continuous, plain flooring is advised as a sudden change of colour can appear uneven which may cause someone to hesitate which may lead to a fall.

 

Lighting

Research has suggested that light therapy can help reduce the common behavioural symptoms such as disturbed sleep-wake patterns, nocturnal wandering and agitation, which are commonly presented by individuals with Alzheimer’s Disease and Related Dementia (Hanford and Figueiro, 2013). Based on research about how light affects aging vision, circadian and perceptual systems, a journal by Figueiro (2008) proposed a 24-hour lighting system to provide:

  1. A high circadian stimulation during the day and low circadian stimulation at night.
  2. Good visual conditions during waking hours
  3. Nightlights that are safe and minimize sleep disruption.

(Please see the journal reference for further information about the effects on lighting and dementia - an interesting read!).

Visit the DSDC Dementia Care website to see in more detail these ideas demonstrated in a virtual hospital http://dementia.stir.ac.uk/design/virtual-environments/virtual-hospital.

 

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A person with dementia may have difficulty expressing their feelings or emotions and as healthcare professionals, it is our responsibility to  bridge this communication gap.

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With dementia comes care demands. The Kings Fund (2017) have estimated that by 2018, there will be 7 million older people unable to walk up the stairs without resting. This example is one of many whereby physiotherapists will be able to step in and assist with the physical aspects of aging. Cognitive changes often go hand in hand with the physical demands older people face, therefore it is important for us to have a toolbox of communication skills to help this aging population.

Kitwood (1997) discusses the concept of personhood - the attributes of being a person - and applied this to people with dementia. His theory suggests that it is important for a person with dementia to be in an environment which is supportive of personhood as they are less likely to take action themselves to satisfy their psychological needs. He highlighted the psychological needs present in human beings include; comfort, attachment, inclusion, occupation and identity. Therefore, in order to deliver person-centred care, it is important to consider that these needs may need to be enhanced through effective communication and not undermined.


A person with dementia may have difficulty expressing their feelings or emotions and as healthcare professionals, it is our responsibility to  bridge this communication gap.

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      Nikki Anderton

      About the author

      Nikki Anderton

      Nikki is a newly-qualified physiotherapist with a previous degree in Human Communication Sciences, currently working in a busy university hospital in East London. She was the first ever to sign up to one of our seminars when we started back in 2015; now a year down the line, she's our first ever resident blogger! Expect to see (and read) more of her very soon!

       

       

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      1 comment

      • Rozz McDonald

        This is a truly lovely post Nikki – what a privilege to see what happened after the training and it’s impact on practice! How generous of you to share this learning with everyone.

        Such simple things can make such a difference in the way we deliver care can’t they!
        I hope that many people can learn from you and your post and transform the way we support people to live well with dementia!
        Rozz

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